Ghost of friendship present

Well, there was that.

I’m starting to spiral down again. Have been all week, slowly. Spent most of last weekend with Friend. I was alternatingly irritable, anxious, avoidant, and numb.

Friday, staring at the TV watching Aladdin {of all things?} was all that kept me from bitching at the wife. There’s only so many times I can tolerate being cut off before I’ve completed a thought process.  I shut up, retreated inwards, and refused to look at anyone.

Friend and I went to see Sucker Punch. If you like cute girls in short skirts with multitudes of weapons and excellent explosions and no expectations that it will be much more than fun eye candy and escapism, this movie is for you. I thought it was a ton of fun. The empty space surrounding the beginning and end of the movie though… It was odd for me, before the movie it was like talking to someone I knew a long time ago but now I’m not sure if we have any common ground anymore. I feel no connection to him. Afterwards was equally as strange. I could have been talking to a random stranger that had seen the same movie, who coincidentally happened to like all the same parts I did.

Next day I went over to work on a project. He wanted to bump up the start time, but I hadn’t pulled myself out of bed yet and still needed to go to the gym. I told him I could be over an hour later than he wanted which he was fine with, but sent me rushing around like a mad woman. Hauling ass out of bed, rushing to the gym, cutting my workout in half, just so I could get home, shower, and get over there. Why I felt compelled to rush myself like mad, sending myself spinning in a free fall of temporal anxiety is beyond me. I always do this. I don’t care, but I can’t say no, or in my own time. At least Friends wife was gone. Every time I go over there now, it feels like I’m there for the first time. That I know where everything is, is a strange sort of déjà vu. Everything looks familiar, but I walk in the house seen through a glass wall from the outside in, through a museum of rooms I’m not supposed to sit in. Never be a part of. I’ve completely lost my connection to it all. I'm pretending to be someone I think I'm expected to be. Going through the motions of caring. About {everyone}. It’s exhausting and grates my nerves. I’ll be alone if I don’t. If I don’t act the way I’m expected to, play in an acceptable way – there’s no point being there at all, b/c all I’ll do is push people away.  I could walk away from it all and feel like I was never there in the first place. 

There were points in our project that I wanted to rip things out of his hands. I needed things to be a certain way. That he was doing it and not me, he was doing it wrong, and my stomach kept twisting into knots, tighter and tighter.  Barely controlled anxiety I could tell him to do things differently, though it would have been so much easier to just do it myself, but I’m trying to act inclusive so I don’t. Finally we finished up and I was actually pretty happy with the results, but then…

I had nothing to focus my attention on. I had rushed out of my house so fast that I forgot all my stuff to distract me with. I just felt blank. Blank and out of place. I wanted to go home and get my stuff but then there wouldn’t have been any point coming back and I didn’t want to not be there. I didn’t necessarily want to be there either, but spending the rest of the day/night alone was not acceptable. I just, couldn’t leave. It made me anxious to stay, anxious to go. Stuck. Stuck. Split. Without other things to do I felt like I would have no excuse but to interact. I don’t know why this bothered me so much. I needed something else to focus on that wasn’t directly interacting with him, which is stupid b/c {essentially} it was just me and him. Hyper aware of when we sit to close. Usually touching someone is grounding for me, even just feet touching curled up on opposite ends of the couch. A physical connection that brings me back down to earth. Not now. Trying to hold onto a shadow of something sitting further off into the light. I did what I would normally do all day and didn’t feel attached to any of it. My Self floating and drifting somewhere outside of me. Everything dizzy and slightly surreal.

I get so sick of feeling like this.

I left rather abruptly. As soon as I left the house though my energy started to ramp up. By the time I got home I was much too hyper than a 10 minute drive should allot for. 

My therapist says I've detached from my emotions. I can't have completely because the irritation, anger and anxiety are still there. I don't know how to get back. I want to have functional friendships. I can see myself pushing away, but refusing to let go.

Maybe if I keep trying, keep pretending like everything is normal, I'll eventually convince myself that it is. Delusional. This never works. All it does is work to make me lose myself more. I am the only one I truly need to hold onto.

