Friday, December 17, 2010

Surrealizing - Criteria 9 / Part 4: Derealization

The final segment of my Criteria 9: Dissociated series is Derealization. Derealization: is an alteration in the perception or experience of the external world so that it seems strange or unreal.

For me this comes across as an unnatural brightness, things are too in focus. Hyperfocused. The outline of objects, things, houses, horizons, are too sharp. Sun is too bright, the air is too bright, colors are too crisp.  Everything has a stark contrast and I feel like I’m removed from the scene, like it was erected and I’m walking through a movie set. There lacks a depth to the reality. There’s no deeper attachment to anything because it’s as if those things weren’t placed there long enough ago to have formed an attachment to them.  

It’s oddly beautiful as a surreal observation.

This happens relatively often but it’s not as intense as my depersonalization. For example, I was in my Eating Disorder Anonymous meeting the other day. The room itself was hyper lit and it looked like a herd of children had vomited crayons all over the walls. The room itself was very vivid but the sheer brightness triggered me right into a derealized state. It was almost dizzying. It felt like something encompassed my brain, pressing to a common center point.

Or another time, I was simply driving home in the late afternoon. The sun was low enough to be just over the horizon. There were trees closely spaced on the side of the road. As I would pass each tree the sun would blot out, then flash bright as I drove past an gap. From my peripheral vision I would see flash bright, dark shadow, flash bright, dark shadow like an old 8mm film reel being played on the edge of my vision. It made me feel almost as if I was floating.

It’s never an out of body experience or anything such as that. I always maintain a focus that I am doing whatever it is that I’m doing, but my perception is hyperfocused and surreal.

Dissociated Emotions

In the moment they are real, outside of the moment they are gone.

Feeling Inside, Outside - Criteria 9 / Part 3: Depersonalization


Continuing along the dissociated path of Criteria 9, my specific interest is especially in Depersonalization. This is my most intense break from reality.
 
Sometimes I feel as if I'm in the wrong body. Like I'm watching myself, my body, do things from someone else's perspective. Cognitively I know it's my body but the person that feels what's going on is somewhere else, removed. My feelings are gone. Here, but part of me is left somewhere else, on the outside, not inside me where it belongs. Going through the motions of what I know I would normally do but without any connection to the motivating forces that would drive me to do these things. 

I don’t process emotions directly, internally. I process them from a dissociative place, “outside”, of my sense of Self. This creates a huge disconnect in how I think and how I feel towards the things I am thinking about. It’s like having two separate bodies; one to process thoughts, one to process feelings, but I’m only connected to one at any given time.  They don’t work symbiotically like they should. I either experience as an observer with detached emotions or I FEEL everything but don’t temper it with my rationale. Where most people have a natural balance I can either experience my emotions, my environment, or I can observe them. Seperately.

Having taken an objective look at, or talk about, my emotions I feel fine. I feel fine because I feel nothing. The act of talking about my emotions or experiences, causes me to not feel them.  But since feeling nothing is better than feeling emotionally destroyed, nothing = fine. When you can recognize that a situation should produce an emotional reaction, and instead all you feel is {blank}, it can be very disconcerting. It seems like nothing was ever there in the first place. Except it’s not only this one incident…

It’s with everything.

I can wrap myself in an experience. Throw myself into the heat of a moment but afterwards, all I have is a recording. No emotional attachment to the memory. It's akin to taking a physical step back from a situation to look at it objectively, only to be left with a very noticeable lack-of-emotion. Because I am no longer 'in the moment' it's like trying to remember emotions experienced in a dream. I wonder if they were ever real because after having stepped back, the closeness is no longer there. On the plus side, nothing phases me. Things that should have reduced me to tears or at the very least made my heart ache, are now after thoughts left in the wake of yesterday.

Imagine this. You and a person you care for are standing a few feet apart, holding a rope just long enough so it’s pulled taught. The rope is a symbolic representation of the emotional connection you share. When you take a step back the rope is not long enough and your end slips from your hand and falls to the ground. You can still see the person, still see that person holding their end of the rope, but you no longer feel the connection of the rope fibers even though you remember having held the rope. It’s like dropping the rope and trying to maintain/remember the feel of the fiber. Physically you can’t.

It’s disconcerting to not feel. Surreal.

Sleep walking through my own consciousness.

Thursday, December 16, 2010

Quotes from the Borderline



"...how hard it must be to live only with what one knows and what one remembers, cut off from what one hopes for!... There can be no peace without hope."



     ~ Albert Camus, 1948, The Plague





Here, There, Nowhere - Criteria 9 / Part 2: Dissociative Disorders


The next episode in our Criteria 9 series is Dissociative Disorders. 

