Friday, July 22, 2011

Lucid Analysis: Trials in Therapy - Career Change

I’ve been very bad about posting about therapy. I switched therapy to Thursday. I’ll be honest. I really did not want to go in yesterday. I was very worried about it in fact. I was consumed with RAGE. I wanted to crush and destroy everything around me. I can usually contain it but there was no bottling it up yesterday. I worried that my therapist would reject me and my mood swings like is so stigmatized with BPD. Of course, my fears were unwarranted. If anything, she was even calmer and less scattery than ever.
I was frustrated and angry when I went in. All she said was anger is normal and expressing anger in ways that are not impulsive is healthy. Almost as soon as I sat down my frustration bubbled over into tears because I didn’t know what to do, why I felt this way, or what to do about it. She assured me that by just expressing that I was angry and allowing those emotions to surface was good, especially as I was not engaging in unhealthy impulsive displays like thoughts of suicide, cutting, binging or the like. So cheers to me.
The combination of the massive heat wave and the stress from work, I think, are what really set me off. Fortunately, we talked about my plan. I brought up the fact that I was thinking about going to school again. That I was interested in Clinical Psychology and as a secondary study Art Therapy. She was a little dubious at first since this was the first time she was hearing about it, and she wanted to make sure I wasn’t being impulsive. However we talked about my growing interest. I’ve been doing this blog for almost 8  months now and my interest is still consuming. The comments and feedback I get from people are very encouraging in a way that makes me believe what I’m doing has benefit. I feel fulfillment. Which is something I do not feel with engineering. I work. I produce. I do not feel like I am contributing something worthwhile (though obviously the things I design are beneficial and crucial to the projects I work on). Worthwhile in a deeper sense. I find more satisfaction in almost everything else that I do and I want to bring that to all aspects of my life. We talked about my plan. Currently I’m waiting on my transcripts from my previous University. Then I’ll sit down with an academic advisor and figure out which courses transfer, which I need, and go from there. I will begin part time, probably night courses.  One or two classes at a time to start, to see how it fits and if it’s something that does truly grab me. Financially it is well within my means, especially if I do classes at night and keep my current job.  I have no children, no mortgage, no real obligations to anyone else other than myself. And lets face it, worst case scenario, I start stripping again. J/k. Sorta.
Therapist reassures me that I have a positive, healing energy about me. She believes that some people are good at psychology, but it’s those people that have had true need for it in their personal lives that make the best psychologists because they’ve been there. You have to be mindful not to over identify with patients, but since there has been personal experience and need, it brings a greater depth of understanding. I hope she’s right.
I also talked to my parents about this. They’ve known I haven’t been happy with engineering for a long while now. As soon as I mentioned it my mother was like, “Go. Go now. Go talk to an academic advisor. Sign up for classes. You’ll be amazing.” My father was also very supportive even though he grumbled a bit about believing that I should pursue costume design for a local theater. I found that cute but pretty typical of him.
By the time I left therapy I felt worlds better. I’m sure the Klonopin kicking in helped too. Seriously. I hate this Abilify. As far as I can tell it makes me feel sluggish and body exhausted all the time. I’ve never before felt so useless until I started medication. Therapist agrees that it does not seem like any of the medication I have been on has been helping me. She’s had plenty of patients that are on medication that have occasional ups and downs but are basically steady and happy. They might miss the super highs, but the lows are no longer there. This is not the case with me. I am still fluxuating all over the place and I do not have anything resembling a baseline of happy or okay. I’ll be discussing this with Psychiatrist on Thursday. The only things that have ever helped me at all are the situational benzos my last GP had me on (Klonopin and Xanax). I’m actually a little afraid of benzos and their addictive tendencies so I’m very careful about only using them in the most necessary of situations, but they calm me down, help me sleep, and don’t make me feel like I can’t function.

Honestly I feel like a weight has been lifted off of my shoulders. I won’t be quitting my job, but I have a plan for the future and the means to work towards a more fulfilling life.

Choosing a new direction

Thoughts from across the Borderline

Emptiness and an intolerance to boredom are products of BPD. I fill my life with hobbies and friends and it helps to an extent but never so much as the rush that comes with something truly turbulent.

Thursday, July 21, 2011

Borderline Personality Disorder, Impulsivity, and the Orbitofrontal Cortex

Yeah it’s a mouthful, I know. Since I’ve been talking about impulsive behavior I thought I’d take a look into one potential neurological explanation for impulsivity in Borderline Personality Disorder. Specifically this article focuses on the Orbitofrontal Cortex as a main cause for impulsive behavior.

