Friday, January 21, 2011

What causes BPD? Linehan theory Part 3

Up next we have: Active passivity vs. Apparent Competence

Active passivitythis is defined as: the tendency to be passive when confronted with a problem and actively seek a rescuer. 
 No. Not even a little. When confronted with a problem I confront it right back. I don’t run away from anything. I’m not afraid of people’s reactions in the way that is typical of BPD. I’m hate the thought of negative outcomes but I also believe that as long as a problem can be worked on, talked through, and people are willing to communicate it is possible to get through a problem and not have a devastating outcome. I suspect my Dissociative Disorder acts up in this arena as well. When faced with conflict my emotions turn off completely and I argue with pure logic. I can talk about emotions but not feel them. Then if it becomes inevitable that a situation can not be resolved I go numb to the negative emotions that should come of it. This doesn’t always work. However, I don’t need a white knight, I’ll save myself, thanks.

My personality tends to be too dominant, independent to rely on other people. I can see where some passivity comes into my life, and I guess if I’m really honest, I do hope for someone to come along, see me, and accept me for all that I am. Save me from a lifetime of loneliness. But I’m also not willing to latch onto every shmuck that falls my way. I have standards after all.

Apparent competenceappearing to be capable when in reality internally things are falling apart. Sure. Because I actually am extremely competent. I worked my ass off to be intellectually, logically, mentally competent in some of the hardest fields I could have chosen to pursue. Not to mention some very useful creative fields. I read constantly and I know A LOT about a great many things. That doesn’t mean that internally things aren’t still falling apart for me though.

After a lifetime of rollercoaster emotions I’m disgusted by my own lack of control in this arena. I’ve worked hard to control my emotions. I learned to mask my inner turmoil, not display it, so I always appear calm and rational. In my defense, I am rational. But sometimes it’s too hard to get past the overwhelming emotional upheaval to think straight. I often have the impulse to lash out and say things that reflect how I feel, but I’m sick of being ruled by my emotions, so I hold in my reactions. It doesn’t stop me from experiencing them, but it stops the expression of them. I try very hard not to unleash my emotions publically because the repercussions would only act to alienate me from the people around me. When this happens, I try not to be around other people. I hate anyone seeing me like this. I’d rather them continue to believe the calm, friendly fa├žade. However, underneath the surface little by little it builds up until I can’t control it and I have to either physically vent my emotional frustration or have a self inflicted melt down, alone.

I’m learning how to deal with this though. Through therapy and my journaling I am learning to recognize the emotions that are not … for a given instance. Once you can recognize that a situation is not beyond your capacity to handle, can take a step back and analyze why a feeling is so intense it becomes easier to understand it and thus, manage it and learn to respond more appropriately in the future. It’s not easy, and it doesn’t happen overnight, but it does work. So maybe this field isn’t quite a ‘yes’ for me either because I actually am learning to competently deal with my emotions.

As a side note: I HATE considering myself an emotional person. Anyone that meets me and gets to know me a little would tell you I am one of the most rational women you’ve ever met. Not emotional at all. Just like one of the guys. Crude, funny, outgoing and witty. These certainly are parts of my personality, but they’re parts I put into focus in order to mask everything else beneath the surface.

Thursday, January 20, 2011

What causes BPD? Linehan theory Part 2

Continuing on with Dr. Linehan’s theory I’ll take a look at Vulnerability vs. Invalidation

Vulnerability - I detest admitting vulnerability. Over the years I have built defenses and fortresses of walls to keep other people out. Do I have vulnerabilities? Eeeeeeeeeeeeeh, everyone does. I’m loathe to put them out there where others can easily find them and use them against me though. Because they have. So I don’t. I know where my strong points end and my weaknesses begin. That doesn’t mean I need to wear these on my sleeve. Rarely, oh so very rarely, someone will put in the effort to get close to me, really want to get to know me. Slowly, my walls begin to crumble around this person. They can now see into the darker areas of my world. I have no secrets, but there are things I don’t share right away. Every time I open up, reveal something less pleasant about myself, I wait in fear, that their entire opinion of me will shatter and change, and they’ll leave. Every revelation is a wrench to my heart. The closer someone gets to me, the greater the potential that they can hurt me.

