Friday, December 16, 2011

DeJa Vu Too

Today is also the day of the DÉJÀ VU Blogfest.

Basically everyone who signed up will repost an old blogpost that they think hasn’t gotten enough attention, is helpful, or that they just like a whole bunch. I know a lot of bloggers put out a lot of really good material when they first start blogging but don’t really have much of a following. This is sort of a chance to highlight some of that stuff. I honesty couldn’t decide what to choose. For a minute I thought about talking about my latest tattoo, but I’ve received a lot of e-mail and thankful responses about the post that I finally decided on.

It’s also something that I think is good for people to remember about me. I have a:

Lack of Object Constancy  ( <---- Original post - Go Ahead. Click it! )

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

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

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

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

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

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

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

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

Lucid Analysis: Trials in Therapy – Abandonment Trauma

First I’d like to say Hello to all the new followers that have joined me recently! ::waves:: I hope you like it here, or at least find it interesting here. Say hi, leave me comments, or yanno, keep lurking. Friday is my on-going series that I call Lucid Analysis: Trials in Therapy. I discuss and dissect the things that I have been going over in therapy. That said, let’s get to it.

Yesterday I saw Psychiatrist and Therapist. No new developments in my meds. I’m happy with the Pristiq. Still going. I told her I had a meltdown the night before. It hasn’t happened in a very long time though. She said things like that will occasionally happen along the road to recovery. It doesn’t negate the progress I’ve made so far.
Therapy. I don’t know how to describe how I felt going in to therapy.   Resigned, I guess. I was so exhausted and so emotionally drained that I don’t think I had room for the anxiety or worry about disappointment.
She asked how things with me and Tech Boy were going. I told her about my meltdown Wednesday night. I told her how he told me he was going out of state this weekend and that I snapped (not at him). I was frustrated and disappointed and just broke down and cried. She asked me why I got so upset. I told her I guess it was because I was more attached to him than I thought and for once I’d like someone I invest in to invest something in me.
Then I told her how I finally yelled at Friend.
When I was done she clearly had an “Ah, ha” moment.
What Tech Boy did triggered me, but who my real anger was directed at is Friend.
Trigger. I have abandonment issues. Surprise!
Therapist said that she’s been wondering where my anger has been for a few weeks now. I’ve been avoiding, I’ve been repressing, I’ve been bottling and trying to not let anyone see what really bothers me.
Last week when I was at Friends' house. After his wife went to bed, we were sitting on the couch watching bad movies like we always do. I stretched out as is usual for me. He started rubbing my leg. Running his hands up on down my calves. Gave me a foot massage. It got late and I sat up to leave, he leaned his head into my neck and just hugged me. I haven’t let this happen in months. I’ve very purposely been maintaining this boundary between us. I was lonely. For an hour it felt good to have someone pay attention to me. To be close to me. I wanted that again. But it brought back all the pain of the last year from the ending of the more intimate aspects of our relationship. And how ultimately, he abandoned me emotionally when I was in a very vulnerable place. With no warning. With no regard for how devastating it would be to me. Instead of talking to me about what was going on, explaining, he dropped off the Earth, quit talking to everyone, including me, for a week. No texts, no communication, nothing. While I was extraordinarily confused and in pain. He just left me like that with no consideration.
Yes. I am angry at him. I’m pissed. And then on top of that, afterwards while I’m working on trying to maintain our friendship and heal, every week after week he rubs it in my face that he’s working on his failed marriage. In front of me he acts all cuddly and kissy and ‘I love you’ with his wife. Rubbing it in my face is tactless and not okay. Especially when the utter indifference is so clearly written all over her face and body language. Not to mention she’s told me directly that she is traditionally a very selfish person with no regard for how anyone else feels, including her husband. So yes, that hurts. I finally told him so.
Therapist thinks it was about damn time too.
I’m so afraid of hurting him, and losing my friend, that I’m hurting myself and losing my mind (ok maybe a little exaggeration there).
I have a lifetime of abandonment trauma. From my parents not being there, from moving, from friends moving, from people dying, from friends that I thought I could trust doing unspeakable things to me, to losing people that I cared for and loved deeply.
None of this has anything to do with Tech Boy. He’s just a guy. A guy I like and is fun to hang out with, but he’s not the love of my life or anything like that. The problem with triggers though, is anyone can set them off. He doesn’t know my issues and did so accidentally. Hell, I’m still working on how to sort through and connect all my issues. None of this really has anything to do with him though. It has to do with my fears and my trauma… and a lot of anger that I have towards Friend and the people that have abandoned me in my life.
Therapist introduced me to a new concept this week. It’s the concept of having a Healthy Adult, an Inner Child, and an Outer Child. We all know the Healthy Adult is the fully functioning, responsible person that we are supposed to be. The Inner Child is the part of you that is vulnerable, that is all about feelings, and craves safety, security and wholesome, loving relationships. The Outer child is the self-sabotaging nemesis of your personality. Therapist gave me a book to read called “A Journey from Abandonment to Healing” by Susan Anderson.
Imagine a parent leads a child into the woods. In the woods there’s a rock. The abandoning parent tells the child to sit on the rock and wait until they come back and get them. The parent never returns. The Inner Child does as she’s told, waits and waits and waits, vulnerable and exposed to the elements. Scared. Feeling. Alone. The Outer Child, however, refuses to stay on the rock. Outer climbs down, picks up a hatchet, and goes on the warpath.
Here’s a blurb from her website about the Outer Child.
Outer Child acts out your inner child's feelings - especially your abandonment feelings - without giving you, the adult, a chance to intervene. When you feel hurt, angry, or insecure, Outer acts out these feelings in ways that sabotage your relationships. Outer works like a bungling undercover agent in trying to protect (overprotect) you from abandonment. Stealthy, quick, and misguided, it intercepts love before you ever know what happened.

