Friday, May 6, 2011

Understatments understate


“Your risk for relapse of symptoms of borderline personality disorder is greatest when you feel threatened by being left alone (abandonment).”

Relapse - is the reappearance of or increase in symptoms in a person with an illness or disease after a period of improvement

Saw this statement over at Health.com.

I’m so amused. As if the symptoms of BPD aren’t expected to reoccur. As if they ever go away in the first place (without treatment).
OMG Don't leave me!
Maybe we should try a twelve step program. Personality Disorders Anonymous or PDA (Public Dispalys of Affection are acceptable for the Histrionic). Eh, hem. Step #1, “Hi, my name is Haven. I have a generally untreatable personality disorder but I hope by sitting with other emotionally volatile people I’ll be able to stop being emotionally volatile.” What? This may help if Step #2 comes with a straight jacket and step #3 is a lobotomy. Not that I haven’t considered lobotomy a viable option on occasion, but even I think that’s a little extreme after a couple hours.

Heh. Treatment for BPD is difficult,  though certainly, not impossible. The outlook is actually getting better and better every day, but relapse is going to be part of the process. Relapse is going to be a very common part of the process. To say that the risk of relapse is greatest when threatened by being left alone:

1.) There is no consistent cause for what sets us off.  
2.) Does not automatically imply abandonment.


Being abandoned does mean being left, but being left alone does not necessarily mean abandonment.
Or maybe it does but it’s a mild form of it.  Personally I need to be in a relationship for the thought of being left (not necessarily alone) to make me most crazed. That’s the kind of abandonment that would set me up for the greatest relapse.  Left and removed from someone’s life forever, abandoned to the ether to never be seen again. This does not mean just anyone leaving me alone.

I’m alone a lot. I live with one Roommate who has a boyfriend so she’s out of the apartment all the time. I’m very happy for her. She deserves someone who makes her happy. She’s one of the best people I know. Some people might consider this statement as me Splitting her into the all good category. She’s never let me down though, and until she does she’ll stay right where she is. I’ve known her for years. Hell, my very first memory of significance concerning her was of her taking care of me after I unintentionally gave myself alcohol  poisoning on vacation (I didn’t know I was drinking Everclear – never again). She didn’t know me and yet she took care of me. That’s not something that is easily overridden. Years later and she still hasn’t let me down in a way that people inevitably do. That said, I have begun to notice that I drink a lot more when she isn’t in the apartment. Drinking takes me out of my head, even just a little bit so the emptiness isn’t so bottomless. As I type this I wonder if part of it is some subconscious connection to the fact that my first strong memory of her was of her taking care of me because of alcohol. I digress.

I do have a pretty severe intolerance to being alone. I have a lack of object constancy. If you’re not with me, I lose my connection to you. What’s more, if I’m not with you I cannot internalize the thought that I am still a part of your thoughts or your life. How can I be an part of your life if I’m not doing anything with/for you? You’re gone. I’m gone. I don’t know where I am.

What also gets me is the statement of ‘after a period of improvement’. What improvement? I’m far from healed. I’ve just begun this process. Just because we’re not in a constant state of suicidal ideation or ripping open our arms doesn’t mark a period of improvement. It marks a period of lessened triggers. My symptoms don’t go away, they just aren’t as apparent.
As mentioned, I’m alone a lot. And yes, some of the absolute worst times for me have been at the thought of being completely abandoned by someone. Even someone I didn’t really care for. Take a look at my trip to the Psych ER. I didn’t even like Boring-ex. However, relapses are relative. My being alone when Roommate is gone is a pretty mild ‘relapse’, though frequent. When I was at University the stress and anxiety cause by the course load I took on, the fear of failure, the need to punish myself for lack of perfection drove me to some incredibly traumatic tailspins. I had a nearly complete nervous breakdown when I received a ‘B’ in a class. Keep in mind that my major was considered one of the hardest majors to complete. The pressure I put on myself was unreasonable, but it had nothing to do with being alone. All relative.  

