Saturday, November 12, 2011

Lucid Analysis – Trials in Therapy – The Body Issue

I know I usually do this on Friday, but I was a little, busy, yesterday ß---- Secret.

I like to think of my session on Thursday as I Hate Everything but I’ll do it anyways. And by everything, I really just mean my body.  I’ve been bumping up my workouts like mad, started a food journal again to track everything I’m taking in, and I’m still not seeing the results I want to see as fast as I want to see them. But let’s face it, if it didn’t happen yesterday it’s not going to be fast enough for me.

I’m freaking out about putting on weight because I’m trying to kick a really bad habit. Maybe habit isn’t really the word so much as addiction. I’ve been addicted to diet pills for longer than I care to remember. I hate them, I need them. I stopped taking them. They’re a major crutch for me. I don’t overdose on them, but I take the max possible. Every day. The same times every day. If I don’t, or I miss a dose, the panic starts. The thought of gaining weight is terrifying to me. The thought of taking these pills for the rest of my life disgusts me.

I hate talking about this stuff in real life. Guys don’t like to hear you obsess about your weight or pick apart your flaws, I don’t like to show that things like this bother me. When you see me in person I’m confident and I have a very “I am the way I am, if you don’t like it, get the hell out of my way” attitude. Which isn’t all an act. I don’t care what other people think of me (unless I’m very emotionally attached), I care what I, me, think of me. And I’m not happy.

Therapist wondered what triggered this because I don’t usually harp on about it. I talk about my bulimia often enough, but I don’t usually tear myself apart to her out loud. She actually thought that I didn’t have these thoughts very often. ::blinks:: I OBSESS about my body.  
I’m sick of it.

My health is really important to me. I am worried about the affect these things will have on my healt. I just got so disheartened when Psychiatrist put me on the drugs that made me gain weight. I won’t even see him anymore. I see his PA, and I like her a lot better. I worked so hard to get my body to a place where I was truly comfortable with myself and in ONE MONTH he destroyed that for me. I’ve been struggling ever since. 

And what’s ridiculous, is no one else sees it. Everyone tells me that I have a killer body, but it’s not what I want. Even when I got my tattoo, it took a lot for me to post the pics of my body, b/c to me, I am over weight in those.

Homework: Pull out my pencils, pens, and/or paint, and draw how I perceive my body to be.

I have a completely distorted view of myself and I’m not sure how to fix this. Therapist absolutely can not relate to this at all though. She’s the kind of person that’s always had to work to GAIN weight. Boo hoo. So she wants to get a better idea of the difference between what actually is and what I see in myself. 
Regardless of all this body image weight phobia I’m doing something that I need to do for me. I kicking this addiction.  It’s been about 3 weeks already. I think about it every day. Not opening up that bottle is still really difficult, but I’m doing it.

And despite all these bad thoughts, and these overwhelming feelings that I should be hiding myself away so no one can look at me, I’m still going out. I’m still working to put myself out there. Hell, I’m still dating! In fact I had a date with Tech Boy right after my session.

So, we haven’t had sex yet (not to be confused with not doing a lot of other stuff though haha). This actually freaks me out. He hasn’t pressured me for it at all. I don’t know if it’s because his ankle is still broken or what.  It makes me paranoid though. Even though he’s like super cuddly, eye contact, really into everything I say… wtf? I have to say, he is a Borderline’s dream to sleep with. Let me tell you how much I love waking up next to someone like him. If I even try rolling away from him he pulls me back and wraps his arms around me. And then says he could stay like that all day. So I guess all in all things are going relatively well there.

I’m still struggling with how much I can trust him with. I have such a hard time trusting anyone, especially men. I know there are some decent ones out there, they just haven’t been very prominent in my life. Sorry guys. I’m still struggling with how much I should invest too because I don’t know how right we are for each other. Then again, sometimes I think I could fall in love with anyone.

Alright I’m a little drugged up at the moment, so I honestly can’t think straight. I have no focus. Spin spin spin.