Outer is the impulsive, obstinate, self-centered ten-year old within all of us. Outer wants what Outer wants NOW, and overrules you, the adult, in getting it. Outer prefers to binge on candy when you are steadfastly sticking to a diet (or so you thought). Outer says yes to a third glass of wine when you, the Adult, had decided on a two drink minimum.

Outer child is born of unresolved abandonment. It wreaks havoc in your relationships when it acts out your inner child's primal fear of abandonment. For example, it aims its emotional suction cups at our prospective partners and scares them away.

Outer fights change - especially change initiated by you, the adult. Outer balks at doing the right thing and only wants things that are bad for your health, figure, or bank account. By bringing Outer out of the bunkers and into the daylight, you get to subvert its mission, rather than let it subvert yours.

Outer is fueled by emotion. Take anger. Outer either overreacts or under-reacts to your anger. For example, abandonment survivors tend to be too insecure to risk expressing anger or assertiveness to someone because they fear it might break the connection. Outer takes advantage of this fear and gets you to take your anger out on yourself, damaging your self-esteem. Conversely, Outer takes your anger out on innocent bystanders and makes you look like a monster.

Outer is the "yes but" of the personality. If you let it, Outer ties your life up in knots.

Outer child likes to play games, especially in relationships. It wears many disguises including "hard to get" and "Florence Nightingale" (where Outer panders for 'love-insurance' by over-caretaking). It poses as your ally, but is really your gatekeeper. Its covert agenda is to maintain your patterns - albeit your most self-defeating ones. By deconstructing your Outer Child defenses, your Adult Self has the opportunity to guide your behavior, rather than remain driven by your hidden nemesis.  

For the past few weeks, maybe month or two, I’ve been rooting pretty firmly in my Outer Child. I’m indulging my Outer Child with Tech Boy. He likes to drink, and gamble, and is all about in the moment gratification. I’m letting myself get swept along with these things, rushing physical intimacy, doing what feels good RIGHT NOW, instead of what is healthy for me in the long run.
Surprisingly she doesn’t think I need to stop seeing him. But I do need to change my approach with him. Start over in a sense. Really take time to get to know each other. Do healthy, adult things, not just uncontrolled indulgences. Make healthier choices and base my actions off of those. I won’t see him this weekend, I won’t see him next weekend (It’s Christmas, I’ll be going out of state to see my family). It’ll give me time to take a break and figure out what it is I want to do.
I love my Therapist. I’m starting to believe she really does know me.
Homework: I’ll be reading this book this weekend. You’ll be getting a book review when I’m done as well. I’ll post the Outer Child Inventory a little later. I find it enlightening.
We didn’t talk about what I should do about Friend. I have no intentions of talking to him right now though.  

Thursday, December 15, 2011

Off with Her Head! - Punitiveness

Despite the hiccups of last night I will not be deterred from finishing this last schema. Yay the last one! Going through each one of these has definitely given me a lot of insight into the method behind my madness. I hope you’ve taken something away from it as well. Now. Onto the last (very appropriate) schema!