There are so many things wrong in this write up. Maybe I’m nitpicking. Maybe I’m just rant-y. Bad article. All bad.

I guess my amusement comes from the incredible understatement of this sentence. One sentence. Totally enough to sum up BPD abandonment implications. Right.

Angry penguin is angry

Thursday, May 5, 2011

Cluster Me

Huddle up. Cluster B.
I really hadn’t planned on doing a DSM-IV style series but as I’m already headed in that direction let’s keep on it.
Personality Disorders are described as “enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts” and “are inflexible and maladaptive, and cause significant functional impairment or subjective distress”.

According to the DSM-IV there are 10 different personality disorders + 1 catch all ‘personality disorder not otherwise specified’. These disorders are broken down into 3 Clusters (A,B, & C). The purpose of these Clusters is to further organize these disorders into groups that are related to each other by their symptoms.

Characterization:-------------------------------------------------------------------------------------------------------------
Cluster A – Odd or Eccentric Behavior - includes Schizoid, Paranoid, and Schizotypal Personality Disorders.
Schizoid Personality Disorder - A pervasive pattern of detachment from social relationships and a restricted range of expressions of emotions in interpersonal settings. Those with SPD may be perceived by others as somber and aloof, and often are referred to as "loners."

Schizotypal Personality Disorder - A pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. This disorder is characterized both by a need for isolation as well as odd, outlandish, or paranoid beliefs. In social situations, they may show inappropriate reaction or not react at all, or they may talk to themselves.

Paranoid Personality Disorder - A pervasive mistrust and suspiciousness of others such that their motives are interpreted as malevolent. Although they are prone to unjustified angry or aggressive outbursts when they perceive others as disloyal or deceitful, those with PPD more often come across as emotionally “cold” or excessively serious.

Cluster B – Dramatic, Emotional, or Erratic Behavior - includes Antisocial, Borderline, Narcissistic, and Histrionic Personality Disorders.
Antisocial Personality Disorder - A pervasive pattern of disregard for and violation of the rights of others. APD is characterized by lack of empathy or conscience, a difficulty controlling impulses and manipulative behaviors. This disorder is sometimes also referred to as psychopathy or sociopathy, however, Antisocial Personality Disorder is the clinical terminology used for diagnosis.

Borderline Personality Disorder - A pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses. This mental illness interferes with an individual’s ability to regulate emotion. Borderlines are highly sensitive to rejection, and fear of abandonment may result in frantic efforts to avoid being left alone, such a suicide threats and attempts.

Histrionic Personality Disorder - A pervasive pattern of excessive emotion and attention seeking often in unusual ways, such as bizarre appearance or speech. With rapidly shifting, shallow emotions, histrionics can be extremely theatrical, and constantly need to be the center of attention.

Narcissistic Personality Disorder - A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. Narcissism occurs in a spectrum of severity, but the pathologically narcissistic tend to be extremely self-absorbed, intolerant of others’ perspectives, insensitive to others’ needs and indifferent to the effect of their own egocentric behavior.

Cluster C – Anxious, Fearful Behavior -  Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders.
Avoidant Personality Disorder - A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and are unwilling to take social risks. Avoidants display a high level of social discomfort, timidity, fear of criticism, avoidance of activities that involve interpersonal contact.

Dependent Personality Disorder - A pervasive and excessive need to be taken care of which leads to submissive and clinging behavior and fears of separation. Dependent personalities require excessive reassurance and advice, and are extremely sensitive to criticism or disapproval.

Obsessive-Compulsive Personality Disorder - Also called Anankastic Personality Disorder display a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. They can also be workaholics, preferring the control of working alone, as they are afraid that work completed by others will not be done correctly.

-------------------------------------------------------------------------------------------------------------
My questions is: Are these clusters necessary?

Once you know which personality disorder someone has you’ve got it pegged. It would make more sense to use clusters to further narrow down behavior before diagnosis.