InvalidationYes. This especially applies to my emotions. I am constantly questioning whether I have a right to feel the way I do when it comes to other people. Who’s to say what right I have? If the person feels otherwise about something, then my feelings aren’t justified and therefore not valid for the situation. If my feelings aren’t valid or accepted, I’m not valid or accepted. You can’t only accept parts of me, I have to be accepted as a whole. Or not at all. However this also applies to my work, my crafts, my hobbies. I do things, present things to people hoping it meets with approval but looking for criticism that will invalidate my ability, prove that yet again, what I have done, is not good enough. I don’t get defensive with criticism but having become so accustomed to it, I have a tendency to not believe people when they only give me praise with no critique. 

Constantly putting myself out there for others to view and judge exposes my vulnerabilities. Opens me up to the potential criticisms of others, then when I look for those criticisms, expect them, it heightens my feelings of vulnerability because I’ve put myself at the judgment of others. Will I be accepted, or won’t I? Because I have a hard time with object constancy, I often can’t hold onto the feeling that each individual event isn’t the sole basis for a relationship/friendship. Just because something isn’t perfect doesn’t mean that people will leave me or not value me. It’s a self fulfilling cycle of hurt. Emotional masochism.

When you are constantly discredited it’s difficult to hold onto a solid sense of self. Who you are is perpetually in question. It weakens the ability to accept or even understand criticism or praise as something constructive and not necessarily judgemental. The judgement of the self is so impaired that it leaves someone with BPD open to adopting a skewed opinion of themselves based on the views of others.   When a sense of self is not solidly in place, changeable at the influence of others, this leaves a person susceptible to being wounded and hurt. Each word of praise or criticism is taken as a completely separate event, with no context to past interaction. Praise is a beautiful high. Criticism or harsh words a crushing low. This increases the need to be loved and accepted, causing someone with BPD to expose themselves even more, perpetuating a cycle of intense emotional turmoil.

Wednesday, January 19, 2011

What causes Borderline Personality Disorder?

One theory is presented by Dr. Linehan’s. Linehan has developed a comprehensive sociobiological theory which appears to be borne out by the successes found in controlled studies of her Dialectical Behavioral Therapy.

Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings and who are confronted by three basic dialectics they have failed to master (and thus rush frantically from pole to pole of):

- vulnerability vs. invalidation
- active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs. apparent competence (appearing to be capable when in reality internally things are falling apart)
 - unremitting crises vs. inhibited grief.

So it’s nature and nurture here, or nature and lack of nurture. So let’s see how this applies to me.

“Beliefs about the self were constantly devalued.” I hate to say this is true, because I was raised with incredibly loving parents in a very loving home where both my parents wanted the best for us, for us to be the best. My father however, was an art critic, our coach, our teacher… so everything we did was always capable of being improved upon, never good enough, always something wrong, always could be better. That's not to say he never praised us, he often did, it was always followed by... "and now you could do this", "that's good but this is off, try doing this", "but this could be improved in this way", "watch out for this". For me this translated as, if there’s something wrong with my work, there’s something wrong with me and I need to work harder, to the point of obsession, in order to be the right kind of person. If I'd get hurt or upset, about anything, I was often told to suck it up and deal like a grown up. Crying was not acceptable so I learned to hide my feelings. He didn’t mean to cause these feelings, but I guess being predisposed to this kind of thinking made his critiques all the more impactful.

One of my earliest memories was when I was 3 years old. I had a Little Shop of Horrors coloring book. I did an entire picture all in orange crayon. It was the very first time I had stayed completely in the lines and not messed up. I proudly showed my father. He said good job girl, took my crayon, and decided it was now a good time to show me how to shade my colors. On my current picture. He went outside of the lines. I was heartbroken with disappointment that my painstaking achievement wasn’t good enough and was now ruined. I thought I had done so well, but apparently I hadn’t done well enough. It may not seem like much, but to a 3 year old, it seemed like a big deal. That’s just one example, I could go on with a lifetime of me being pushed to be the best, pushing myself to be the best, but maybe another time.

I will say that as a result of a lifetime of this, it is difficult for me to ever believe that what I do is good enough, that I am good enough. I constantly question and second guess my own sense of self worth and often measure it by what people think of the things I do for them, be it cooking, baking, costuming, gifts, art, work, etc. In an odd twist, I also have a hard time believing people, believe they are telling the truth, unless they give me uneditted criticism. It's so ingrained in my thinking that I can always improve things, that unless someone tells me how I can do things better the next time I doubt whether the thing that I've done was actually ok. So I set higher goals, harder goals, and work my ass off to prove to myself that what I do is valuable. That I am capable of doing things of value. I've never set a goal I haven't accomplished beautifully, and yet, I always wait for someone to tell me how to improve.