It was a really well designed study that compared people with BPD to those with legions on the orbitofrontal cortex (damaged OFC), legions in other regions of the brain, and to healthy individuals. They subjected each group to various questionnaires and tests and produced an array of fascinating data which I will attempt to share concisely. So let’s begin shall we.

The goal of this study was to determine if certain aspects of BPD, in particular impulsive behavior, are associated with orbitofrontal cortex dysfunction since this has been associated with disinhibited or socially inappropriate behavior and emotional irregularities; all common features of BPD.

There were many similarities but also some significant differences. However these differences came in areas that were looking to draw conclusions in other areas of the Big 5 personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism. This leads to the conclusion that many behaviors may be due to other brain regions, however, since impulsive activity was so similar in both groups it supports the fact that impulsive behavior may be linked to the orbitofrontal cortex.

What are some of the findings?

-        -   Personality: Significantly more impulsive.
-          - Behavioral Impulsivity: More behaviorally impulsive.  
-          - Time Production:  Produced significantly less time than the other two groups
-          - Impaired openness to new experience
-          - Subjective anger was higher and subjective happiness was lower

-         -  BPD patients were significantly less extraverted and conscientious, and more neurotic than the other groups.
-          - BPD patients had increased levels of sadness, anger, and fear    (<~~~~~ Totally darksiders I don’t care what anyone says).
-         -  OFC groups reported a greater overestimation of time passing – indicating a faster subjective sense of time.
-          - OFC patients were more insensitive to reward

So what does this all mean? There was significant evidence that both groups were more impulsive as assessed with both behavioral and self-report measures. Since patients with OFC lesions and patients with BPD both performed similarly on tests that indicated more impulsivity and reported more inappropriate behaviors, more BPD traits, more anger, and less happiness than subjects in both of the comparison groups,it can be assumed that there is a connection in these areas. The tests also indicated they were less open to experience and have faster perceptions of time. These findings suggest that the orbitofrontal cortex functions may be related to these aspects of BPD but not to other BPD traits (such as levels of extraversion, conscientiousness, neuroticisms, and emotion).   Therefore it concludes that impulsive behavior could be related to orbitofrontal cortex function.

One thing I found interesting was the time studies. Patients with BPD and OFC lesions both had significantly lower time latencies on behavioral impulsivity tasks.  This result may be related to a desire to complete a task fast, combined with a lack of sensitivity to punishment (OFC lesions) and perhaps with the desire for the reward of finishing sooner (BPD). So, since those with BPD are more emotionally receptive to reward we are likely to rush into something in anticipation of gaining the end benefit. Both groups also produced less time than the other groups. A common cause could be a higher level of frustration in waiting for time to elapse. This study supports evidence that impulsivity and time perception are related. “The frustration in waiting and/or the faster cognitive tempo that may cause patients with orbitofrontal cortex lesions and patients with BPD to under produce time may also be related to some of the inappropriate social and emotional behaviors they display.”

However this study also found that patients with BPD were more neurotic, less extraverted and less conscientious than all other groups. Since the OFC legion group was similar to the other groups this shows that these areas are not related to the orbitofrontal cortex region. Other areas that are probably unrelated to the orbitofrontal cortex region are: higher levels of emotionality. One of the studies showed that an increased sensitivity to punishment might make patients with BPD more emotional, and the higher level of emotionality might then contribute to impulsive behavior.

This study was very well rounded in it does support exactly what it set out to prove, by both demonstrating direct correlations to impulsive behavior and by ruling out behavior that is not associated with that area of the brain. It goes on to say, “Our findings relate well to the hypothesis that the amygdale and orbitofrontal cortex act as part of an integrated neural system, as well as alone, in guiding decision making and adaptive response{s}. Patients with BPD have some deficits that can be related to the functions performed by the orbitofrontal cortex. These deficits might be related to smaller volume of the orbitofrontal cortext or to lower levels of activity in the orbitofrontal cortex.”

Fascinating. I’ve been meaning to take a look at more neurological and biogenetic causes for Borderline Personality Disorder for quite a while now. I think this is an interesting start, if not a bit dry. I hope it was informative at least. 

Wednesday, July 20, 2011

Med Update

I’m exhausted.