If the patient is obviously dramatic and emotional it is easier come to the Cluster B conclusions and therefore rule out disorders characterized by other clusters. However there can easily be overlap and therefore confusion. With Borderline (Cluster B) there’s an intense fear of abandonment, often paranoia that something will happen and people will leave, which is why we attach so hard to people regardless of there being any evidence to support this paranoia. To me this indicates anxious and fearful behavior which would be Cluster C, even though Paranoid PD is Cluster A. Confusing, no?

Being Borderline I’m grouped into Cluster B. I can tell you with absolute certainty that my personality characteristics fit almost all Cluster A criteria. In Cluster B I obviously hit Borderline but also Histrionic PD. As far as ASPD goes, I have at least the difficulty controlling impulses and manipulative behavior. For NPD a case could be made for being self-absorbed, intolerant of others’ perspectives (if they don’t satisfy what I need at the moment), and indifference to the effect of egocentric behavior. For ASPD and NPD my motivations are fundamentally different though. Maybe that’s the deciding factor. Motivation. Not consciously of course, but those underlying factors that set us apart from the other PDs that we’re not diagnosed with. To me this conclusion is obvious. It boils down to which behaviors are most predominant. This still doesn’t explain what the point of further breaking personality disorders into clusters is. In all of my research, so far, I have not found a single reason why these clusters are necessary.

Who’s to say what the difference between these traits are anyways? Who defines what is erratic (Cluster B) and not eccentric (Cluster A)?  Lack of interest in social relationships (Cluster A) and social inhibition (Cluster C)? There is no solid, scientific way of distinguishing between clusters. There is a lot of overlap between the Clusters so they don’t help narrow down the playing field. Any conclusions reached about a person will point directly to a personality disorder(s) regardless of which cluster they fall into, especially as symptoms may indicate multiple clusters. In fact, the cluster groupings may work to limit the consideration treatment options that other personality disorders could provide insight to.

My conclusion is that they’re basically erroneous.

Hah, Ok. I just found this abstract on Neuropsychological, Psychophysiological, and Personality Assessment of DSM-IV Clusters:

Testing the construct validity of the three DSM-IV cluster groupings of personality disorders, in terms of neuropsychological, psychophysiological, and personality traits measures, was the purpose of this study. The results hardly confirm significant differences between B and C cluster groups in their neuropsychological functioning, but, instead, suggest that Cluster A could have some empirical validity based on executive prefrontal deficits (concept formation and sustained attention tasks) and clinical features. Similarly, no consistent differences among groups emerge when psychophysiological measures are compared. With regard to the Big-Five personality dimensions, the results also indicate that clusters may be more heterogeneous than the DSM-IV suggests. It appears, therefore, that the categorical division of DSM personality disorders into three discrete clusters may not be empirically justified.

See, no real reason for the Clusters. I win. (Apparently this was a competition.)


Wednesday, May 4, 2011

Some Random Things about me...

So I was visiting Maasiyat over at Inside the Bipolar Mind and saw her fun little question thinger and figured why not. All I'm doing is reading Star Wars novels anyways. 

QUESTIONS: 

1. If money didn't matter, where would your perfect vacation take place? Briefly describe.

 2. What's a bad habit that you have {or had} that is/was hard to break?

 3. If you weren't on a diet or counting calories, what would you like to have for dinner tonight?


 4. If you had the chance to interview anyone in the world, dead or alive, who would it be and what's one question that you would ask?


 5. Describe yourself in 6 words.

ANSWERS:

1.)           I love to travel. I can’t wait to have more time and money. With unlimited funds the very first vacation I’d take would be to Africa. I want to go on a photo safari from the top to bottom. Climb Mt. Kilimanjaro, parasail over the Serengeti.  I want to see a different side of this world. Something unaltered, and unsheltered.