Dissociation is one of my more severe challenges. I will cover this in three parts. The general Dissociative Disorder. Depersonalization, and Derealization (this spectrum also covers things like Dissociative Identity Disorder, Dissociative Fugue and DD non-specified… but since those aren’t my issues I’m not going to cover them now).

What is a Dissociative Disorder? Dissociative Disorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. Dissociation is a partial or complete disruption of the normal integration of a person’s conscious or psychological functioning.  The hypothesis is that symptoms can result to the extent of interfering with a person's general functioning.

It’s actually pretty normal for people to feel brief instances of Dissociation such as Psychological numbing. Psychological numbing is a mental mechanism to prevent psychological trauma. The mind chooses to ignore thoughts or emotions relating to a specific event, occurrence or body of knowledge, emotions, or ideas. It’s an important function for sanity when someone whose basic moral principles or ideology would be destroyed by comprehending the full implications of an action or occurrence.

When this feeling state becomes persistent, that's when it’s identified as a disorder.

So what causes Dissociative disorders? In short, it’s a defense mechanism. At least that’s thought to be the primary reason for it. It’s a way for the mind to protect itself from extreme emotional trauma, prolonged stress and anxiety or alternatively, a response to drug use. Part of your mind and memory are compartmentalized to a different feeling state so you can process them separately, or not at all.

My version of Dissociation (Depersonalization and Derealization to a lesser extent) isn’t like a total break from reality. I don’t have amnesiac fugue states or multiple personalities. I can always, ‘check in’ and know that I am actually in the real world, I just don’t ‘feel’ like I am real. This is Depersonalization....

Madness of the Mind - Criteria 9 / Part 1: Paranoid Ideation

I'm skipping ahead to DSM IV criteria 9. This will be at least a four part series.

Criteria 9: transient, stress-related paranoid ideation or severe dissociative symptoms.

Just because you’re paranoid, doesn’t mean they’re not out to get you.

For a Borderline personality that has such a tenuous grasp on connectivity, every little social queue is up for interpretation. Always on the look out for a sign that abandonment looms, that what you’ve been told is a lie, any reason why the people you fear to lose are actually out to hurt you. There’s a dozen different places a turn of phrase could be taken depending on how the inflection falls or the way body language speaks. A Borderline personality will think of them all, and often settle on the worst. Expect the worse, and you can prepare for it. Hope for the best, and you’ll be disappointed. It doesn’t help that he/she is often right. Doing so a BP may also set her/himself up for that fall by creating the circumstances for that very thing to happen. Self-fulfilling prophecy.

If I have an inordinate amount of stress or very unstable relationships, then I begin to second guess everything. My hold on what people said vs. what they meant becomes nebulous. Everything has a potential double meaning. Did they really mean that? Yes? No? No. They’ve only told you this thing, allowed you in, to get your hopes up, so they can turn around and take it away, hurt you. You could lose everything you’ve struggled so hard to hold onto.

In short, I over think EVERYTHING. The downside of being too smart is it’s possible to consider too many possibilities. See every fork of every thought and ruminate on all the potential paths that could possibly be.

Normally, however, I take almost an opposite extreme. I can be too literal in my interpretation of people, thoughts, and things. I choose to accept what people say at face value and expect them to live up to their word. Don’t confuse this with trusting what people say, because I rarely do, but in order to lessen the paranoid ideation, I take words for what they are and act on them as such. This allows me to control the obsessive ruminations and removes my responsibility for when other people don’t live up to what they say.

How do you make these thoughts, stop? You can’t. At least, I’ve never found a way. Speaking up, communicating the irrational thoughts that buzz through your brain, helps. Start your sentence with, “This may not be rational but I have this {insert thought} in my brain, can you help me figure it out so I can move past it….” This way the people around you understand and can clarify an interpreted intent.

Wednesday, December 15, 2010

Quote

"To grasp life and meaning, we assume constancy where it does not exist. We name experiences, emotions, and subjective states and assume that what is named is as enduring as its name. Human beings blessed and cursed with consciousness - especially consciousness of their own being - think in terms of names, words, symbols."
     ~ James F. T. Bugental, 1999, Psychotherapy Isn't What You Think



… What happens when you no longer feel this constancy of  terms? 








.

Said Alice to the Caterpillar - Criteria 3: Identity Disturbance

Number 3 on the DSM IV spectrum is identity disturbance, but I think this ties in closely with number 9 which is where Severe Dissociation comes into play so I’ll cover these in series. One post after the other.