I saw Psychiatrist Thursday (actually Psychiatrists PA).  She upped my Abilify to 10mg/day. So far I’m more fatigued than ever. I seriously feel like a zombie. I hate it. I have no drive, no motivation, no caring. My body feels sluggish and weighed down like someone turned up my personal gravity. Every movement is a major effort. This is not fun and it’s not ok. I have to go back next week to talk about how it’s affecting me so hopefully I’ll either be over the initial side effects by then or, idk. He’ll give me something new? I kind of don’t want to be on medication. Back to this. I know. I’m so tired of feeling so tired. If it’s not one thing, it’s another. My moods are mildly more stable but not in a significant way. I’m still depressed, but now I’m sluggish too so it’s harder for me to concentrate and exercise. Which makes doing anything that I love difficult to do. It even makes blogging hard. Seriously. I have a whole series of blogs I want to write concerning the neurological contributors to impulsivity except reading is just too tiring. Sitting upright takes to much energy. I went to the gym before work this morning and only managed a half hour of cardio and upper body lifting. Ok, before you get on my case that I was at the gym for an hour at 6a.m. anyone would be tired… this is not normal for me. The tired, not the 6a.m. 6a.m. is normal for me. I should have plenty of energy for an hour of cardio and lifting should not be a struggle in motivation. Additionally, I should have MORE energy after leaving the gym. Counterintuitive? Nope. I always used to feel more energized after working out. Now I just feel like I stole all the free weights, tied to ropes around my waist, that I’m dragging across the parking lot.
Part of the problem is, I was super fatigued when I went in to see her and I’m not even sure it’s from the damn drugs. I’m not sleeping terribly. They always ask about my sleeping. I’m back down to only taking 50mg of Trazadone a night because I don’t want to be groggy in the morning, and that seems to be fine. So I’m averaging about 6.5 hours of sleep. Yay! 7-7.5 seems to be optimal for me, but as long as I’m getting more than 4, I’m happy. 
So who knows. Maybe this is all a wash and I’m med resistant. I definitely believe I’m hypersensitive to the chemical changes in my body but apparently not in a way that is helpful.
I’m beginning to truly understand what Amy Lee was piping about in Lithium.

The only productive thing I’ve done so far is submit my entry for the Expressive Arts Carnival. It’s a weird word cloud this month and I pulled inspiration from a poem I wrote back at University. I really love the concept of this site. Stringing 4 words together has never taken so much energy. And not from mental taxation either. I’m just typing slow today.

Tuesday, July 19, 2011

Why are Borderlines so Sexual?

The Why’s of Sex, Promiscuity, and Borderline Personality Disorder

Why are you so sexual my dear Borderline? That’s a good question isn’t it? One that does not come with a quick answer. This is a first. I’ve found almost no information on why sex seems to be such a prominent feature of Borderline Personality Disorder. What I have found has been only a paragraph or a sentence here or there. So let’s look at what I’ve found, what I feel, and what some of my own theories are.

One of the more obvious theories as to why people with BPD have such reckless sex lives is the fact that they constantly feel emotional emptiness. “Even when they find a stable emotional relationship their fear of abandonment causes them to become paranoid about the stability of their relationship and the validity of the love coming from their partner. A possibility for the reasoning behind sex and borderline personality disorder is that the sufferer of BPD actually tries to self-sabotage their relationship in order to end the relationship before they are actually abandoned by their partner. Another theory as to reckless sex and borderline personality disorder is that the BPD sufferer actually gets an emotional high from bonding with the sexual partner even if only for a short time. They are literally trying to fill in emptiness inside themselves and they try and try to fill that void with sex. After having a sexual affair the person with borderline personality disorder may not have the same amount of guilt as someone with non-BPD. The reason is projection; oftentimes people with borderline personality disorder project their negative behaviors onto others including their partners. This means that someone with borderline personality disorder who is having a reckless sexual affair may have a tendency to build a fake affair that their spouse or loved one is having in their head. They literally make themselves believe that their partner is also cheating and that they are therefore justified in having their reckless sexual affair.”

A previous article I mentioned notes that there may be a number of reasons for the more negative attitudes about sex. “First, many women with BPD are survivors of child abuse, which may contribute to overall negative reactions to adult sexual experiences. Also, women with BPD are more likely to experience a great deal of conflict in their relationships, so they may feel less positive about sex because relationships in general feel less fulfilling.”

Having these negative attitudes doesn’t however, justify why we may still have an attitude directed towards reckless sex. I would take this from a different angle and say that perhaps due to previous abuse there is a subconscious need for approval where it was not given, withheld, or used against us. Overt sexual behavior may be a way of taking back control, exerting control in the present where control was once absent.

Also, knowing that we have the ability to interest and consume someone with our sexuality or ability to seduce them is a form of validation of our own self-worth.

Those are my thoughts currently. I’m sure I’d have more but I’m utterly brain fried from today and yesterday at work. I’ll be sure to post more on this if the thoughts should arise.