2.)           Really? Haha. Everything I do is a bad habit =P If I’m being honest, and really what’s the point in not being honest, I would have to say cutting and drinking. I’m currently 6/7 months cutting free. I do drink more than I probably should though. It’s not like I’m getting smashed every night but it’s enough that I’m concerned. Of course, everything concerns me, so there’s that.

3.)           I love experimental home cooked food. I am the king of this. I make an amazing Wild Mushroom Risotto, Gorgonzola Potato Soup,  Upside-Down Honey Cheesecake, Caramelized Shallot Mashed Potatoes… I’m going to stop here. There's just too much good food to want. 

4.)           Merlin: Can you teach me? It’s been my answer since the 4th grade. I’m not changing it now.

5.)           Hi, I’m Haven. Consider yourself warned.


Your turn. Go! 


**Quite a while back I was taking questions, any questions, for me to answer when I had hit my 100 post milestone. I got a bunch of questions. I didn’t forget, I just feel guilty posting non-BPD stuff currently. I’m going to hit 200 soon so maybe I’ll post then. In the mean time if you feel like it, go ahead and ask me more random questions here or to my e-mail. I’ll keep you anonymous. 

Speaking of Changes: DSM-IV to DSM-V

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

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

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


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

Five personality types
2.a.) DSM-V has simplified the system by cutting down Personality Disorders from10 to 5:
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder (ASPD)
Borderline Personality Disorder (BPD)
Histrionic Personality Disorder (HPD)
Narcissistic Personality Disorder (NPD)
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder

They plan to collapse these 10 into the following 5 buckets:
Antisocial/Psychopathic Type
Avoidant Type
Obsessive-Compulsive Type
Schizotypal Type

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

Tuesday, May 3, 2011

Lucid Analysis: Trials in Therapy - 5



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

Bottled

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

Monday, May 2, 2011

A rose by any other name…


Still dies, rots and decomposes like anything else, I suppose.


  
Last week I talked about where Borderline Personality Disorder got its name. It may not stay that way forever though. Borderline Personality Disorder renamed? For some time now clinicians have been calling for the label of Borderline Personality Disorder to undergo official change. There are a number of different names used around the world and under consideration for the same disorder:


Borderline Personality Disorder (BPD) – Current
Emotional Regulation Disorder (ERD)
Emotional Dysregulation Disorder
Emotional Intensity Disorder (EID)
Emotionally Unstable Personality Disorder (EUPD)
Emotion-Impulse Regulation Disorder (EIRD)
Impulsive Personality Disorder (IPD)
Impulse Disorder
Post Traumatic Personality Disorganization (PTPD)
Complex Post Traumatic Stress Disorder

The most commonly used name today is Borderline Personality Disorder - or BPD - as defined in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR).

The term "Borderline" is the historic term coined to describe people who were diagnosed to be on the borderline between a neurotic and psychotic disorder. It is commonly felt that the "Borderline" label is misleading and stigmatizes the disorder. From the beginning the term Borderline Personality Disorder has been stigmatized and this has only been compounded by decades of misunderstanding. It implies that the entire person is flawed instead of looking at BPD as a medical problem. By renaming Borderline Personality Disorder it will be easier to move away from those stigmas that are automatically associated with the label. Originally it was termed Borderline Personality Disorder because it was thought to be on the ‘borderline’ of multiple diagnoses but not falling into any one category. However this is no longer believed to be the case. It isn’t on the border of anything. It is its own distinct problem; a disorder characterized by intense emotional experiences and instability in relationships, behavior, and emotions. Some clinicians don’t even want it labeled as a Personality Disorder because it implies that there is no hope for a cure when in FACT it has been proven that with psychotherapy and the aid of medication there is the ability to heal and live a life free from the symptoms that categorize BPD. They want it renamed and removed from Axis-II designation and placed firmly in the Axis-I category because of the high rate of comorbitity with other Axis-I disorders (as previously mentioned here).