3. identity disturbance: markedly and persistently unstable self-image or sense of self.

Identity disturbance. For me this is a shifting depending on my environment, my mood, my company. An ex of mine used to point this out to me. I don’t think I ever fully understood what he meant when he would tell me I was like different people. My personality changing depending on what we were doing. Unstable sense of who I am.


Caterpillar: Who... are... you?
Alice: Why, I hardly know, sir. I've changed so much since this morning, you see...
Caterpillar: No, I do not C, explain yourself.
Alice: I'm afraid I can't explain myself, you see, because I'm not myself, you know.
Caterpillar: I do not know.
Alice: I can't put it any more clearly, sir, because it isn't clear to me.


Whether I’m at work, with a group of friends, even in my own head the way I identify, socially/sexually, is transient. I tell myself I’m fluid; that one thing bleeds to another, never solidifying into one stable set of features grouped to form a whole. Travelling from group to group with skill points of Illusion, Subterfuge, and Charisma. Every personality point is part of you, but some scenes don’t utilize all skill sets. So for the Borderline Personality this translates as coming across as very different people depending on the setting.

To me it feels normal to be more outgoing, loud, wilder when I’m out dancing, it’s appropriate there. But what's more I feel like I'm that kind of person.  It's not an act, I AM wilder. When I’m hanging out with friends, I’m quieter, my intelligence comes out and I joke, heap on the sarcasm and enjoy people’s company. I'm a nerd girl. When I’m at work I am reserved, aloof, stone cold and efficient; my personality almost completely held back. I'm an efficient machine. When I’m with my family I am open, my walls crumble, I’m more melancholy but loved. I'm small. To me this normal. The variations are not subtle. Not one overarching personality with small variations, appropriate for the environment, it’s a completely different set of traits depending on the location. I’m not sure if this is normal or not, maybe everybody feels like this. To me it seems like certain things are appropriate for certain places, and not for others, so depending on what the circumstances are, will decide which parts of me show. Which me, is the real me?

At work I adopt a more business like persona. Amusingly I make no effort to conceal my piercings or tattoos, things that are glaringly different in my professional setting, I’m waiting for the rejection. Though I do wear clothes that are completely appropriate for the office if not my personal style. My work persona is by far my least stable. By this I mean, I feel like I am the most out of my own skin, trying to fit an image I imagine to be acceptable for a professional setting but which is not me. I don’t maintain this character well. I always feel out of place, if not like an outright fraud, even though I know I am capable of doing my work better than anyone else. I do not have any sense of solidarity with my working environment or the kinds of people in my office. It’s a place to go where I waste 8-10 hours a day and come home with a monetary exchange.


I am anatomically female but I don’t feel like a girl. I’ve never been a boy so I can’t say I feel like a boy, though I do value masculine qualities more than feminine. I have no gender identity. Or if you ask I will tell you I gender ID neutral. In the GLBTT community I would call myself Queer.
I don’t see rigid definitions. I don’t believe in absolutes. With no absolutes comes a certain fluidity that blends from one area to another. Like a chameleon changing colors to fit the foliage as you walk through an unknown social jungle. The leaves and bark may change but the wind still bites without a solid shield from the elements.  

Because the Borderline may not have a full sense of self they may adopt the group culture in a desperate attempt to fit in, not be excluded. This works as long as the group is a stable set of characters. If things begin to vary from the norm, change, people have problems or things become socially tumultuous, this will affect the Borderline’s sense of stability. The group is falling apart, so she/he will feel like she is falling apart as well. If she/he’s based so much of herself on the group dynamic, and the group dynamic fails, it’s as if who she is crumbling down around her and she has nothing to grab onto for stability or control. Changing to fit the group has never been my social experience, personally, though that crumbling stability seems to happen all too often.

For me, in smaller social settings, I don’t blend. I stubbornly stick to who I want to be, think I am. I am me, I’m just not sure what that means most days. Not being able to attain a group identity, to fit in a with a set of people, always makes me feel Other. An outsider, looking in. I laugh with the group but don’t feel included in the joke.

This bleeds into my Dissociation, especially when my body image is a mess...

Tuesday, December 14, 2010

Demon on a pedestal - Criteria 2: Idealization & Devaluation

The next criteria laid out in the DSM IV goes like this. People with BPD may display:

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation : They may idealize potential caregivers or lovers quickly, demand to spend a lot of time together, then switch quickly from idealizing them to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough.

Where does the line between true affection, obsessive devotion, and heartfelt betrayal become skewed?