Now do I think this is the only theory? or the best theory? No, but it's interesting to explore.

Coming up next… Vulnerability vs. Invalidation

Tuesday, January 18, 2011

Quotes from the Borderline

"Borderline individuals are so completely in each mood, they have great difficulty conceptualizing, remembering what it's like to be in another mood."

Lack of Object Constancy

“Borderlines have problems with object constancy in people -- they read each action of people in their lives as if there were no prior context; they don't have a sense of continuity and consistency about people and things in their lives. They have a hard time experiencing an absent loved one as a loving presence in their minds. They also have difficulty seeing all of the actions taken by a person over a period of time as part of an integrated whole, and tend instead to analyze individual actions in an attempt to divine their individual meanings. People are defined by how they lasted interacted with the borderline.”

Object Constancy - They may have problems with object constancy. When a person leaves (even temporarily), they may have a problem recreating or remembering feelings of love that were present between themselves and the other. Often, BPD  patients want to keep something belonging to the loved one around during separations.

My therapist tells me I have a lack of object constancy.

Out of sight, out of mind: For me, I don’t believe people hold me in their memories. If I’m not around, or I am not in some form of contact/communication with them, I don’t exist in their world. I have an extraordinarily hard time holding onto the thought that people remember me, hold me dear or care for me when I am not in their physical presence. Out of sight, no longer connected. I'm sure to most people this is not how they perceive relationships (be it friendship, dating, familial). I think it should be a consistent progression of emotions and experiences that build together to form a deep bond. I also have a hard time holding onto the strong emotions I feel for those I care about, and when I do manage to I also manage to convince myself that I am the only one that feels this way and no one else could possibly share my depth of emotion though I desperately hope they do. This creates a feeling of panic and loss for something that may actually be there and I need to find a way to reaffirm these feelings in myself and others every time I am back in contact with them. It’s a maddening cycle of doubt, loss, connection and disconnection.

Holding Time:  I have a hard time holding together one event after the other. I remember events just fine, but holding onto the sentiment of events in series that something is bound. It doesn't always feel to me that everything is connected. One thing may happen after another, but it does not seem like things hold together in essence after the former has passed. Like if I'm gone too long, that I was there before will cease to be relevant. There is no continuum of events. Everything is like a single instance in time and I have to completely reestablish how I am connected to the event, the environment, the people every time.  It’s very difficult for me to remember that everything is NOT a series of individual events. They ARE a continuum. The attachment of one event bleeds into the sentiment of the next giving life to yet another. That continuum is what binds memories, sentiment, and relationships. Yes? At least that is what I imagine it should be. I imagine so, I don’t feel it.

I often have terrible anxiety when people leave. There’s a desperate need to understand how others feel about me, hold me to them, our connection, because I can’t hold onto this concept myself. On the other hand, when people do leave, abandon me, never to return, after a while it’s as if they were never in my life. I have memories of experiences with people, but no emotional connection to the memories. It’s like I’m remembering a story someone else told me. Sometimes this happens immediately, other times it takes weeks of panic at the loss before I break from the emotional attachment I’ve been able to build. Lately though, I notice this happening more and more quickly, with less time spent obsessing over every instance that lead to the break.

My dissociation helps me here because after the initial fear and anxiety, my emotions deaden. I become numb to the experiences I have just been through. I feel detached from my own body and it becomes logical that others wouldn’t be attached to me when I am not even attached to myself.

How attached are things, moments in time, events, really? How does it feel to be so strongly bound by sentiment that you feel indefinitely connected by a series of things? I simply don’t know.

Monday, January 17, 2011

Comments from across the Borderline...

A reader left me this lovely message today.

 I really appreciate you sharing your experience on here, it really helps people like me to know that there are other people dealing with the same thing. At the same time, I wish I could help you as I know even if you can talk about this openly that it still hurts to some degree.

Yes, it is still painful to talk about. But also, like you, it helps me to know that others are going through the same thing. Even the small words of encouragement and connection make me feel better. Thank you.