The next day I did stuff I knew I was supposed to do but slightly detached from everything. Wine helps, even though I know it shouldn’t. This week though I’ve been ok, but I feel myself slowly sinking. It’s getting harder and harder to drag myself out of bed again. I feel weighted by invisible hands holding my head down. Suffocating on the very air I need to breathe. Don’t want it, can’t live without it.

I’m defective.

Spiral out, Keep going.
Spiral out, Keep going.
Spiral out, Keep going.

Borderline Boredom

Boredom should not be allowed.

Came home from the gym. Increased my lifting weight. Everything is tired. I don’t want to move. I have no motivation. No inspiration to draw. No attention span to read.  Nothing to keep me occupied. Alone with my thoughts. Empty. Everything just feels empty. I want a drink. Drinking at least lets me fill the void a little. Take my mind away ::sigh:: At the same time I want to not drink. When you know you shouldn’t do something and you need help not doing that thing, that’s when you ask for help right? So I ask Friend for motivation to not drink, and I just get fucking angry when I’m given reasons not to! I make no bloody sense. Fucking Buddhist meditative logic like: it messes with my meds, frustrating levels of libido, and makes irrational thoughts crop up. Whatever. The libido issues I deal with daily. I’ll give him they mess with my meds, but my meds don’t seem to be helping anyways so what’s the point? I already have irrational thoughts, my mind is a very busy place to be >> But they tend to lead to self loathing and the last couple times I drank (that he knows about) I said things trying to get him angry at me. >> Which I promptly freaked out about. I need to not be left alone. I need to not be left to my own thoughts. Something, anything to occupy this space that goes on forever. I can’t stand it.

And by the way ‘Empty’ is not a feeling. It’s a lack of feeling. What the hell is there to say about feeling empty. There’s nothing there! Of course now I’m worked up and agitated, so I guess that’s something.

Too many thoughts that go everywhere and nowhere and wrap back in on me. I need distracting. Just for a while.

Maybe just one…

This thought brought to you by: Rage Against the Buddhist.

Grr.

Ignore This

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Quotes from the Borderline

 "It is absolutely impossible for a subject to see or have insight into something while leaving itself out of the picture, so impossible that knowing and being are the most opposite of all spheres." 

 ~ Nietzsche,  Philosophy in the Tragic Age of the Greeks

    

Comments from across the Borderline...

"I just want to thank you for creating this blog. It has helped me validate and understand a lot of issues I have dealt with in regard to BPD and inspired me to finally seek treatment. Again, I cannot thank you enough. I wish you the best."




::smiles:: Thank you for such lovely thoughts. I am grateful to know that I have been able to reach out to you. You have my warmest wishes and support for all that lies ahead of you. Good luck. .

Where are all the men?: Controversy in BPD – Part 6

Discrepancy in Gender Diagnosis

Why does it seem that men have such a low frequency of Borderline Personality Disorder?  There seems to be two main reasons.

1.)    Men are diagnosed with something else.

2.)    Men are more likely to be treated only for their major presenting symptoms.

Some studies have reported that men are more likely to be diagnosed as paranoid, passive-aggressive, narcissistic, sadistic, or with anti-social personality disorder. I’ve done a lot of research into BPD (clearly) and I’ve often come across articles that focus on BPD with ASPD. Primarily the subject study group for BPD is women, and the study group for ASPD is men. This is not necessarily an accurate distinction though.

Men and women do often present with different symptoms when you break it down to Axis I and Axis II comorbid criteria. However these symptoms are still all encompassed in the range of BPD diagnostic criteria.

Axis I co-morbid disorders:

Men with BPD tend to have higher rates of substance use disorders, while women have higher rates of PTSD and eating disorders.

There isn’t a significant difference in frequency though. These things are pretty much expected with you take into account general psychopathology/temperamental differences in gender. In things like major depressive disorder, anxiety disorders, or mood disorders there was not found to be any significant difference in BPD diagnosed gender representation.

Axis II co-morbid disorders:

There is significant difference in how men and women present in Axis II disorders which are the presentation of other personality disorder traits. Men are found to have higher rates of antisocial, narcissistic, and schizotypal personality disorders.