For me it takes a very long time to reach this point. I'm more likely to try and put people off getting close to me at first. I also differ in that I need to spend time alone. A lot of time alone. While, yes, I would love to spend lots of time with select people, I am easily overwhelmed by people and need to have time away from everyone. When I want to focus inwards my brain is too busy to drown out the external noise and it feels like a tidal wave of social obligation. Solitude is my life raft.

If someone sticks around long enough to breach the walls of my superficial fun, contrariness and melancholy I will eventually hold them closer than anyone else.  Like a death grip on my heart.

It usually plays out like this: Once again, you meet someone new (even though you swore you wouldn't). You share so much in common, practically everything in common. In fact, they’re probably the perfect example of exactly what you look for in a confidant! They can do no wrong. Everything they do inspires you to be exactly what you'd hoped you always could be. The world is a springtime musical, frolicking with puppies and ethereal music in a field of opiates and LSD.

Begin Cycle: Everything is wonderful, you talk for hours, spend as much free time together as you can, laugh, bask in each others love, friendship, whatever... Until one day they can’t do something you ‘need’ to do, or want to do. Sure it’s just this time, and it’s something small, so you brush it off. Then a few days later, it happens again. They’ve let you down.

Oh sure, it may be some small necessary thing in their life, that takes obvious priority, but that thing has pulled their attention away from you! You See red. What could really be so important? Don’t they understand what friendship means? Why won’t they put the effort into it that they had before? Clearly everything they had said now means nothing. Everything was a lie. They are a hypocrite and worse. Using you for the benefits that you bring to the table. What do you mean your have a meeting? a doctors appointment? We had plans!

Logically the brain says, of course you have to take care of such things, but that other thing... That other insidious voice taunts that you’ve been betrayed. The friend you thought you knew is now the enemy. This “friend” never really meant anything they’d ever said to you… b/c this time, this one time, they could not fulfill the role they’ve found themselves in. Their life is now affecting your life in a way in which you have no control, forcing your life to turn from the fields of music to a deeper well of disappointment. Down the stairs, into the cellar darkness.

Control. Out of control.

When she was good, she was very good. But when she was bad, she was very, very bad. No middle ground. Relationships are all, or nothing. He/She is all, or nothing. I, am all or nothing. Angels and Demons in rooms of black and white. There is no grey area or room for middle ground. 


What we need help understanding, is sometimes the paint gets mixed and there is an entire spectrum of grey, an entire rainbow of color, in fact.

I may want to be everything that person needs. Until I don’t. While my attention is there I will pool all my energy into the wants of someone I care for. I offer as much and usually they accept. Somewhere, though, I hope the same sentiment is returned. Without my having to ask, but if I do ask it should be offered automatically because look at everything I’ve done for them! When they can’t reciprocate it feels as if the coin has come up tails. It begins to smack of an advantage being taken. Why is it good enough that they can take what I offer but won’t offer their own as well? Or consider the opposite, they don’t ask for anything, they don't accept something or deny something offered from the heart. Why don’t you want this assistance, this help? This thing? Am I no longer good enough to provide this?

This one night they’re not going out with you, not chatting with you, they must be doing something else, spending time elsewhere, what kind of friend ignores you when you obviously need a shoulder to lean on, for time spent otherwise?!? As your world crashes down … Then they text or call, and the world slips gently back into place. At least for th e moment.  End Cycle. Rinse. Repeat.

Where does the line between true affection, obsessive devotion, and heartfelt betrayal become skewed? When there is no emotional memory; if the person or object is not in the now, it may as well not exist. Or ever have existed.

I worry about the time I've lost in reminiscing, ruminating, my energy squandered where it could have been turned to brighter things. Then again, I wouldn’t be me, if I didn't turn to the past to help me figure out my way into the future. Even if it is just to find a way to hide these thoughts or focus them into a finer tool to use.

I’ve learned to hide these thoughts, the actions that fall from them. Fake it, as if these things don’t bother me while my heart crumbles inside. All there is to do, is get through the next moment, and the next, until the next thing comes along to lift you up.

Note: Writing about this is an experience of its own. I feel no attachment to these words. It's as if i'm seeing someone else fingers skimming the black keyboard, typing the words that appear on this screen. Recording someone else's memories, that have been relayed to me but I have not experienced myself. Dissociated.
What we need is a way to hold on, to understand that relationships are a continuum, not just points on a grid. If anyone has any help for this, I would dearly love to know it.



Cake and Cigarettes...