Typical Presentation of the Schema
These people believe that people – including themselves – should be harshly punished for their mistakes. They present as moralistic and intolerant, and find it extremely difficult to forgive mistakes in other people or in themselves. They believe that, rather than forgiveness, people who make mistakes deserve punishment. No excuses are permitted. People with this schema display an unwillingness to consider extenuating circumstances. They do not allow for human imperfection, and they have difficulty feeling any empathy whatsoever for a person who does something they view as bad or wrong. These people lack the quality of mercy.
This schema is a HUGE problem for me. However for me it is almost entirely self-directed. I forgive and allow for “imperfections” and mistakes in everyone around me…. But not for myself. Not ever. I have no mercy on myself. I absolutely allow for extenuating circumstances for others. After all, no one can control everything! Except I should have somehow foreseen these things and made contingencies in the eventuality that something went wrong. I allow for other peoples mistakes because I’m afraid of losing them. If I’m kind and understanding they won’t feel bad and need to leave me. I know I’m not going anywhere though. And if I don’t do things right, I won’t be good enough, worth enough, and that might be enough to make someone not want to stay. So I have to push myself. Sometimes that push needs to be more of a shove.  
Ok, one addendum. I can reach a snapping point with other people too (I mean obviously). Even I have my limits. When Evil-Ex would pull his manipulative, abusive bullshit I reached a point where I could no longer forgive him, and frankly, believed he deserved to be strung up by the balls. I don’t think this is undeserved though. It takes an extraordinarily long time for me to reach this point. I absorb a lot. Once I have though, the split is pretty complete and I have no more tolerance for anything they do at all.
The best way to detect this schema is by the punitive, blaming tone of voice these people use when someone has made a mistake, whether they are speaking about other people or about themselves. The origin of this punitive tone of voice is almost always a blaming parent who spoke in the same tone of voice. The tone conveys the implacable necessity of exacting punishment. It is the voice of the “fire and brimstone” preacher: heartless, cold, and contemptuous. It lacks softness and compassion. It is a voice that will not be satisfied until the wrongdoer has been punished. There is also the sense that the penalty the person wants to exact is too sever – that the punishment is greater than the crime. Like the Red Queen (Gah! This is wrong! The Red Queen and The Queen of Hearts are two different characters! It’s the Queen of Hearts that shouts this!) in Lewis Carrol’s Alice in Wonderland, shouting, “Off with his head!” for every minor infraction, the schema is undiscriminating and extreme.
My father would yell at me all the time ‘Girl! Watch that sharp tongue of yours’. He would tell me on an almost daily basis that my tone of voice was harsh and negative. I worked to successfully change this, but when I’m angry it slips right back into place.
Punitiveness is often linked to other schemas, especially Unrelenting Standards and Defectiveness. When patients have unrelenting standards and punish themselves for not meeting them, as opposed to simply feeling imperfect, they have both the Unrelenting Standards and Punitiveness schemas. When they feel defective and punish themselves for it, as opposed to simply feeling depressed or inadequate, they have both the Defectiveness and Punitiveness schemas. Most people with Borderline Personality Disorder have both Defectiveness and Punitiveness schemas: They feel bad whenever the feel defective, and they want to punish themselves for being bad. They have internalized their Punitive Parent as a mode, and they punish themselves for being defective, just as the parent used to punish them: They yell at themselves, cut themselves, starve themselves, or otherwise mete out punishment.
Trifecta! I have all three. Tell her what she’s won Johnny! Well Miss Haven, you’ve won a faaaaaabulous vacation to the depths of your own inner most hell … and because we like you so much we’ll throw in this box of razor blades as an added bonus!
Hey, at least I have a sense of humor.
Punishment. Punish myself. I feel the need to punish myself ALL the time. I’ve mentioned before that one of the reasons I cut and burn is because I feel like I have failed at something I believe I need to do. Or to keep me on track so that I don’t slip. I also cut because I believe I am a bad person and deserve to be punished. It is also motivation to be better. I berate myself, {used to} cut, starve, deny myself pleasurable activities, seclude myself from the supports I need, and I’m sure a number of other things that I just don’t have the mental capacity to recall at the moment.
Last night was the first time in a very long time that I had a nearly undeniable urge to cut (I didn’t. I restrained myself and didn’t give in to the impulse < --- see,  progress). I should have known better than to let another guy into my life. Every time I tell myself I won’t allow it, won’t get close… and every time I forget. At least it’s not as bad this time. I haven’t let him get very close, and I’m not too attached yet. Believe it or not I still have a lot of distance between him and my heart. Everything just feels amplified with BPD. Sometimes a harsh reminder (read: punishment) is enough to keep that lesson clearly etched into my skin brain.
Goals of Treatment
The fundamental goal is to help people become less punitive and more forgiving, toward both themselves and others. To start it is important to learn that most of time there is little value in punishing people. Punishment is not an effective way to change behavior, particularly when compared to other methods, such as rewarding good behavior or modeling.
Each time a person expresses the desire to punish someone, it’s important to ask these questions:
“Were the person’s intentions good or bad? If the person’s intentions were good, doesn’t that count for something? Doesn’t the person deserve some forgiveness? If the person’s intentions were good, then how will punishment help? Isn’t the person likely to repeat the behavior when you’re not there to see? Even if the person behaves better next time, isn’t the cost too high? The punishment will have undermined the relationship and the person’s self-esteem. Is that what you want?” These questions guide people to discover that punishment is not the most beneficial approach.
People work toward building empathy and forgiveness for human beings in all their frailty and imperfection. They learn to consider extenuating circumstances and to have a balanced response when someone makes an error or fails to meet their expectations.
Ok, I have my abandonment fears theory. Why is it SO much harder to forgive myself than it is to forgive someone else? I’ve taken so much abuse from other people; you’d think the one person I could expect a little sympathy from would be myself.
Strategies Emphasized in Treatment
Cognitive strategies are important in building people’s motivation to change. The main strategy is educational: People explore the advantages and disadvantages of punishment versus forgiveness. They list both the consequences of punishing a person (or themselves) and of being more forgiving and encouraging the person to reflect on the behavior. Exploring the advantages and disadvantages helps the person accept intellectually that punishment is not an effective way to deal with mistakes. Becoming convinced on a cognitive level that the cost of the schema is greater than the benefit can help strengthen the persons resolve to battle the schema.
Because the schema is almost always the internalization of a parent’s Punitiveness schema, much experiential work focuses on externalizing and fighting the Punitive Parent mode. In imagery, people picture the parent talking to them in the punitive tone of voice. They talk back to the parent, saying, “I’m not going to list to you anymore. I’m not going to believe you anymore. You’re wrong, and you’re not good for me.” Doing imagery work with the Punitive Parent gives a person a way to distance from the schema and to make it feel less ego-syntonic. Rather than hearing the punitive voice of the schema as their own voice, they hear it as their parent’s voice. People can say to themselves: “This is not my voice that is punishing me; this is my parent’s voice. Punishment wasn’t healthy for me in childhood, and I’m not going to punish other people (or myself) anymore, especially the people I love.”
My problem here is, I don’t remember my parents yelling much at all; at least not until I was in middle school and high school. Then we SCREAMED at each other almost every day. My self-punishment started well before this. But when I was younger I just can’t recall. I don’t have a lot of memories from that age though so maybe. I do remember being spanked as a kid every now and again, but that was pretty rare and only for the bigger transgressions. I don’t think that would be enough to spark this. Then again, I can’t say either way.
The aim of behavioral strategies is to practice more forgiving responses in situations where people have urges to blame themselves or others. By practicing this they can compare whether the consequences match their dire predictions.
I don’t know how to forgive myself. I always feel like it’s my fault if something goes wrong because I put myself in that position. If a bad thing happens I have no one to blame but myself (even if it was someone else that hurt me < --- I know this is faulty logic). I’m not even sure I see the point of forgiving myself. Will that help me make better decisions in the future? No. It would just feel like I’m not taking responsibility for my actions.