When you take a look at the diagnostic criteria for BPD the only real significant difference is women tend to have greater frequency of identity disturbance. Men do present slightly higher in Intense Anger and Impulsivity criteria while women tended to be a little higher in Affective instability and Avoiding abandonment.

When it comes to diagnosis between genders in BPD it was found that the function of impulsivity, how men and women tend to differ in the specific type of impulsive behavior displayed, were often different, even though the frequency was negligible. That is, Acting In or Acting Out. While women might tend towards food (internalizing behavior) men might turn towards drugs or alcohol (externalizing behavior) for self-destructive behavior. But because men tend towards externalizing it is easier to overlook the other more passive/internalized symptoms.

More aggressive acting out is likely to overshadow other symptoms that are also present. So men will be referred to anger management or therapy will focus on that particular displaying symptom, what brings it out, how to react appropriately. Or try to. I don’t know how well this works if you’re only treating one symptom and not the entire problem. Or take something like alcohol/substance abuse for example. If a woman walks into therapy and says she has a drinking problem the therapist is likely to delve into the more emotional reasons for drinking. Social stigmas for men tend to focus on the physical problem, focus on rehab and detox. They might ask what events make them want to drink and suggest how to cope with these, but not as likely to look into why they are more prone to having these reactions that cause them to imbibe in the first place.  

Additionally, finding men to have higher co-occurrences of Personality Disorders is consistent with basic differences in how men and women relate to others socially. Women are socialized to be more interpersonally connected then men. A higher percentage of men with BPD also having antisocial, narcissistic, and schizotypal PDs shows increased difficulty in relatedness to others, a typical gender difference in the more pathological forms of these PDs. For example, in a sample comprised of inpatients and outpatients, men scored significantly higher on mistrust, manipulativeness, aggression, entitlement, detachment, and disinhibition, while women scored significantly higher on negative temperament, dependency, and propriety. Because the presentation of these symptoms is different, and there is a stigma towards the more passive symptom presentations, it is easier to overlook BPD as a diagnosis in favor of a more aggressive diagnosis, like ASPD for men.

All of this muddies the ability to make distinct diagnosis in men, because there may not be a distinct diagnosis for some men or they’re not being treated for their whole problem.

Maybe men should just seek psychiatric treatment more often so clinicians can get a better idea of how their PDed brains work and take some of the stigma off of us. Come on guys, help us out here. Just kidding.  Sort of. ::smiles::

Poor decisions...

My drinking hasn't been totally out of control lately. I'm keeping it to 1-2 days a week currently. Tonight apparently is one of them. Don't know why. Decided drinking would be better than dinner. Not my {something} decision. Espec when I have to be up at 6 for work. Don't need worry about calories so much though. Didn't eat much today.

Drew a lot. Maybe artistic inspiration. Wanted to draw all day. Vodka is artistic lubricant. Sketching variations for my next tattoo. I've been working on this for the last couple months. Iterations, variations... next I need to grab some colored pencils and try to color it. Don't typically do color, just graphite and micron pens.

What the hell's the date? Not this weekend. Next. I hope to talk to my tattoo artist. Wanna get a small tat behind my ear while I discuss plans for this piece. It should take up my entire right side, tipping under my breast, trailing down to the top of my ass. No small piece here. Eventually I hope to incorporate it into my other back pieces. I have no clue how much this will cost. Don't care. Want it. Wanted it for a long time. Ready now.

Female Problems: Controversy in BPD - Part 5

Myth: Only women have BPD, it’s female disorder. 

That’s not to say that BPD isn’t diagnosed more often in women. It certainly is with a 3:1 ration or approximately 75% of people diagnosed with BPD are women. But men have it too. There are a lot of theories about why women are diagnosed with BPD more often:

-          Sexual abuse, which is common in histories of BPD patients happens more often to women than men.

This in itself is debatable. Women tend to report these things more often, but does that mean men don’t have a similar frequency?

-          Women experience more inconsistent and invalidating messages in this society.

Fortunately I think this is beginning to change, but there’s still a ways to go. And it doesn’t make up for the fact that women have been treated differently than men for most of documentable history. Especially in recent decades of greater communication women have had strong messages of how we’re supposed to act, behave, look, dress, take care of others, etc. imposed upon us… and any deviation from these cultural norms has not been met with open acceptance.  We’re often told it is acceptable to be one way, but when we are it is met with negativity and sentiments of being difficult and different.