Amusing incident last night. You know that old addage about how a lady never reveals her age? Well, I'm 29. I quit smoking 9 years ago but last night I was very restless and for some reason, craving cigarettes. Cigarettes and frosting/icing. I'm eating disordered. I've been bulimic for almost 17 years but in recovery for the past 7 until a few months ago. I don't like cake, just frosting.


Back to the point. I haven't bought a back of cigarettes in nearly a decade. I went to the gas station on the corner, asked for a pack of Camel Lights. The attendant asked for my ID, which I promptly gave him. He looked at me, looked at my ID, asked me my age, I told him.... than informed me the I must be at least 18 to buy cigarettes ::shockface:: He wouldn't sell me a pack of cigarettes with my state issued driver's license b/c he thought I looked too young! I guess that's a compliment, and I took it as such, but really now? I was both annoyed and amused at the same time.

I went to the grocery and got cigarettes and a cake. Sat in the parking lot with my oreo cake. Had a few fingers full of frosting before I was disgusted enough with myself to dump the rest of the cake onto the parking lot and took off to drive aimlessly and enjoy blackening my lungs. 

Btw, the new flame retardant shit they put in cigarettes... bullshit. It's fucks with manual dexterity. Frankly, if some fucker is dumb enough to fall asleep with a cigarette in their mouth they probably deserve to get burned.

Monday, December 13, 2010

I'll take an order of Happiness please, with fries on the side...

Honestly, I love the idea of choosing to alter my brain chemistry. It's the ultimate expression of choosing who you want to be, even ahead of what your biology says. To not be sad, detached, depressed, anxious, I like the concept. I choose to be a happy loving person, please, with an order of fries on the side. 

People often have mixed feelings about medication that alters brain function. I know many that dislike the idea of meds that affect the brain, drugs that tinker with mood and personality. Personally, offense intended or not, when people say they are averse to the idea of tinkering with things that affect your brain, it's usually because they've never had problems serious enough, for long enough durations, that it becomes something crucial. Consideration is no longer given pause. 

I don't actually believe that BPD is a treatable disease. It's not something like Bipolar that you can measure, track and throw lithium at. BPD is more of a categorical Label that encompasses a whole group of problems. So it's not the BPD that is being treated but the identifiable symptoms like depression, anxiety, eating disorders, dissociation, etc. that my psych is trying to treat for.

I fought medication my entire life. Well, since I was 12 and it became apparent to me that I was not exactly normal. I also fought therapy, but that's a tale for a different day. 

I think in many people's life, they hit a point where something drastic must be done or there won't be a tomorrow for something drastic to be done in. Along with my BPD and Dissociative diagnosis. I am also Major/Clinical Depressive. This was also the only consistent diagnosis I’ve ever been given {therapy and diagnosis are a post for different times).Suicide has never been an option for me. I don’t believe in an afterlife. There is no god saint to welcome me through pearly gates. It was more like slipping into ambivalence. I don’t want to die, but if something were to threaten my life, I might not do anything to stop it. Nothing dramatic, just, numb. This life is all I have, so when I begin to lose attachment to the only chance I have, it’s time for something new to be tried.

 

I don’t roll over so easy. So finally, FINALLY, I accepted help and braved the roller coaster of mind altering drugs.

I’ve tried Lexapro, Zoloft, Klonopin and Xanax. Klonopin and Xanax work wonders for my anxiety but they knock me out. But hey, it’s hard to be anxious when you’re unconscious. Lexapro zapped my ability to orgasm. To me, this is unacceptable. Sex is one of the few things I derive unadulterated pleasure from. Not that just the act itself isn’t fun, but I’m not willing to feel nothing from the waist down for the rest of my life. I’m sure you understand. Zoloft worked fine while there was nothing to bother me, which is to say, it didn’t work at all. After being on Zoloft for a week I was in the Psych ER (story for a different day). Once again, I bottomed out and went back to my Dr. After the initial round of standard questions he asked me why I’d come to him and not straight to the Psych ER.

Have you ever been to the Psych ER? It’s a shithole wrapped in cellophane. No thanks. But I didn’t tell him that. He directed me to call a psychiatrist. I started seeing a therapist the next week, and a week after that finally managed to find a psychiatrist. Dr. T is my Therapist, Dr. P is my Psychiatrist. So after a trial round of a new drug, Dr. P has decided to up my dose of Symbyax. It’s a combination anti-psychotic and SSRI. Since I have a personality and mood disorder , along with sleep issues and eating, anxiety, laundry list o’problematicas, this drug is meant to stabalize my moods to a baseline norm while also working on my seratonin levels to eliminate my depression…. It’d had some affec ut not nearly enought. Today I saw Dr. P for the second time. He upped my dose.