Special Problems with This Schema
This can be a difficult schema to change, particularly when it is combined with the Defectiveness schema. The person’s sense of moral indignation and injustice can be very inflexible. Maintaining the person’s motivation to change is the key to treatment. It’s important to stay focused on the costs and the benefits of the schema in terms of improved self-esteem and more harmonious interpersonal relationships.

My inner monologue is a capital B-I-T-C-H. < ---- This is the more polite word I was thinking of actually. As bad as some people believe Borderlines are to others, that’s nothing compared to how bad we can be to ourselves. The way I treat myself is magnitudes worse than how I treat anyone else.

Thoughts from the Borderline

I’m better at taking care of other people than I am at taking care of myself. This is a problem. I put what other people’s wants ahead of what I want about 99% of the time.  Unfortunately this only contributes to the buildup of frustration and anger in me. I need to seek more of a balance from the beginning so this internal pressure doesn’t get to the popping point.

Live and learn.

On another note. I haven’t had a meltdown like I did last night in a very long time. I’ve been making a lot of progress this year. I guess a behavioral relapse now and again isn’t unexpected. Three steps forward, one stumble back. I just have to regain my footing and get back in the right direction.
I cancelled lunch with Tech Boy. No issues, no drama, just told him I wasn’t feeling up to it today.
I told Friend to leave me the hell alone. I don’t know how long this will last. I’m sure he’ll want to talk at some point. I’m not sure I’ll want to respond. Maybe after I cool down a bit, but definitely not right now.

Therapy is going to be awesome tonight. Ugh.

Wednesday, December 14, 2011

Do relationships ever work?

I’m so dizzy I want to vomit.

I won’t see Tech Boy this weekend… again. He’s going out of state to bar hop and see friends. I think I know where I rank in his priorities. He texted me to see if I wanted to go to lunch tomorrow b/c he wouldn’t be around this weekend. I said sure {but over a series of texts} he didn’t need to feel obligated to me or anything if he didn’t want to.

Does this sound overly weird?

Tech Boy: Wanna do lunch tomorrow? I’m not gonna be here this weekend?

Me: Yeah I’m down for lunch. Where ya going this weekend?

Tech Boy: Philly to see my friends for a night. Maybe two, haha.

Me: Cool. Cool. You’re gonna owe me night or two soon.

Tech Boy: Haha I really am… I’ve been slackin.

Me: Don’t think I haven’t noticed buddy haha. It’s whateves. What ya gonna get up to in Philly? Anything special or just chillin?

Tech Boy: Getting into troublelol rabbling around bars and whatnot. I’m a big fan of drinking and just seeing what happens lol.

Me: hah me too for sure.

(after a drink and a few minutes) Me:  I’d like to hang, but we don’t have to do lunch tomorrow if u really don’t want to see me. I don’t want u to feel obligated or anything?

Tech Boy: Now why on earth would you go and say something like that?

Me: Nothing to it. Just don’t want u to feel like u owe me anything. You’re not the easiest guy to read.
Tech Boy: I know… I don’t much like being simple.

Me: no worries, haha.

I also texted Friend, venting “I hate men.” He asked if it had anything to do with Tech Boy.