-          Women are more vulnerable to BPD because they are socialized to be more dependent on others and more sensitive to rejection.

This goes along with the cultural norms imposed upon women. Personally I was taught independence to a fault, and railed against the conflicting messages of the control my parents tried to assert.  I hate the idea of being dependent on anyone. Functionally, in terms of my job, my finances, the day to day aspects of my life this holds true and anyone that questions my ability to do these things is met with a rather volatile response. I hate the idea of emotionally dependent as well. I hate it. I hate it more that this is something that I can’t control when it comes to the people I get close to and involved with. The magnitude of emotional attachment that comes with BPD is part of what makes it a disorder in the first place. Becoming dependent on someone for emotional validation does make the idea of rejection so scary. Especially when there is a tendency for black and white thinking, splitting. If you do one thing wrong, you’ll lose the love and caring of that person. If they reject one thing, they’ll reject all things, and all that will be left is loneliness and abandonment. It’s not rational, but what about this disorder really is? It’s what it feels like that makes it so devastating.

-          Clinicians are biased. There have been studies that show professionals tend to diagnose BPD more often in women than men, even when patient profiles are the same.

It’s not that men aren’t diagnosed with anything, their diagnosis is just different. Men tend to display symptoms differently and meet some criteria for paranoid, passive-aggressive, narcissistic, sadistic,

and antisocial personality disorders, which leads to a diagnosis of these even when BPD is a more accurate diagnosis. Since BPD has a feminine association, it’s ruled out for men almost automatically.

-          Men seek psychiatric help less often.

It’s hard to diagnose someone with something when they don’t seek help for a problem. I can’t tell you how many guys I know that refuse to even go to the regular doctor when they’re ill, let alone seek therapy. I think it has to do with a culturally cultivated concept of the male ego and how men are supposed to behave. But I could be wrong.

-          Men are more likely to be treated only for their major physical presenting symptoms, not necessarily the emotional associations that correspond to them. Their BPD symptoms go unnoticed because it’s assumed to be a woman’s disorder.

-          Female borderlines are in the mental health system; male borderlines are in jail.

While Acting In and Acting Out are major issues for anyone with BPD, women acting out still tends to be directed towards themselves or of a magnitude that is not so outwardly destructive. Men tend towards aggression and act out towards other people leading to different consequences.

* I was incredibly destructive and explosive. I absolutely took out my problems on myself. However I constantly picked fights with my family, explosive screaming arguments, I broke down doors, put my fist through windows and walls…though these things weren’t the kind of thing that could get me thrown in jail. However, the vandalizing, drinking, shop lifting all could have.

-          There has simply been very little research specifically investigating the occurrence of BPD in men.

This couples with men seeking psychiatric help less often. It’s very difficult to form a study when you don’t have a target group to focus on. It also couples with the fact that men are diagnosed and treated with potential inaccuracy so those men where BPD does present are overlooked.

So, it's not that Borderline Personality Disorder is only a women's disorder it's, again, given a biased perspective. It make me sad really, that there are so many misconceptions and biases in the mental health field. It's getting better. In the past it was taboo, not something to ever be talked about or admitted. Today it's pretty common to seek therapy, for men and women. There's still a ways to go though. Part of my goals for doing this blog are to increase awareness and education for Borderline Personality Disorder. I'm in no way a clinician, but I know how I'm affected, how some people in my life are affected, and I am happy to do A LOT of research to futher my own process of change. Knowing what I'm/we're up against, options, information, treatments... simply that we're not alone in this struggle, is encouraging. Hopefully, and it seems to be so, others find this useful as well.

Tomorrow I’ll talk more about the difference in presentation of BPD symptoms in men vs. women.

Axis I vs. Axis II: Controversy in BPD- Part 4

Where does Borderline Personality Disorder belong?

I’m referring to the DSM criteria for Axis I and Axis II designation. Let’s start off with, what’s the difference between Axis I and Axis II.

