Saturday, March 26, 2011

Reinvention


The best thing about having an unstable identity is the ability to reinvent yourself however you want.

…and it confuses the shit out of everyone.





Friday, March 25, 2011

I have a request...


Dear Brain,
Please let me sleep.
Thanks,
~Management~

Seriously. Went to sleep late. Woke up at 2am. Woke up at 3am. In a cold sweat. After mildly disturbing dreams. Didn’t fall back to sleep. Got out of bed at 6.30am. What the fuck? I was a good girl. I took my Trazadone. I don’t use stimulants in general (read: no caffeine). Why does this nocturnal phenomena elude me? Some highlights from my dream included:
Saw everyone hurrying towards the exit. Apparently the building was on fire. I didn’t understand/know what was going on at first because I couldn’t hear any alarm. I strained to listen but I didn’t hear anything. I thought maybe there was a signal I hadn’t been told about. A blonde woman, maybe mid-40s looked over at me in a panic as she rushed by. I decided to go back to my desk and grab my stuff first, even though everyone else was panicked enough to leave theirs where it was. I had too much stuff and was having a lot of trouble picking it up and carrying it all. Things kept slipping. As I finally made my way out I began to see the smoke.
At some point I was picking at the palm of my hand. There were little bits of skin that I wanted to get rid of. I ended up pulling almost all the skin off of the palm of my hand until it was completely red and raw and there was a puddle of blood in my palm. I went over to the first aid kit on the far wall and got a large bandage. I knew this was something I shouldn’t let anyone see. It took me a minute to position it because I had to cut the one side to wrap it through my fingers, but it wouldn’t stay on. The EHS lady aw that I was bleeding and tried to get me to show her so she could report the injury but I refused.
I miss my apocalypse dreams. They’re way more fun.  
On a lighter note. My mood has been stable since Monday. This may or may not be a good thing as I dissociated from my emotions last week and other than some self-destructive impulsive problems Thurs/Sat/Sun, they haven’t returned. I’ve been calm and ok though. I actually cannot remember any period of time in years that I’ve had more than a couple days of relatively stable moods. I’m not necessarily in a good mood, but I’m not depressed either. Calm. It’s weird. It shouldn’t be weird for steady emotions to feel odd, but it does. I don’t recognize this as a part of my existence.  
Thoughts:
1.)    The meds I’m on are kicking in. I do feel less depressed and less anxious. Almost not at all. However I was on these last week when I was flipping out and over the weekend when I was entertaining some destructive impulses and they hadn’t helped then. By the way, my pdoc increased my dose to 200mg/day the last time I went in to see him.
2.)    I’m still dissociating from my emotions. This makes doing my therapy homework pretty difficult. I’m supposed to be writing about my emotions to cognitively recognize them as I’m experiencing them in order to form a functional connection. It’s hard to do when I’m not really feeling anything. I’m calm. It’s calming. I feel ok. I don’t know how to internalize this.
3.)    I’m not in a relationship and am therefore not completely emotionally dysfunctional.  Having purged or been purged from all of the dramatic factions of my friendships and relationships, with the exception of Friend – whom I no longer feel anything for, I have no drama filled emotionally turbulent external influences. Granted I also haven’t been completely alone all week so I don’t have much to compare my experimental phase to, but hey, gimme a break.

If I had to hazard a guess I’d say it was a combination of 2 and 3. My dreams seem to be a better indicator of what’s going on with me than what’s actually going on with me. Regardless, 4-5 days is good for me! Yay me. This weekend should be interesting so we’ll see how that goes.

As for tonight: Sucker Punch, bitches! 


Thursday, March 24, 2011

Trash talk – Controversy in BPD


Myth: BPD is a "wastebasket definition." Clinicians give patients this diagnosis when they can't figure out what's wrong with them.
Reality: “ BPD should be diagnosed only when patients meet the specific clinical criteria.
Janice Cauwels (1992) wrote: BPD is still a wastebasket diagnosis, a label slapped on patients by therapists trying to pretend that their illness is understood. It is also used to rationalize treatment mistakes or failures, to avoid prescribing drugs or other medical treatments, to defend against sexual issues that may have arisen in therapy, to express hatred of patients, and to justify behavior resulting from such emotional reactions.
In other words, some clinicians use the word "borderline" like some schoolyard bullies use the word "cooties." But the fact that BPD is used as a wastebasket definition doesn't make it a wastebasket definition, any more than calling grapefruit a fat burner makes it a fat burner. A patient should be diagnosed as borderline only if they meet the clinical criteria and only after a clinician has worked with the patient over time to verify that the BPD symptoms are persistent, extreme, and long standing”.