My response, “All men are the same.” He responded with….

“Okay, Well, You’re my friend, he can go F himself for all I care if he hurt you.”

And I fucking snapped and finally told him, “Right, like it matters. Not like you don’t still fucking hurt me too. WTF ever.”

He’s supposed to be this super Empath that is totally in tune with the emotions of everyone around him. This is his claim. And yet, any time I’m over and we do something  as simple as go to the grocery story, he makes a point of making out with his wife and making a big scene of “I love you” right in front of me. With absolutely no regard for the fact that this is extremely uncomfortable for me. He’s told me himself that he never falls out of love with someone that he has loved. When his wife told him we couldn’t do what we were doing anymore I confessed how deep my feelings for him were. He knows what it’s like to always feel for someone, and yet, he has no concern for how I feel. He also completely disregards this right in front of me face Every. Time. I’m. Over. There.

Fuck him.

I told him all of this and that I was sick of the  hypocritical nature of someone that ignores my feelings for a woman that has admitted to my face that she doesn’t give a shit about how he feels. So far…… no response from him.

Surprise! Not really. My taste in men is tragic.

I hope I never see Friend again. I’m glad I played it cool with Tech Boy. It’ll make things less awkward at work. GF loves me AND wants to be with me. Remind me again why I’m not with her?

 I’m so fucking sick of investing in people that don’t give a shit about me. 