I think I’ll go make Honey Lavender Biscotti and Buttermilk waffles for Roommate.

I love food. I hate food. There is no in between. 

Thursday, November 10, 2011

The Sky is Falling! – Vulnerability to Harm or Illness

Holy $h!t such a busy day. Non stop non stop rush rush rush. Met a cute guy though. And he’s from my alma mater. I actually found myself appreciating a nicely constructed male backside today. This is so not my style. Girls, yes. Guys? Not so much. But lemme tell you, he had a nice booty. So you’re probably wondering what this has to do with today’s schema. Absolutely nothing.
On that note. Today I’m talking about the Vulnerability to Harm or Illness Schema.
Vulnerability to Harm or Illness
Typical Presentation of the Schema
These people live their lives believing that catastrophe is about to strike at any moment. They are convinced that something terrible is going to happen to them that is beyond their control. They will suddenly be struck with a medical illness; there will be a natural disaster; they will become victims of crime; they will get into a terrible accident; they will lose all their money; or they will have a nervous breakdown and go crazy. The predominant emotion is anxiety, ranging from low-level dread to full blown panic attacks. These patients are not afraid of handling everyday situations, like patients who have Dependence schemas’ rather, they are afraid of catastrophic events.
            Most of these patients rely on avoidance or overcompensation to cope with the schema. They become phobic, restrict their lives, take tranquilizers, engage in magical thinking, perform compulsive rituals, or rely on “safety signals,” such as a person they trust, a bottle of water, or tranquilizers. All of these behaviors have the goal of stopping the bad thing from happening.
This strikes me as very OCD and Paranoid PD, not that it can’t present in other personality disorders or even those without. Again, this is not a schema I relate to very well. While yes, I do have massive panic and anxiety attacks, it’s usually triggered by a real situation or perceived threat (which ok, may not be strictly real). Meh, even that isn’t strictly true because I have an anxiety disorder and I’m very familiar with that constant low level of dread, but this is due to other schema triggers I believe. And I do have the fear that I’ll just have a nervous breakdown and go crazy, but let’s face it, that isn’t exactly irrational. I think my point here is, there’s a difference between having panic/anxiety attacks for different reasons, and having panic/anxiety attacks because you think a meteor is going to spontaneously crash through the atmosphere and land on your house. One is not necessarily this schema, the other is.  
Heh, in fact, I have a tendency to live like the world IS about to end and I want to do everything I can. Or if the world is going to end then there’s nothing I can do about it, I’m going to go out with my own kind of bang.

Goals of Treatment
The goals of treatment are to get patients to lower their estimations of the likelihood of catastrophic events and to raise their evaluations of their ability to cope. Ideally, patients come to recognize that their fears are greatly exaggerated and, even if a catastrophe did occur, they would be able to deal with it adequately. The ultimate goal of treatment is to convince patients to stop avoiding and overcompensating for the schema, and to face most of the situations they fear.
Strategies Emphasized in Treatment
            Patients explore the childhood origins of the schema and trace its pattern through their lives. They count the costs of the schema. Patients explore the changes they would make in their current lives if they were not overly afraid. It is important to spend time building motivation to change. The patient should stay focused on the long-term negative consequences of living a phobic lifestyle, such as lost opportunities for fun and self-exploration; and on the positive benefits of moving more freely in the world, such as a richer, fuller life.
            It’s important to do both cognitive and behavioral work to overcome this schema.
            Patients counter their exaggerated perceptions of danger. Challenging catastrophic thoughts – or ‘decatastrophizing” – helps them manage panic attacks and other anxiety symptoms. Cognitive strategies also build motivation by highlighting the advantages of changing.
            Behaviorally it’s important to face the situations that are feared by undergoing gradual and graduated exposure to phobic situations in homework (try to face it on paper before you face it in real life): Picture entering specific phobic situations and, with the assistance of the “healthy Adult” coping well. Anxiety management techniques such as breathing exercises, meditation, and flash cards help patients cope with the exposure as they go through them.
            Reassurance is important. It’s necessary for a person to know that they will be able to cope in a healthy way.