Rumor has it that the fifth version of the Diagnostic & Statistical Manual (DSM-V) is likely to rename Borderline Personality Disorder (BPD) as Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD). Indeed, Emotional Dys/Regulation Disorder is the most popular alternative for Borderline Personality Disorder. It’s felt that this more accurately describes the expression of the symptoms encompassed by BPD as it is just that, a disorder of regulating emotions.

Another term is post traumatic personality disorganization (PTPD) or complex post traumatic stress disorder, reflecting the condition's status as (often) both a form of chronic post-traumatic stress disorder (PTSD) and a personality disorder in the belief that it is a common outcome of developmental or attachment trauma. I’m not sure I entirely agree with this because there are many people with BPD that don’t report any kind of traumatic event.  Personally, maybe, MAYBE, some arguable attachment traumas when I was a toddler, but even I don’t think this was so much environmental trauma as a predisposition to reacting the way I did. As I’ve mentioned in a previous post, I don’t agree that PTSD is an accurate diagnosis for me at all. I’ve had plenty of traumatic events to speak of but not until after my BPD began to present at a young age.  

Emotionally Unstable Personality Disorder…. Really? REALLY? Yeah, I see that diminishing the stigma that Borderline already has. Why don’t they just name it I-Am-Insane-And- Potentially-Violent-It-Is-In-Your-Best-Interest-To-Remove-Your-Children-From-My-Presence-Duck-And-Cover Disorder. IAIAPVISIYBITRYCFMPDAC Disorder is rather a mouthful though.  How about simply, BitchPleaseI’mCrazy Disorder. Seriously.


I'm against renaming Borderline Personality Disorder.  Renaming it doesn't actually change a thing. Anyone with half a brain is going to know that ERD/etc is the same thing as BPD just with a new name, IF they even knew what BPD was to begin with. The symptoms are The. Same. Damn. Things. I mean, yeah it'll take away the general stigma of BPD but then again, it may work to perpetuate others. BPD is already stigmatized as a female disorder. "Emotional this/that Disorder, Post Traumatic Something Disorder, those will all only perpetuate if not increase that particular stigma. It'll make it more difficult for men to be diagnosed and make women an even easier target for ridicule. I can just imagine anytime a woman speaks her mind or has a strong opinion because she has an actual voice and isn't a doormat, some douchebag guy is going to replace "is it that time of the month?" with "Emotional Disorders are treatable, get help for that shit". It's all ridiculous. In that way, Borderline is safer because a good majority of people don't even know what it is so they can't jump to asinine conclusions. So while, yes, ERD, encapsulates the fact that it is a disorder of emotional regulation, at the same time it almost trivializes the severity of what this disorder is. That is not okay.

Personally? I’m not sure I want it to be renamed. I like the term Borderline Personality Disorder. I like the idea that something can overcome the stigma and be understood for what it is; kind of civil rights activation for personality disorders, haha (for that matter I don’t like that there will be a full re-categorization of PDs from 10 to 5 in the new DSM V). I still don’t like admitting that I have a disorder of emotions because I was lead to believe that I needed to repress them for so long. At least Borderline doesn’t directly state a disorder of emotional problems (though obviously it is) since it doesn’t have Emotion in the title. It doesn't stamp CRAZY BITCH on my forehead right away. Someone hears Borderline Personality Disorder and they may cock their head and ask, 'what's that?'. Someone hears Emotional Dysregulation Disorder and they're going to start creeping backwards because this person is OBVIOUSLY emotionally unstable.

Idk, maybe I have no logical reason for it. Mostly it’s probably due to my attachment issues. I have a hard time giving anything up that I’ve become accustomed to and this label is one more example of that. I like the name, I don’t want it to change. I’m familiar with it. I mean... BPD is a disorder characterized by abandonment! Don't make us abandon our label! It's mine. I've embraced it. Don't take it away from me! (Jokes. Sort of). And quite frankly, all the other names for it are kind of lame.

While I’m on the topic of continued designation of things; please return Pluto to its previous planetary status; “Dwarf planet“ is just insensitive.  
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