I'm not Perfect... Yet - Unrelenting Standards / Hypercriticalness

Another day another Schema. Just two more to go! The one we’re covering today is especially relevant for me.
Unrelenting Standards/Hypercriticalness
Typical Presentation of the Schema
People with this schema present as perfectionistic and driven. They believe that they  must continually strive to meet extremely high standards. These standards are internalized; therefore, unlike the Approval-Seeking/Recognition-Seeking schema, people with the unrelenting Standards schema do not as readily alter their expectations or behaviors based on the reactions of others. These people strive to meet standards primarily because they “should,” not because they want to win the approval of other people. Even if no one were ever to know, most of these people would still strive to meet the standards. People often have both the Unrelenting Standards and Approval-Seeking/Recognition-Seeking schemas, in which case they seek both to me very high standards and to win external approval.
If I were to hazard a guess I’d say that my brother has both of these, where I only have the Unrelenting Standards schema. Ok, I may have some Approval-Seeking in there as well, but I think it’s highly overshadowed by my need to meet the standards I believe I should reach. No one sets standards for me. I do. If what I do is not perfect, it’s not good enough. If I am not perfect, I am not good enough. I’ll make elaborate dishes of food, costumes, etc., and if I think there’s even a chance of them not meeting the standard I think they should I’ll scrap it all and toss them right out.
 It’s like I believe I’m only as good as my accomplishments.
The most typical emotional experienced by patients with the Unrelenting Standards schema is pressure. This pressure is relentless. Because perfection is impossible, the person must perpetually try harder. Beneath all the exertion, patients feel intense anxiety about failing – and failing means getting a “95” rather than a “100”. Another common feeling is hyper criticalness, both of themselves and of others. Most of these patients also feel a great deal of time pressure: There is so much to do and so little time. A common result is exhaustion.
This is perfectly me. When I was at University I would study from the time I woke up until I passed out in the Science and Engineering Library. If I received a homework assignment, quiz, or exam that wasn’t perfect I refused to let anyone know my score, even though I routinely scored higher than everyone else. Making any mistake at all filled me with shame that someone would judge my failing. Pressure. Everything feels like so much pressure. The anxiety starts in the pit of my stomach and seeps out through my pours until I’m weighted down by a wet blanket of my own expectations. The only relief is to be flawless…. Which never quite happens. Which always remains just out of reach.
It is difficult to have unrelenting standards, and it is often difficult to be with someone who has unrelenting standards. Another common feeling in people with this schema is irritability, usually because not enough is getting done quickly enough or well enough. Yet another common feeling is competitiveness. Most people who are classified as “type A” – that is, as demonstrating a chronic sense of time pressure, hostility, and competitiveness – have this schema.
Well I definitely have the irritability part down. If I ask someone to do something and it’s not done by precisely the time I need it done by, exactly how I need it to be done, I begin to fume. Consequently I tend to do a lot of things myself because at least I know I’ll do it right. Which doesn’t do anything to relieve the intense amount of pressure I already feel. However I am in no way competitive at all. Competition is the equivalent of being judged in my mind and I want to avoid judgments at all costs.
Often, people with the Unrelenting Standards schema are workaholics, working incessantly within the particular realms to which they apply their standards. The realms can be varied: school, work, appearance, home, athletic performance, health, ethics or adherence to rules, and artistic performance are some possibilities. In their perfectionism, these people often display inordinate attention to detail and often underestimate how much better their performance is relative to the norm. They have rigid rules in many areas of life, such as unrealistically high ethical, cultural, or religious standards. There is almost always an all-or-nothing quality to their thinking: People believe that either they have met the standard exactly or they have failed. They rarely take pleasure from success, because they are already focused on eh next task that must be accomplished perfectly.
People with this schema do not usually view their standards as perfectionistic. Their standards feel normal. They are just doing what is expected of them. In order to qualify as having a maladaptive schema, the person must have some significant impairment related to the schema. This could be a lack of pleasure in life, health problems, low self-esteem, unsatisfying intimate or work relationships, or some other form of dysfunction.
Lack of pleasure in life? Check. Low self-esteem? Check. Unsatisfying intimate or work relationships? Check. How about self-loathing? Or chronic disappointment? It’s funny, because I don’t view my standards as perfectionistic. I often say I don’t believe in perfection because to me perfection equates to stagnations. However, there’s always room to grow and improve. There’s always something more to learn. There’s always some way to make what I’m doing, better.
Goals of Treatment
The basic goal of treatment is to help people reduce their unrelenting standards and hyper criticalness. The goal is twofold: to get people to try to accomplish less, and to accomplish it less perfectly. Successfully treated people have more of a balance in their lives between accomplishment and pleasure. They play, as well as work, and do not worry as much about “wasting time” and feeling guilty about it. They take the time to connect emotionally to significant others and are able to allow something to be imperfect and still consider it worthwhile. Less critical of themselves and others, they are less demanding and more accepting of human imperfection, and are less rigid about rules. They come to realize that their unrelenting standards cost more than they gain: In trying to make one situation slightly better, they are making many other situations a lot worse.
Bleh.  Accomplish less and accomplish less perfectly? This sounds horrid. I actually can not fathom why I would want to do this. How can someone love me if I’m flawed and not the best that I can be?
Strategies Emphasized in Treatment
It’s important for people to learn to challenge their perfectionism. They learn to view performance as lying on a spectrum from poor to perfect – with many gradations in between – rather than as an all-or-nothing phenomenon. Conducting cost-benefit analyses of perpetuating their unrelenting standards is also helpful. They ask themselves: “If I were to do things a little less well, or if I were to do fewer things, what would the costs and benefits be?” Here the advantages of lowering standards can be highlighted – all the benefits that would accrue to their health and happiness, all the ways they are suffering as a result  of their unrelenting standards, and all the ways the schema is damaging their enjoyment of life and relationships with significant others. The cost of the schema is greater than the benefits: This conclusion is the leverage that can motivate a person to change. It’s also important to reduce the perceived risks of imperfection. Imperfection is not a crime. Making mistakes does not have the extreme negative consequences that people anticipate.
It feels like the consequences will be extreme though. If I feel like I’m not performing to the standard I should at work, I have a low lying dread that bubbles over into heart clenching anxiety that I will get fired. Taking breaks, taking lunch, this is all time I’m afraid someone will see me not working and I will get in trouble for because I am not utilizing every moment towards productivity. Don’t even try to convince me that taking vacation and sick days are ok. I feel guilty and like I’m practically guaranteed to get suspended or judged as being a slacker. And don’t even get me started about my appearance. Right now I am not at my ideal weight and I am hideous. I obsess and dwell on every perceived imperfection endlessly, regardless of the fact that no one else seems to see these things. I don’t want to go out in public if I’m not at my ideal place within my own skin.
The Unrelenting Standards schema seems to have two different origins, with different implications for treatment. The first and more common origin is the internalization of a parent with high standards.
The second origin of the Unrelenting Standards schema is as a compensation for the Defectiveness schema: People feel defective and then overcompensate by trying to be perfect.  
I think I qualify for both here. I know I feel defective, however I also had a father that pushed us to constantly achieve bigger and better standards.
Special Problems with This Schema
The biggest obstacle by far is the secondary gain that comes from the schema: There are so many benefits to doing things so well. Many people with this schema are reluctant to give up their unrelenting standards because, to them, it seems that the benefits far outweigh the costs. In addition, many people are afraid of embarrassment, shame, guilt, and their own self-criticalness, if they do not live up to the standards. The potential for negative affect seems so high that they are reluctant to risk lowering their standards even a little bit. Moving slowly can help these people, as can closely evaluating the outcomes of lowering the standards.

Embarrassment. Shame. Guilt. Self-Criticalness. Yep. Having these standards for the things that I do is proof that I have something to offer people. If I have nothing to offer, why will people stick around? I inherently feel like I’m a bad person. Being able to do these things is a way of proving that I have some good in me. Something good to offer. Something to keep people around. Something to keep them from leaving. Something for others to value in me. Why would I want to “fix” this? Why would I want to diminish the things that make me of value to other people?  Because the things that I can do for people does not actually comprise the entirety of my value. The few friends that I’ve talked to about this (Friend and Roommate) have told me that even if I were to never do any of the baking or cooking, or painting, or crafting, or whatever the things I do for other people, it wouldn’t change the fact that this is not all of who I am. They tell me I’m sweet, funny, loyal, an amazing listener, incredibly intelligent (with the most bizarre range of knowledge), caring… and all these other things. All these other things are the reasons people like having me around, not just because I make a killer pie. I don’t see it though. Or I do, but it’s lost in the shadow of my imperfections. You know the expression, “A chain is only as strong as its weakest link”? That’s how I feel about myself. I’m only as good as my worst flaw. And I’ve had a very flawed life. I think that’s the cost of being human though. I need to learn to let the past remain where it belongs, in the past. Maybe not forget it, definitely learn from it, but also let it go so I can move into the future with more knowledge that I can do things differently.