What’s the cost of sanity you ask? Really fucking high. My mother may feel my life is priceless, but my insurance company only thinks it’s worth about $150/month.

That’s what you get when all you are is a number in their system. For the price I’m paying, beyond what my insurance covered, I better see results. You’ll be sure to know if I don’t. 

A disease called Friendship - Checklist Criteria 1: Abandonment

I will begin my look into the specific criteria listed in the DSM IV that qualify one as having BPD. Once I take a technical look at what it means to be me, I will branch off into the personal, the gritty, the mundane and macabre.

For those not in the know, the DSM IV is the experts guide into madness. It is the Diagnostic and Statistical Manual for Mental Illness. This is what psychiatrists, thereapists, councilors, doctors, etc. reference in order to pinpoint a diagnosis and ultimately, bill your insurance company.

First up on the DSM Checklist for BPD is:

1.) Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

Abandonment issues. If there's one thing that makes us sound like clingy, lonely, emo-kids, it's probably this. Someone never loved us enough not to leave. Did not see us worth the effort to stick it out for. So how do you keep people from leaving? You crawl under their skin until you are so fused with their being there is no longer the chance of escape. False.

At least in my experience, it's easier to not get too attached in the first place. Becoming too attached is a recipe for hurt, disaster and disappointment.  That's not to say that it doesn't happen. Some days it seems inevitable.


If we’re so afraid to be left, why let anyone close at all. No one wants to be alone. Not really. Humans are social creatures, pack animals. They thrive in groups, growing stronger as each contributes to the herd until all the sustenance is used up and they begin to gnaw at the bones of the weak.

Some days the loneliness is palpable. We need to reach out to remember we are part of a whole. Other times it’s almost insidious. Like friendship is a disease that has snuck up and infected you when you least expected it. A friendly word here or there, leadings to general inquiries of well being and before you know it, you’re discussing art, philosophy, the meaning of Life, the Universe and Everything. You’re attached before you ever saw it coming. One small symptom, then another, and before you know it you have stage four cancer and need weekly chemo just to function.

But now that it’s here, how long til it goes away? Is taken away? When will this disease called 'friendship' be 'cured'?

Boundaries were made to be pushed. If you can act out, act up, push back and yet they stay, isn’t that a testament to how dedicated they are to you? Your friendship? Your relationship? If you don’t test these boundaries how do you know if they’ll hold when it counts?

So you push. You test the fences, looking for weakness, chink in the chains that hold you together until finally one snaps. A tiny break at first. One link loosened in the whole. It inspires a response. Apologies are quickly made. The gap patched, soldered back together. But the break has been made and that point will never be as strong as it initially was. Everything is fine for a while. It’s been proven that you can withstand conflict. All is well in the world. You’re a brat, but a brat that cares.
Until the next time. And the next.

Even small very reasonable seperations can cause anger or fear. Make you question yourself, doubt yourself, make you think you've done something wrong. What is it about me that isn't good enough to spend time with? I understand you need had a last minute meeting but what is it about me that makes me less important that you would break our plans? Don't even consider large things.  I'm losing the time I would have spent with you, does tha mean I am losing you too? Rage. Hurtful words. Anger is my emotion. Anger at being used because clearly up until this point you have just been using me when you didn't really think I was good enough to do anything with.

Despair.

Every time the apologies are more profuse, and they're always sincere. The excuses, reasons, justifications become more frantic. Pleading, desperately hoping they forgive you to prove you worth their love. Please, I didn’t mean for it to sound that way, for it to mean that. I will learn, it will never happen again. Except it does.

Each time the test is a little larger, a little more extreme, until finally the structure is so unsound it collapses under it’s own weight for having the foundations picked apart.

The world crashes down, left alone, in the dark without the light that that relationship shed. The void is consuming. A vow is made to never let someone so close, ever, ever again. Well, with one exception…

It can be that the people chosen truly are uncaring, people not worthwhile that do not care to stick around or aren’t looking for anything beyond a superficial friendship. These people don’t tend to stick around anyway. But the people that you develop a firm belief in, the thought of them leaving is a waking nightmare. Also, a self-fulfilling prophecy. Who’s to say the fence would not have held up forever had you not felt the need to test the foundations? Would they have left if you had not created the circumstances that pushed them being their tolerance? By the time that thought occurs, it’s usually too late to let it go.

Through a Looking Glass, Shattered.


Hello. I am Haven. My hopes for this blog is to reach out, to connect, to touch you in some way that will increase awareness of what it means to have a Borderline Personality Disorder.