Basically this is more the fault of therapists. It comes about when a patient’s problems are not so clean cut and identifiable. A patient may have one or two or many problems but instead of taking the time to understand if these are separate issues the patients are thrown under the heading of BPD because it’s a disorder that encompasses such a wide range of symptoms. Actually getting to know the patient would require more effort on the therapist’s part. It’s easier to lump them under a more general category.  Regardless of whether these people meet the designated criteria. Because as we know, any patient that is emotionally problematic must have a personality disorder. Dumping them under the Borderline Personality Disorder label allows them to utilize the stigma associated with BPD and dismiss them as untreatable or as a disorder that they are not equipped to deal with {read: biased against}. In short, it’s easier for the therapist to not deal with a challenging patient.

::Alternatively::
Like many clinicians, my roommate who has her M.S. in clinical psychology, describes it differently.  They do not believe that BPD is an actual mental disorder. It’s not like Bipolar or Depression that is a chemical imbalance and can be quantified.  She does see it as a wastebasket definition. This stems from the fact that the Borderline Personality Disorder does encompass such a wide range of problems, it’s as if any problem that cannot be explained by another disorder/diagnosis is swept together into a catch all category and filed under BPD. There is no reason that the co-morbid symptoms that comprise BPD can’t simply be separate co-morbid symptoms. For example, she’s not convinced that all of my issues don’t stem from Depression and a General Anxiety Disorder (which was the diagnosis I received from my first therapist). Except my depression and anxiety are alleviating and I still have a mess of issues.
I can understand this perspective even if I don’t agree with it. Even if it were a catchall for all these extraneous symptoms it doesn’t make it an invalid designation. Again, it provides a label that helps identify the wider range of problems that comprise the patients’ symptoms and allows for a means of recovery. Recognizing BPD as its own disorder also recognizes that these symptoms contribute to one another, compound, and are not necessarily separate entities. That there are co-morbid symptoms does not mean that these symptoms don’t stem from a common origin.
Personality disorders are tricky little bastards. You can’t quantify a personality. You can’t quantify emotional experience or relationships. All we have are our reactions and responses to the world around us. Personality is the lens through which we perceive that world. It permeates our entire being providing the means to interpret what we see and feel.  Recognizing how we relate to the world around us is what allows us to function in it. For someone with a Borderline Personality Disorder, that range is expansive, so yes, it does encompass a lot, maybe too much, but then again, most days we feel too much.

Wednesday, March 23, 2011

A Matter of Severity: Controversy in BPD - Part 2

I thought to add this to the previous post, but I'm adding things as I find them so .... Another controversy revolves around the question:


Is it possible to distinguish between a normal personality and a personality disorder, how do you do it, and where do you draw the line?

Without a clinical measurement of severity in personality discrepency it's difficult to recognize where you draw the line between a healthy, relatively normal personality and something severe enough to be considered a disorder. Not only that, but who's to say what is normal for one person is not normal for another? Unfortunately {in terms of diagnosis} people are all different so it's nearly impossible to devise a steady measurment from patient to patient. So how do you decide on a distinguishing factor...

"It has become increasingly clear that some form of severity assessment is necessary to decide on the priorities to use for the management of personality disorder. The notion of severe personality disorder is central to much of the work in the area of forensic psychiatry. What is clear from empirical research studies is that those with more severe personality disorder do not have stronger manifestations of one single disorder as often postulated, but instead their personality disturbance extends across all domains of personality. Although severity is not normally taken into account when classifying mental illness, it is important in personality disorders, as normal personality and personality disorder are both on the same continuum. Unfortunately, there is no measure of severity for personality disorder in the DSM or ICD classification, and the absence of these measures is of significant concern. Indeed, treatment is justified when it is likely to ameliorate distressing or disabling syndromes, even when the patients fail to meet the full diagnostic criteria of psychiatric disorders and, consequently, the measure of severity is highly relevant to the planning and provision of treatment. A reliable way of assessing personality disorder is to use 3 levels of severity (SeeTable Below). By using this measure of severity, it is possible to use the cluster system to get a measure of severity and this measure is also relevant in assessing those with the most severe personality disorders in forensic psychiatry."