Tuesday, December 13, 2011

Is Borderline Personality Disorder Treatment Resistant?

A Reader brought this situation to my attention and I feel that it’s important enough to address in its own post because it is a problem in the clinical community concerning Borderline Personality Disorder. The Reader stated…
"I put this question to a psychotherapist from the Community Mental Health agency who came to evaluate my teen BPD  at the residential treatment center. She said that in her 20 years of practice, she had not seen BPD patients get better with age. Many stayed the same, but some got worse. She said the problem came from not being able to challenge or push them to improve. They cannot handle the challenge, and just wanted to come in and whine to her and seek justification and validation for their actions and emotions. Even when confronting them with this observation, they continued on with the same behavior. Often she would be the one to say "don't come back if you don't want to work on pathways to improvement." It amazed her to see patients in their 60s coming in and dealing with the exact same issues she read in their charts from 30-40 years earlier."

It sounds like your psychotherapist that you spoke to was not equipped to handle someone with Borderline Personality Disorder. This is quite common. When someone does not have the right tools to understand and work with the problem they easily become frustrated with their patients. It's a failing on the part of both the patient and the practitioner. However it is not an accurate opinion to say that someone with BPD will never get better. If she has not seen any progress in a BPD patient I would 1.) question how many BPD patients she’s treated for an extended period of time (not just a couple months, I mean a couple years), and 2.) I would question whether she’s had any actual training that focuses on the specific issues of Borderline Personality Disorder. Not all psychotherapist have the same fields of study and are therefore not as qualified to deal with some kinds of people.
We can handle challenges, but because of the nature of our disorder it takes a different approach than someone who does not have BPD. It’s true that many people with BPD do seek therapy because they need validation, but a good therapist that understands the treatment of BPD is willing to take the time and put in the effort to help these people see through their actions and overcome their behaviors while building a more productive set of life skills.
You also can’t ‘merely confront’ someone with BPD and expect them to be able to change. Characterological problems, personality disorders, are deeply ingrained issues. Basic cognitive behavioral techniques are  not enough to correct deep psychological issues. It’s akin to slapping a band-aid on an amputation. As I spoke about previously, the very nature of personality disorders means that the way we perceive the world, how we interact with the world, how we experience emotion and our very selves is quite different than your average Joe. By extension, how we are capable of utilizing, dealing with, and incorporating therapeutic technique is also going to be different. That’s not to say that we don’t want to work through things, obviously this may not be the case, but since our base functioning is different, we need to approach these problems from a different point of view.
There are many faulty Assumptions made by clinicians regarding Borderline Personality Disorder (Click here to read them all).
Assumption: With brief training, patients can access their cognitions and emotions and report them to the therapist.
Cue the broken record. Someone with a Borderline Personality Disorder does not experience emotions the way a normal person does, by definition. Sometimes the buildup of emotion is so frustrating and such a jumble of so many different things that it’s impossible to distinguish individual thoughts or feelings. Or patients may block disturbing thoughts and images in a cognitive or affective avoidance of disturbing memories and negative feelings. When you learn that by avoiding negative stimuli you reduce your susceptibility to pain, it becomes ingrained into your habits and lifestyle. Breaking an instinctive pattern that you’ve developed as a maladaptive coping strategy isn’t easy. To first face those things that hurt you in order to finally move past them takes courage and time to reach that place of strength. Or you have someone like me that is dissociative on top of my other issues. Where something should inspire intense emotions all I can describe is…. A blank. A void of feeling like speeding to the pinnacle of Mount Everest with emotions ramping up higher and faster only to divert into a dark cave before you hit the top and, stop. How do you navigate the void? 
Assumption:   Patients can change their problematic cognitions and behaviors through such practices as empirical analysis, logical discourse, experimentation, gradual steps, and repetition.
The problem here is that our problems are rarely so straight forward. Our issues have issues.  “Because characterological patients usually lack psychological flexibility, they are much less responsive to CB techniques and frequently do not make meaningful changes in a short period of time. Rather, they are psychologically rigid. Rigidity is a hallmark of personality disorders. These patients tend toward hopelessness about changing. Their characterological problems are ego-syntonic: Their self-destructive patterns seem to be so much a part of who they are that they cannot imagine altering them. Their problems are central to their sense of identity, and to give them up can seem like a form of death – a death of a part of the self.” Do you know what it’s like to want to be rid of something, to despise it so much, and fear the losing of it in the same breath? Or to feel in your bones that something is so, despite all evidence to the contrary? I do.
Assumption: The patient is presumed to have problems that are readily discernible as targets of treatment.
Fill my emptiness please. What? You don’t have a prescription for that? No definitive list of reasons why this may be? It’s hard to treat a problem when you don’t have a clear idea of what the problem even is. Vague senses are difficult to discern for anyone, especially someone who has trouble connecting with how they feel in the first place.