I promise nothing but an attempt, an honest look into the experience and insights of someone that walks through this world in a way other than you may do so yourself.

I do not claim to be representative of BPD. In fact, I don’t believe there is such a thing as a general representation. As one of the predominant features of my disorder is my dissociative condition, I feel almost no attachment to a group of individuals whatsoever. I hope to convey just how separate, other, this worldly experience is. Raise awareness, increase understanding, and challenge the perception of what is commonly held as the social norm of being.

Let us begin, shall we? Through a Looking Glass, Shattered.

Sunday, December 12, 2010

According to the DSM IV...

I have a personality on the Borderline of a lot of ‘issues’.  There are 9 distinguishing characteristic categories, 5 of which are necessary for a Borderline Personality Disorder diagnosis. Where do I fall, personally? Well, let’s see…

√ CHECK  1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

√ CHECK    2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 

 √ CHECK   3. identity disturbance: markedly and persistently unstable self-image or sense of self. 

 √ CHECK   4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 

 √ CHECK  5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 

√ CHECK    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). 

 √ CHECK  7. chronic feelings of emptiness 

 √ CHECK  8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant
anger, recurrent physical fights) 

√ CHECK    9. transient, stress-related paranoid ideation or severe dissociative symptoms

9 for 9. Aren’t I special? Not, really. The next question you’re probably asking yourself is, what exactly are those impulsive behaviors? Wouldn’t you like to know. I’ll share… eventually.

But for the record, here we go with my ordered list of functional brain ‘disorders’…. Dissociative Dissorder (depersonalization/derealization), Eating Disorder (bulimia), Major/Clinical Depression, General Anxiety Disorder, Self-Harm, kleptomania, sexual promiscuity, and a slew of other fun and exciting things that draw people to me like flies to honey.
Seriously, I don’t understand it. I attract people like mad and I see no reason why, except that I am physically appealing. Oh, and I don’t emote, so all of the aforementioned issues? No one knows unless I make an effort to tell them. Who would like to wager a guess at how often that happens? Lower. Looower. There you go.  My family and a handful of very, very close friends know. The rest of the world be damned. Oh, and you. Doesn’t that make you special. 

Borderline Personality Disorder

Because we should start with what the Experts say, right?




Borderline Personality Disorder DSM IV Criteria


A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:  
  1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
  2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 
  3. identity disturbance: markedly and persistently unstable self-image or sense of self. 
  4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 
  5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 
  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). 
  7. chronic feelings of emptiness 
  8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 
  9. transient, stress-related paranoid ideation or severe dissociative symptoms
The DSM IV goes on to say:

The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.
Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.
Individuals with Borderline Personality Disorder have a pattern of unstable and intense relationships (Criterion 2). They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver who nurturing qualities had been idealized or whose rejection or abandonment is expected.

There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self (Criterion 3). There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

Individuals with this disorder display impulsivity in at least two areas that are potentially self-damaging (Criterion 4). They may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with Borderline Personality Disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (Criterion 5). Completed suicide occurs in 8%-10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for help. These self-destructive acts are usually precipitated by threats of separation or rejection or by expectations that they assume increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating the individual’s sense of being evil.

Individuals with Borderline Personality Disorder may display affective instability that is 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) (Criterion 6). The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the individual’s extreme reactivity troubled by chronic feelings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger (Criterion 8). They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil. During periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.

Associated Features and Disorders
Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last). Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnotic phenomena) during times of stress. Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships. Premature death from suicide may occur in individuals with this disorder, especially in those with co-occurring Mood Disorders or Substance-Related Disorders. 

Physical handicaps may result from self-inflicted abuse behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and broken marriages are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder. Common co-occurring Axis I disorders include Mood Disorders, Substance-Related Disorders, Eating Disorders (notably Bulimia), Posttraumatic Stress Disorder, and Attention-Deficit/Hyperactivity Disorder. Borderline Personality Disorder also frequently co-occurs with the other Personality Disorders.

Specific Culture, Age, and Gender Features
The pattern of behavior seen in Borderline Personality Disorder has been identified in many settings around the world. Adolescents and young adults with identity problems (especially when accompanied by substance abuse) may transiently display behaviors that misleadingly give the impression of Borderline Personality Disorder. Such situations are characterized by emotional instability, "existential" dilemmas, uncertainty, anxiety-provoking choices, conflicts about sexual orientation, and competing social pressures to decide on careers. Borderline Personality Disorder is diagnosed predominantly (about 75%) in females.