This sounds easier than it is. It’s been my experience that when you have an irrational fear, you pretty much know it’s irrational. However that doesn’t change how you feel or think or act. So just having someone tell you that what you’re doing is irrational is not going to change anything. And the longer you’ve done a particular coping strategy, the harder it’s going to be to undo all that habit and reform new, healthier, habits. However, that’s what time is for. You take the time. You work on it little by little with someone you can trust.
I think this is a problem that a lot of nuero-typical people have with the personality disordered. They think that since we’ve been told a better way, have had our problems pointed out, that it’s easy for us to change. Because their brains work in a fundamentally different way they just do not understand that we cannot always follow the path from point A to point B. We have monsters hiding down some paths that they can’t see.  
Special Problems with This Schema
            The greatest problem is that people with this schema are too afraid to stop avoiding and overcompensating. They resist giving up their protections against the anxiety of the schema. As we mentioned earlier, mode work can help patients strengthen the healthy part of them that yearns for a fuller life.

I can relate to this. I’ve mentioned before how I’m afraid to ‘lose’ my Borderline Personality Disorder, my depression, my anxiety…. It’s such an ingrained part of me that the prospect of living without something that I’ve had my entire life is just, foreign. I can’t wrap my head around it, and it’s scary. However I’m also not the kind of person that’s afraid to try new things. So I keep doing what I’m doing to get healthier, despite these irrational fears that I’ll lose a part of myself by healing. Being who I’ve always been is comfortable in it’s own dysfunctional kind of way. I don’t want to lose who I am. However, I think this is a faulty way of looking at it. I won’t be losing myself. I will always be me. I’ll just be me in a different stage of growth. Maybe it would help to look at all these coping mechanisms and faulty habits as skills or tools. You grow up learning how to use a certain tool a certain way. It’s not until years later that you realize you’ve been using it wrong, or there are better ways of utilizing that skill. It can be impossible to recognize the problem if it’s what you’ve always known. It’s not until you have someone that knows how to properly use the tool and can show you that there really is a better way of going about doing the work, that you finally can see a different way. It’s upgrading your toolbox. Toss out the broken screwdriver and trade up for the power drill.
Something like that.