If she's actually saying "don't come back if you don't want to work on pathways to improvement," that's a huge red flag that this woman does not have a fundamental understanding of what Borderline Personality Disorder is. And frankly does not sound like a good therapist. A therapist should never give ultimatums to their patients. This is an outright statement of rejection and abandonment which will only make the Borderline patient more confused and hurt. It’s insensitive and hurtful.

It’s a huge stigma in the clinical community that believes BPD is treatment resistant. This is often a problem in the therapeutic technique, not that someone with BPD is resistant. Some styles of therapy are not conducive to treating Borderline Personality Disorder or one technique is simply not enough. It’s often difficult for us to internalize some concepts because the nature of BPD is so transient. What may work for someone without BPD probably won’t work the same for us. Or what does work for us one minute, may not work for us in another because our moods shift so rapidly. All this means though, is that we need to focus on changing our overall mentality, not just on techniques to get us through a situational development (though these can be helpful!). We can’t just record, talk through, and repeat new behaviors and expect them to work right away because these are things that are ingrained in our character, not a learned behavior that we’re just trying to reverse. It might take a variety of integrated techniques, not just one, but treatment is absolutely possible!

Another clinical stigma is that someone with BPD will never get better. With this attitude many clinicians adopt an attitude of hopelessness for someone with a Borderline Personality Disorder. They won’t even bother to treat someone with BPD because they don’t have the knowledge of current treatments and options for the patient. Because it requires more effort to change characterological problems many won’t read updated information and therefore remain stuck in outdated modes of thinking. This is not the patients fault. This is the failing of the clinician.
Whoever this psychotherapist you talked to was, I would seriously take her opinions with a big grain of salt and seek out someone who is specifically equipped to handle Borderline Personality Disorder. Talk to a clinician that specializes in Schema Therapy or Dialectical Behavioral Therapy. In recent years there have been HUGE steps made towards progressively treating Borderline Personality Disorder. It’s not a quick fix. There is no quick fix. It does take time and effort, but it is absolutely possible to learn to deal with and overcome this disorder.

Monday, December 12, 2011

One year Anniversary!

It’s a very special day for me here at Beyond the Borderline Personality! One year ago today I started this blog. Happy Anniversary to me!

Growing up the way that I did I was always hyperaware that I had some pretty significant problems. From the time I was in my mid-teens I had done a lot of research into figuring out what was wrong with me. I came to two conclusions: 1.) I was Major Depressive, and 2.) I had Borderline Personality Disorder. As it turns out, I’m a pretty smart woman (also modest). However when I wanted to look deeper into BPD I kept turning up the same limited information over and over again. What’s more, very little of what I found were personal accounts that I could relate to or really gave me an idea of the things I was experiencing. This was really frustrating, especially since I refused therapy and medication until just a couple years ago.

After my official diagnosis I decided that in order to help gain a better understanding and awareness of my disorder I needed better references so I set out to gather as much information as humanly possible on this disorder AND compile it all in one location. My blog! I figured I couldn’t be the only one out there frustrated with limited information. And I’m nowhere near to done yet. I haven’t even finished covering the things that I expected to cover in the last 6 months let alone what I want to cover into the future. So what’s on the agenda for the upcoming year?

-          Bipolar and Borderline Personality Disorders: A study in comparisons and contrasts
-          Depression
-          Empathy and Borderline Personality
-          Family Support
-          Self-Harm – A deeper look
-          Other types of therapy like DBT (though I’m taking a break from therapy talk for a while after I finish this Schema Therapy run).
-          Emotional Suppression and Isolation
-          Borderline Infidelity and Commitment
-          Avoiding Rejection
-          + a hell of a lot more

I have a lot of questions from Readers that I think will be very insightful. I’ve also had a request or two into some of the backstory with Friend and Evil-Ex. I may even venture deep into my dark closet and shake out a few more of my own skeletons for you.

It’s funny. I post 5 – 7 days a week (usually 5).  I’m always afraid that I’m going to run out of things to write about. I also worry that I’m not getting information out fast enough. One day at a time I suppose.

I’d like to expand my blog and reach more people, but I’ll be honest, I’m not incredibly sure how to do this. If you have any tips or suggestions I’d love to hear them =) I’d also like to have some Guest Posts. If you’re living with BPD/Bipolar/another Personality Disorder or live/help/suffer with someone that lives with any of these and you’d like to share your story, lemme know!

I would run this blog even if I had no one following me, but it’s everyone that stops by that really makes it worth it for me. I’ve had so many people tell me that they appreciate what I’m doing here. Well, I want you to know that I appreciate you being here with me. Borderline is a very lonely disorder. You guys really help make it less so.

Thank you =)

And as always, if you have any Questions, Comments, or just want to say Hello:

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