I think this ties into the idea that recognition and diagnosis of BPD is not stable. With so many different aspects and potential combinations of symptoms it's difficult to pin point what are the distinguishing characteristics for BPD if some symptoms present, but only to a mild degree, wheras others present with much greater prominence. If something is less inhibiting should it be consider part of the dysfunction? Should only the most severe problems be included in diagnosis? Or should all manifestations be addressed and lumped together? I personally thing the 3rd is the best idea. However noting which problems are the most harmful to a persons functionality can provide a guideline for psych/therapists to map out a course of treatment addressing the most prominent features sooner.

Tuesday, March 22, 2011

Nothing to do with anything.

Or does it?

Because it's stuck in my head, I feel it only fair to get it stuck in yours....



Hunter's Kiss - Rasputina

Does Borderline Personality Disorder exist? - Controversy in Borderline Personality Disorder

 
There is a lot of myth and controversy surrounding Borderline Personality Disorder. This is due to the fact  that the nature of BPD is very complicated.
Controversy ranges from Diagnostic criteria, usefulness of medication, effectiveness of therapeutic techniques, gender discrepancy, possibility of recovery, Axis location, terminology, and whether it even exists as an actual disorder at all. There are many, many more. I can’t say I’m surprised though, we’re a pretty controversial group of people.
This will be the beginning of a series of entries surrounding the controversies with BPD.
So to start; I think it’s appropriate to begin with:

Does Borderline Personality Disorder even exist?
One of the myths I’ve found is that there is no such thing as BPD. However more than three hundred research studies and three thousand clinical papers provide ample evidence that BPD is a valid, diagnosable psychiatric illness.
The question about the existence of BPD comes from several claims.
1.)     The first being shear ignorance of current psychological research. Definitions and diagnosis of BPD have changed drastically in the decades that it has been recognized as a disorder and some clinicians may be overwhelmed, or choose, to focus on many other areas of specialization and just not know how this subject has developed.

2.)    Some clinicians believe that it is not a separate disorder. They believe it is a collection of symptoms that are better encompassed by Bipolar Disorder or Post Traumatic Stress Disorder.  I’ve talked about PTSD before {here} and why I believe these are different disorders.  Bipolar II is a bipolar spectrum disorder characterized by at least one hypomanic episode and at least one major depressive episode; with this disorder, depressive episodes are more frequent and more intense than manic episodes. As far as Bipolar is concerned; I can see how Borderline Personality Disorder could be confused with Bipolar II (Bipolar depression) from a mood disorder standpoint. People with BPD tend towards a chronic depressive state with instance of hypomania (this certainly fits me). However BP II doesn’t the address the "instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts,” markers that define BPD. (More on Bipolar II)


3.)    Some simply reject labeling because of the stigmas associated with BPD and find all psychiatric diagnosis limiting and misleading. This one in particular I find to be ignorant. Yes, BPD does have a lot of associated stigmas (which I will also discuss in a later post), and avoiding stigmas is beneficial to the personal interactions of a patient in the outside world. However, by refusing to provide a diagnosis it can be very difficult to provide a clear course of action in therapy. By extension, it makes it more difficult to find a path to recovery. Not to mention, someone with BPD doesn’t have to tell anyone that they have been given this diagnosis, which will also allow them to avoid the general stigmas. If the psychiatrist/ologist/therapist holds onto these stigmas, it’s best for the patient to find a professional that is better equipped to handle the challenges associated with the present symptoms.

4.)    Another reason stems from the fact that the categorical diagnosis and causes for BPD are often disputed among professionals.  While the DSM does provide a list of criteria, there isn’t a single dimensional model that clearly maps how to identify traits and how, or if, they correlate to one another. This means there is dispute over the importance of various criteria, whether they are related to one another at all or just coincidentally present in the patient, existing as distinct problems or pieces of various other disorders. So the root causes that are traditionally used to classify BPD are called into question.  
"There continues to be some debate as to which personality variables should be assessed to make a diagnosis of personality disorder in the normal/abnormal personality continuum. It would seem to be appropriate in this approach to choose those personality variables more likely to be personal and concerned with functioning, in order to assist in understanding the patient's disabilities and obtain strong clues about them. The difficulties encountered in the diagnosis and study of personality disorder include inconsistencies in assessment across both instruments and raters. "

Most professionals agree that the symptoms that compose Borderline Personality Disorder are part of one clinical diagnosis. The symptoms themselves are not deniable. No doctor or therapist would look at a patient talking about their problems and tell them these issues do not exist. That is not the question. The question is mostly one of definition and categorization. Regardless of what anyone thinks, the problems are real and having the ability to recognize the distinction of various symptoms is an important tool in order to deal and work to recover.

Monday, March 21, 2011

Sleep please


Ugh. Therapist decided to change my appointment from Thursday to today. For the last few months I had therapy Monday and Thursday. I just recently went back to one day a week (Thursday).