So there’s that. To fill an emotional emptiness with a physical, well ::grins:: I don’t have an argument for this. I also believe that when it comes to sex, people with BPD are more likely to be sexually open and adventurous. We can be virtually uninhibited. Or exactly the opposite. I’ve noticed a trend towards the extremes. Either we’re all or nothing. So you may have borderlines like myself that are ALL for sex or those that have severe issues from resultant traumatic experiences and avoid it whenever possible.  

Another theory comes from Thomas R. Lynch, a psychologist at Duke University. He and his colleagues found a clue in the reading of facial expressions. “The researchers asked 20 adults with BPD and 20 mentally healthy people to watch a computer-generated face change from neutral to emotional. They told subjects to stop the changing image the moment they had identified the emotion. On average, the people with BPD correctly recognized both the unpleasant expressions and the happy faces at a much earlier stage than the other participants did. The results suggest that BPD patients are hyperaware of even subtly emotive faces—problematic in people who are intensely reactive to other people’s moods. So, for example, a hint of boredom or annoyance on a person’s face that most people would not notice might produce anger or fears of abandonment in a person with BPD. Conversely, someone with BPD might see a happy expression as a sign of love and react with inappropriate passion, leading to the whirlwind, stormy romances that rock the lives of people with BPD.”

I’ve talked about hypersensitivity before. It’s very easy to read too much into what we see in someone else and I do think this theory has some validity, but I don’t think it’s substantial all on its own. This may be a contributing factor but not the main reason.

I’ve said before that I use sex as a means to be close, but not too close. It’s comforting. It allows that very real, very human connection that makes me feel less hollow and alone, while maintaining my safeguards.  I’ve been so hurt and traumatized due to past abuse and experiences that while some part of me does need this closeness, at the same time I do not trust it. There’s something more personal about letting someone into my mind, than into my body. If I can distract them with my body, they’ll have proven themselves not trustworthy enough to get into my mind, but at the same time, I have someone near. I’ll have validated my own paranoia and satisfied my need to not be alone. How’s that for messed up. When I’m alone I feel empty. Sex is one of those ultimate expressions of being not alone. Having your life literally interwined in the arms and legs of another, it’s an encompassing experience, without being completely consumed. There’s the ability to maintain a distance while holding someone close. Or maybe there’s some overdeveloped primitive instinct that if we find a partner, let them into our lives in such a way, we will develop a bond. And from there maybe a lasting one. The more partners, the greater the likelihood of this happening.

Monday, July 18, 2011

Dual Identity

Don't worry, I'm still on my sexuality kick but in reading something else I saw this excerpt and didn't want to forget it since it's very relevant to how I'm feeling right now. We all know I'm a super-villian, but there are days I border on feeling like a hero. An anti-hero at the very least ::smiles:: Dual Natured.

"...BPD shares some features with bipolar disorder, for which it is frequently mistaken, but unlike bipolar disorder, BPD does not lead to lengthy cycles of highs and lows. Instead it causes more rapid mood swings. In less than 24 hours, people with BPD can experience euphoria, suicidal depression and everything in between. BPD is also characterized by a disturbing, but fascinating, dual nature: when people with the disorder are not experiencing flagrant symptoms, they often appear highly functional. “You could meet a patient with BPD in a social setting and not have an inkling that the patient had a major psychiatric disorder,” says psychiatrist Glen O. Gabbard of the Baylor College of Medicine. “The very next day the same patient could appear in an emergency room in a suicidal crisis and require hospitalization.”..."

Will resume shortly...

Full day of laboratory functions today. Just have a few minutes to get a quick blog in.
Drank late last night. Stayed awake hours past when I should have gone to bed. Tired, little brain foggy. I’ve been so extremely stressed out over the presentation I have to give.  I know last night I broke and just didn’t care anymore.
I feel outside of my own skin now, however not feeling like me is almost useful. Dressed up in some of my nicer work attire, hair pulled back into a bun, glasses, walking around with my laboratory badge and notepad my projected image is on of extreme professional. Dressing the part, looking the part, I feel more the part. It’s all a stage play for me today.
My day:
730a-9a: Analysis and presentation organization
9a-1030a: Vendor Presentation
1030a-12p: Analysis
1p-530p: Colleague Talks and Presentations
4p: My presentation
6p: Mandatory dinner function
8p: Home/fight practice
Long, long and drawn out. 12-hour role play. This will be my day. It would be nice if once I slipped into this persona I actually was this person. No matter how many times I do this, how often I slip in on, it always feels like I’m wearing someone else’s skin; stretched a little too tight.

We'll resume our regularly scheduled blogging tomorrow.
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