Emergency appointment with my psychiatrist. Had to change meds. To give you an idea of me; I’m 5’3” and very athletic. I’ve always been what people consider thin. I work out 5-6 days a week and maintain a very good muscle tone. Also having been eating disordered since I was very young I am incredibly conscious of my body, and the changes in it. My body image is often unstable, a grasp I hold tenuously. The medication that my psych had me on made my weight skyrocket. Ok, so I only gained like 15 pounds, but for someone like me, it felt like my world had come crashing down. My body image is destroyed. All these years of hard work and careful maintenance, gone. I’d done a fair amount of research into this drug and weight gain is a very common side effect. On the one hand I’m incredibly pissed off that my dr. would put me on something that he knew was likely to make me gain weight when he also knew I was eating disordered. On the other hand, I also understand that he thought my problems were urgent enough that the side effects would be less an issue than the potential benefits of the medication. I stopped taking my medication. Cold. I was worried that I’d have a slew of bad withdrawal but so far, nothing, and it’s been almost a week.

I’ve been on Lexapro, which worked for my anxiety and depression but destroyed my sex drive. Correction, my libido was still incredibly high but I could no longer orgasm. Problem. I quit taking it.

I was on Zoloft which removed my anxiety but did nothing for my depression. Fail.

Symbyax, (combination anti-psychotic/SSRI) which stabilized my mood swings but still left me at a baseline of mild depression on the one hand, but in destroying my body image sent me spiraling down in a different direction. Also, did nothing for my anxiety. Not to mention, even after insurance Rx coverage, a months supply cost me over $300. Fail.

He also has me on Trazadone, which is technically a mild antidepressant but prescribed to help people sleep. The dose I was on, didn’t help me sleep, so he upped that. 

My new medication is Lamictal. Traditionally Lamictal is an anti-convulsant but with good results for bipolar II (which I’m not). Bipolar II is essentially chronic depression without the manic upswings, which is close enough to my problem. He said he expects no side effects. It will balance my mood AND my anxiety. Won’t effect my sex drive, bonus. And finally there has been next to no reported weight gain from it. Awesome. So here’s hoping this does more good then the meds I’ve tried before. I’m hopeful at least.

Oh the joys of the medication-go-round.

Sunday, January 16, 2011

There was no note...

An acquaintance of mine recently committed suicide. Everyone I know is incredibly broken up by this.

I feel nothing.

I handle death differently than most that I know. Death inevitably comes with life and I don't see it as anything but natural. What will be worse for me is when it does hit and I start thinking about my own mortality. I don't believe in an afterlife. There is life, and there is the void of nonexistence. I literally feel a drop in the pit of my stomach at the contemplation of utter nonexistence. Spending any great amount of time thinking about this will drop me into an almost paralyzing anxiety. Afterwards, I waver between a reckless need to experience everything in life because this is the only one I have, and clinging to that which is safe but makes me enjoy life all the more, but can cause me to hermit. I may be reckless, or structured to stabilize. Now, I don't know. I guess I'll see.

While my friends are screaming about how selfish he was, how could he do this to his friends, his family, why didn’t he ask for help, anger, etc. I can empathize. I have a slightly different perspective on suicide as I've contemplated it so often, for so long. 
I’m sure he did ask for help. For years. Doubtful, this was a quick decision. When you are loved, and still, all you feel is the oppression of hopelessness, there is nothing more to look forward to. Nothing tying you to this plane. Death is a release. The only escape from the pain. It may be selfish, but not understanding, not forgiving someone a release from a life lived in misery because you feel a loss, is selfish too. What makes one act of selfishness, more relevant than another? Who’s to say.

When you tell people you want it all to end, and they cry about how it will make everyone else feel, all this does is add guilt on top of pain. I’m sure there’s the undertone of ‘all these people love you, you have so much to be grateful for’ there, but that’s not how it feels. It’s becomes just one more reason why you suffer and create suffering for those around you.

I can only wonder if he found the release he clearly needed so desperately. I feel no sadness just a sort of resigned understanding.

Most of my friends don’t know how tenuous my hold to my life can be some days. I don’t talk about it. But I understand the need. I can’t feel sad about his decision to end his life. While I understand why his friends and family miss him, I don’t understand the thoughts that he was selfish and inconsiderate. The pain caused to others in the wake of the event I understand. To me it seems like people are forgetting that for someone to make this decision, they pain they have lived with for so long masks the future in only more crippling pain. Why would you want someone to live like that for your own sake? That, to me, is selfish.

There's too little life to waste it on things that make you unhappy. Let go. Forgive. Move on. Reconcile. Release. Find things that make you happy. There is no second chance to live. 

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