I just, really don't want to go in today. I had wanted to go to the gym, but I realized I can't go to the gym because I can barely sit up straight. 2 glasses of wine and half a bottle of vodka on top of maybe 2 hours of sleep last night... practically no sleep for the last 2 weeks. I wanted to go home and go to bed. I had a really messy weekend, so I probably should go in, but I just can't make up my mind. Sleep or therapy. I had my night all planned out already. It was easy and I didn't have to think about it. Work, home, sleep. Therapy is driving all over, an extra two hours out of my night. It's probably a good idea to tell her what happened this weekend while I'm still feeling the effects of it. But if I just went home and got some sleep I would feel better on my own. Or, at least, I wouldn't have to think so much and that's better all by itself, right?

I can do reasearch for an Institute of Nuclear Physics because I know exactly what needs to be done but ask me to deviate from my plans and my brain freezes. It's not a big deal. Changing plans shouldn't be so disconcerting. I can't make decisions like this.

If I could get some sleep I could be productive in therapy. If I go to therapy I might actually be able to work out why I'm not sleeping. If I go to therapy I can't get as much sleep. If I wasn't so bloody tired this wouldn't stress me out so much.

I'll probably just go. What's one more day of less sleep? Geezus this is asinine.

I just want to lie in bed and listen to the rain. Loves the sound of the rain.


EDIT: So I went to therapy, which is cutting into my going to bed early (as is the update for this post). However it was a good decision. Therapist sort of redeemed herself from Thursday which was important. Completely dissociating from my emotions is not the goal here. She got a clearer picture of what goes on in my head, how much I act in (impulsive/destructive), which is important because I don't think she'd really gotten it so much and I've just been feeling misunderstood and frustrated. She talked almost more than I did. She made a point of validating my feelings. I'll talk more about Validation in another post.

Therapy homework: I am apparently running from my feelings; hence the drinking and bulimic binges. Instead of dealing with my emotions I've turned them off. I don't mean to, it's just how I work at this point. When I am in a dissociative state it's important to pay attention to my reactions from different experiences. I need to sit down and write everyday about those reactions. Recognize that I am feeling, what I'm feeling, where these emotions come from and why I'm experiencing them the way I do. Once I begin to recognize and process the states that I am in, hopefully I can begin to integrate my cognitive understanding of the emotions at the same time that I am feeling them. This is actually helpful advice.

So the moral of the story is: Go to therapy kids. You get homework. Hm, wait. Everyone has off days, but it doesn't mean you can't get something valuable from them.

Sunday, March 20, 2011

Test your Personality

Hah. Borderline and Histrionic are my predominant results. Surprise, and yet, still Amusing.What do you get?

Personality Disorder Test Results
Paranoid||||||||||||||54%
Schizoid||||||||||38%
Schizotypal||||||||||||||||||74%
Antisocial||||||||||||||54%
Borderline||||||||||||||||||||90%
Histrionic||||||||||||||||||78%
Narcissistic||||||30%
Avoidant||||||||||||||||66%
Dependent||||||||||34%
Obsessive-Compulsive||||||||||||46%


AVERAGE:

Paranoid:......................... 49%
Schizoid:...........................53%
Schitzotypal: .....................53%
Antisocial: ........................47 %
Borderline: .......................47%
Histrionic:  .......................43%
Narcissistic: .....................41%
Avoidant: ........................39%
Dependent:...................... 37%
Obsessive-Compulsive: ... 40% 

EDIT: For including averages:

I'm most deviant from the norm in: Borderline, Schizotypal, Schizoid , Histrionic, and Avoidant though I'm a little higher in everything except Narcissistic and Dependent.


I also think the Schizotypal is skewed in my case because I'm essentially pagan/heathen/Eastern so mackical thinking and unusual perceptions are par for the course here as it's an ingrained part of my eclectic spirituality
.
I think the most unusual combination here is my Very High Borderline (no surprise) and my relatively low Dependent. These two usually go hand in hand. I was raised to be incredibly independent, and for as much as I hate to be alone, I secluded myself for years out of self-preservation. I also have a strong tendency to push people away so they can't get close enough to hurt me. I'm functionally very capable of taking care of myself, providing for myself, and not relying on anyone when I need to make decisions or get things done. The seclusion kills me. I deaden and numb to everything and need to remind myself that I'm still living. I need family and close friends to keep me stable, grounded, from going over the edge of my own madness. Functionally independent. Emotionally dependent.

We're all mad here


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