*Schema Therapy: A Practitioner’s Guide – Young, Klosko, Weishaar

Wednesday, November 9, 2011

If I follow you home will you take care of me? - Dependence/Incompetence

Man I’ve just been crazy lately. Crazy busy anyways. Anytime I tell Therapist that I feel crazy or have a crazy brain she tells me I shouldn’t say things like that because I’m not, but man. Frazzle. Sorry for my lack of posting yesterday, I have been swamped enough to work through lunch so I didn’t have time to post.
Moving on to Impaired Autonomy and Performance Domain! Yay a new Domain.
Typical Presentations of the Schema
Often this type of person presents as childlike and helpless. They feel unable to take care of themselves on their own, experience life as overwhelming, and themselves as inadequate to cope. The schema has two elements. The first is incompetence. The people lack faith in their decisions and judgments about everyday life. They hate and fear facing change alone; they feel unable to tackle new tasks on their own and believe they need someone to show them what to do. These patients feel like children too young to survive on their own in the world: Without parents they might die. In the extreme form of the schema, patients believe they will not be able to feed, clothe, and shelter themselves, navigate from one place to another, or fulfill the simple, everyday tasks of life.
The second element – dependence – follows from the first. Because these patients feel unable to function on their own, their only options are to find other people to take care of them or not to function at all. The people they find to take care of them are usually parents or substitute parents, such as partners, siblings, friends, bosses – or therapists. The parent figure either does everything for them or shows them what to do at each new step along the way.
The core idea is “I am incompetent; therefore, I must depend on others.”
Typical behaviors include asking others for help; constantly asking questions as they work on new tasks; repeatedly seeking advice about decisions; having difficulty traveling alone and managing finances on their own; giving up easily; refusing additional responsibilities (i.e. a promotion at work); and avoiding new tasks.  Difficulty driving is often a metaphor for the schema. People with the Dependence/Incompetence schema often fear and avoid driving alone: They might get lost; their car might break down, and they would not know what to do. Something unforeseen might happen, and they would not be able to handle it. They would not be able to come up with a solution on their own. Thus, they need someone with them who can either give them the solution or handle the problem for htem.
            A small percentage of patients with the Dependence/Incompetence schema overcompensate for the schema by becoming counterdependent. Even though underneath they feel incompetent, they insist on doing everything on their own. They refuse to rely on anyone for anything. They will not be dependent, even in situations where it is normal to be dependent. Like pseudomature children who have h ad to grow up too soon, they manage alone, but they do it with a tremendous amount of anxiety. They take on new tasks and make their own decisions, and they may perform well and make good decisions, but inside, they always feel that, this time, they are not going to be able to pull it off.
And here I was worried that I wouldn’t be able to relate to this Schema. Psh. If anything I am that small percentage that overcompensates by becoming counter dependent. I HATE, hate, hate, hate, having to rely on anyone. I feel like this is somehow cheating if I need to ask for help. If there’s something I don’t know how to do, have never done before, need assistance with… I can’t claim that I did it or did it well if I had anyone’s help because really it wasn’t me doing it. If it’s not me accomplishing the thing then that means that I wasn’t good enough, smart enough, clever enough. I have to do things myself to prove that I can. That anxiety is gnawing. In the back of my mind I always believe that if I show that I need assistance then I will be fired for not knowing everything already. It’s gut wrenching and keeps me pushing myself harder.
Goals of Treatment
            The goals of treatment are to increase the patient’s sense of competence and decrease dependence on other people. Increasing the patient’s sense of competence usually involves building both confidence and skills; decreasing his or her dependence involves overcoming avoidance of trying tasks alone. Ideally, these patients become able to stop relying on other people to an unhealthy degree.
            Giving up the dependence is the key to treatment. The therapist guides patients through a kind of response prevention: Patients stop themselves from turning to others for help, handle takss on their own, accept that making mistakes is how they will learn, persevere until they are successful, and prove to themselves that they can eventually generate their own solutions to problems. Through trial and error, they can learn to trust their own intuition and judgments rather than disregarding them.

Special Problems with This Schema
            One of the greatest risks is that the patient might become dependent on the therapist rather than overcoming the schema. The therapist mistakenly assumes the role of parent figure and runs the patient’s life. The amount of dependence the therapist allows is a delicate balancing act. If the therapist does not allow any dependence, the patient will probably not stay in treatment. Realistically, the therapist has to start by allowing some dependence and then gradually withdrawing. The therapist should strive to allow the least possible amount of dependence that will keep the patient in treatment.
            One of the greatest challenges in treating patients with this schema is overcoming t heir avoidance of independent functioning. Patients have to become willing to trade short-term pain for long-term gain and tolerate the anxiety of functioning as adults in the world. Building motivation is important.  

So this isn’t really my Schema. I was raised to be independent to a fault. That’s probably where all this counterdependent stuff stems from for me. I was constantly told that if I wanted something, I had to earn it. So I feel like if I need to ask for help then it isn’t completely my doing, and therefore I haven’t earned it.
I do think all people with Borderline Personality Disorder have something of a Dependence issue though. We’re emotionally dependent on other people for our own happiness. When I’m not in a relationship my world is relatively ‘calm’ and ‘normal’ but I feel empty and hollow. When I’m attached to someone I remember and can feel what it is to be happy. These feelings of happiness are entirely dependent on 1.) being with someone, and 2.) their own emotional wellbeing/happiness. I can’t remember being truly happy just on my own. With someone I can be happy for moments, or hours, but it’s not really a lasting happiness. It’s rather like catching fireflies in a jar. The chase is exhilarating, once the moment is captured it’s beautiful, but eventually there isn’t enough air in the jar and the bugs die. Occasionally shaking the jar makes them light up even brighter, but eventually you either have to let them go so they can continue to live and grow or cling to them caged, and watch the feelings slowly wither.
Well there’s an analogy for you.
The problem with all of that is…. No one can make you happy. You are responsible for your own happiness. I think we get so caught up in desperately reaching to one source of positive emotion that we forget about everything else out there that can also contribute to our happiness. There’s a world of delight and adventure to explore, and endless possibilities for joy. Or so I’m told. I once told my Therapist that I didn’t know what joy, real joy, felt like. She found this to be very sad. The problem is I’m not content with myself. I need to work on accepting myself, and worry less about the acceptance of others. Joy comes from within. At least, that’s what I’m told. Hopefully one day I’ll find out.