Prevalence
The prevalence of Borderline Personality Disorder is estimated to be about 2% of the general population, about 10% among individuals seen in outpatient mental health clinics, and about 20% among psychiatric inpatients. In ranges from 30% to 60% among clinical populations with Personality Disorders.

Course
There is considerable variability in the course of Borderline Personality Disorder. The most common pattern is one of chronic instability in early adulthood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources. The impairment from the disorder and the risk of suicide are greatest in the young-adult years and gradually wane with advancing age. During their 30s and 40s, the majority of individuals with this disorder attain greater stability in their relationships and vocational functioning.

Familial Pattern
Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders, Antisocial Personality Disorder, and Mood Disorders.

Differential Diagnosis
Borderline Personality Disorder often co-occurs with Mood Disorders, and when criteria for both are met, both may be diagnosed. Because the cross-sectional presentation of Borderline Personality Disorder can be mimicked by an episode of Mood Disorder, the clinician should avoid giving an additional diagnosis of Borderline Personality Disorder based only on cross-sectional presentation without having documented that the pattern of behavior has an early onset and a long-standing course.

Other Personality Disorders may be confused with Borderline Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Borderline Personality Disorder, all can be diagnosed. Although Histrionic Personality Disorder can also be characterized by attention seeking, manipulative behavior, and rapidly shifting emotions, Borderline Personality Disorder is distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and loneliness. Paranoid ideas or illusions may be present in both Borderline Personality Disorder and Schizotypal Personality Disorder, but these symptoms are more transient, interpersonally reactive, and responsive to external structuring in Borderline Personality Disorder. Although Paranoid Personality Disorder and Narcissistic Personality Disorder may also be characterized by an angry reaction to minor stimuli, the relative stability of self-image as well as the relative lack of self-destructiveness, impulsivity, and abandonment concerns distinguish these disorders from Borderline Personality Disorder. Although Antisocial Personality Disorder and Borderline Personality Disorder are both characterized by manipulative behavior, individuals with Antisocial Personality Disorder are manipulative to gain profit, power, or some other material gratification, whereas the goal in Borderline Personality Disorder is directed more toward gaining the concern of caretakers. Both Dependent Personality Disorder and Borderline Personality Disorder are characterized by fear of abandonment, however, the individual with Borderline Personality Disorder reacts to abandonment with feelings of emotional emptiness, rage, and demands, whereas the individual with Dependent Personality Disorder reacts with increasing appeasement and submissiveness and urgently seeks a replacement relationship to provide caregiving and support. Borderline Personality Disorder can further be distinguished from Dependent Personality Disorder by the typical pattern of unstable and intense relationships.

Borderline Personality Disorder must be distinguished from Personality Change Due to a General Medical Condition, in which the traits emerge due to the direct effects of a general medical condition on the central nervous system. It must also be distinguished from symptoms that may develop in association with chronic substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified).

Borderline Personality Disorder should be distinguished from Identity Problem...which is reserved for identity concerns related to a developmental phase (e.g., adolescence) and does not qualify as a mental disorder."

Why, hello there Handsome.

I'm Haven.

No, you won't be safe here. I won't tell you comforting lies. I am a refuge for the truth.  Large or small, sometimes the greatest epiphanies fall from the most innocuous moments. I have had these, though I make no promises that you might.

I would say, I'm just a girl, but I don't usually feel like one. I don't usually feel human at all. A body walking, talking, thinking. Animated consciousness. I recognize the world around me though it feels as if someone else is stimulating my actions as I witness from afar.

My story is set in the mundane. Recognizable as the world you know. The world you walk through, live in, play in, connect with. I do all these same things, except connect. I am disconnected, interrupted from the flow of the ordinary.  Utterly. I am an observer, witnessing the lives of others and overseeing my own; moving through a measurement of time three feet to the left of the common border. The border between what and what, you ask? I walk the Borderline between a Dissociated worldview and the one you know. For me the scene will differ though the picture may seem the same to you. This is the portrait I hope to portray.

What does that mean? As far as my eye can see, Borderline Personality Disorder, while a clinical diagnosis is not a tangible thing. It's not a condition that can be disected and cauterized like a rotting limb, amputated to leave one functioning whole. It's not a disease treatable like Bipolar or cancer that you can throw lithium or radiation at to 'cure'. But, that doesn't mean it isn't a real problem. It's a category that encompasses an array of symptoms classified by one overarching Title illness. You can try to treat the symptoms, but there's no cure for the category. It's a Label, so the psych can bill my insurance company with a pin-pointed disguise for my diag'nonsense'. I border on a multitude of madness and sanity. It's a part of me.

This is how I journey through that world. How I attempt to understand that world.Your world.



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