* Axis I: major mental disorders, developmental disorders and learning disabilities. Axis I disorders are predominantly mood disorders.
 * Axis II: underlying pervasive or personality conditions, as well as mental retardation. Axis II disorders are personality disorders.

For or Against?

[For Axis 2] Personality disorders are classified as Axis II disorders.

Personality disorders in general have their own list of general criteria that must be satisfied. They’re a class of personality types and behaviors that the American Psychiatric Association (APA) defines as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”.

“These behavioral patterns in personality disorders are typically associated with severe disturbances in the behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in the client adopting maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress and depression in clients.”

The behaviors cause serious interpersonal and social difficulties as well as general functional impairment. I don’t think anyone can argue that BPD fits this criteria, which is a large part of why it is considered Axis II. It also has a sub-designation as Axis II, Cluster B which is characterized by dramatic, emotional or erratic behavior. No argument there either.

Debate:

[For Axis 1] Both Axis I and Axis II are psychiatric disorders. Only personality disorders and mental retardation are segregated onto Axis II. All other psychiatric disorders are Axis I. Does it really make sense to segregate these if they are essentially the same type of thing?

[For Axis 2] However Axis I disorders are generally treatable with medication. While some presenting symptoms of Axis II disorders may be treatable with medication, it’s not shown that medication can ‘cure’ a personality disorder and correct all presenting symptoms.

 [For Axis 1] Moving BPD to Axis I would have economic benefits. Many insurance companies don’t recognize BPD as a treatable condition and use it as an excuse to withhold payments. I know for a fact that my therapist classifies me as Major Depressive when billing my insurance company. I am pretty certain my psychiatrist does as well. This is certainly true, but not completely accurate.  I’m not going to complain though.

I think the major debate lies here:

[For Axis 2] Axis II BPD is pervasive to a person identity, characterlogical in nature.

[For Axis 1]: But…There’s some debate about whether BPD should be considered a ‘personality disorder’ at all because it has such a high rate of co-morbid symptoms that fall into the Axis I designation.

Axis I disorders are primarily for mood disorders that are reactions to atypical situations which are not part of a person’s character. “Mood disorder is the term designating a group of diagnoses in the DSM IV TR classification system where a disturbance in the person's mood {not their character} is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in ICD 10.”

[For Axis 1] There are many disorders that are just as pervasive as BPD such as bipolar, anxiety, and depression that are not caused by atypical situations, and are classified as Axis I disorders.

“Two groups of mood disorders are broadly recognized (though not limited to these two); the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as manic depression and characterized by intermittent episodes of mania or hypomania, usually interlaced with depressive episodes.”

People with Borderline Personality Disorder almost always have a history of long term, pervasive depression.  I’ve never heard of anyone that didn’t, but I’m not a clinician. Hypomania is not always present. If you have manic phases though, that is the definition of Bipolar and while you can have bipolar disorder and BPD, I think you would then have both Axis I and Axis II designations, not just one or the other. From here it could be argued that the mood regulation disorders are the underlying cause for all the other disorder manifestations.

[For Axis 1] There’s also the stigma that a personality disorder just means that a person has a flawed personality that can’t be changed.  Except there has been plenty of research to support the idea that this is an emotional regulation disorder.  Which means it would technically be a mood disorder and qualify it for Axis I.

I can see how the mood disorder aspects can affect a lot of the behaviors and symptoms of BPD. I'm not sure it can explain all of them though. Things like a tendency towards impulsive behavior, identity disturbance, fear of abandonment, etc... these are not necessarily dependent on mood alone.

I certainly don’t believe that a personality disorder just means you have a flawed personality. Calling it a flaw implies that it’s a minor issue, easily corrected. BPD is not minor, nor is it easily treatable. You might not be able to change everything about who you are (or want to), but if there is an aspect of your life that you do not value; if you are willing to put in the effort; if you have hope of living a better life or just a life different from what you currently experience– it is absolutely possible to make changes in yourself. Without hope for change there can only be resignation to the inevitable. But people do have control over their lives, what choices they make, how they want to live. It may not be easy, maybe everything can’t be ‘fixed’, but it is possible to heal from those things that we are willing to work to change.