*Schema Therapy: A Practitioner’s Guide – Young, Klosko, Weishaar

Monday, November 7, 2011

Helpful Tools - Mood Tracker for Borderline Personality Disorder

I would say I hate Mondays, but I really have exactly the same feeling about Mondays as I do every other day I have to tear myself out of my big comfy bed and get to work by 730a. So I suppose I hate all work days. Except I don’t. Only that initial waking up, leaving my dreams behind, and throwing off the warmth of comforters I’m wrapped in. Once I’m moving I don’t really mind.
One of the first things I do once I'm up and at work is record my mood. Something I find very useful for Borderline Personality Disorder is my Mood Tracker (I use I’m not incredibly consistent with it. I only remember to log in to my account a few times a day, but I do remember to do it every day. I’m not able to catch every little mood swing, but I catch enough, and it really helps me see the trends and fluxuations I go through.   
I started doing this about a year ago. This is when I was finally fed up enough to try something stronger to manage my moods. This is when I went back into therapy. This is when I found my first psychiatrist. This is when I really made the commitment to start changing my life. Oh don’t get me wrong. I’ve tried before. I’ve wanted things to change for years, done everything in my power to keep myself steady without anyone’s help. I’d sought help before, but still held back, didn’t allow it the time or honesty to benefit me. This was different. This is when I first accepted help. I’ve fought it at times. I’ve fallen back into bad habits plenty. But overall I’ve been taking more steps forward than I have backwards.
I was looking back on the entries I’d placed at this time last year and decided to compare it to today. It’s only been a  year but the difference is pretty drastic. Oddly I feel a little mixed. I feel like I’m missing a part of myself that made me feel gloriously, tortuously alive.  It’s strange to miss something so devastating. However, now, despite all the little things that I would normally obsess myself into oblivion over I am able to get out into the world, at least pretend to function like a normal person, and *gasp* actually enjoy a hell of a lot more things than I’ve been able to before. That last little bit makes it worth it.
So I thought it would be fun to share with you the transition I made. The way I scale things is slightly different. Along with Borderline, I’m also diagnose Major Depressive Disorder. My baseline is mildly depressed so in my tracking I adjust the scale to mean this:
Manic = Full blown mania (Never had this)
Excellent = Hypomanic
Good = Good
Okay = Okay
Bad = Mildly Depressed
Horrible = Moderately Depressed
Depressed = Severely Depressed

The trendline only gives you the average of the days moods. I can switch from hypomanic to severely depressed and the trendliine will average that to 'Bad' but you can see in the colors that I've been very up and very down. That's why I included the color bars because those give you more of an idea of the individual shifts I am able to catch.
Year 2010:

Year 2011:

I noticed that sometime within the past couple months my Horrible shifted from an actual depressive state to feeling crappy but not depressed. This is mostly due to body image issues. Not depressed, but hating my body. This is also pretty weird for me. Normally I’d be full on depressed about this. Now I’m not happy, so I’m making changes, but I’m also not hidden away in full seclusion, I’m still getting out and trying to keep connected. I’ve been a little down lately, but overall you can see that I’ve been much steadier. I’m still fluxuating, but not as severely.

I don’t know about you, but to me this looks promising.
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