My Kind Of BPD

Is anybody else still out there? I'm still here, despite my fits and starts of disappearing. My laptop broke again, and I've been accessing the internet through my iPad and through a friend's laptop. My memory is no better, and so I forget about things that I usually keep tabbed (such as this blog, and Flight Rising, and Facebook...) when that happens.

Today I've been thinking about stigma, and how even those of us who fight it can still be vulnerable to it. In particular, I've been thinking about the stigma of Borderline Personality Disorder, and the ways in which I've bought into it without meaning to. Have you ever said, "I have BPD, but I'm not a typical Borderline", or something similar? I have, frequently. I seem to always be explaining to people that even though I have BPD, I'm not "that" kind of Borderline. Partly I want to be understood for the individual I am, rather than a stereotyped version of my disorder -- but mostly I'm trying to distance myself from everyone who is "that" kind of Borderline.

And every time I do that, I drive another nail into the stigma-coffin. Every time I say it, I may as well be screaming out that there is a "good" BPD and a "bad" BPD. There's not. There's just BPD, in varying degrees of intensity and with myriad presentations of symptoms. It's all the bad kind. It's all the good kind. It's all BPD.

Given that, maybe instead of rushing to defend myself by sticking that "bad" label on the people with different symptoms, I should quit telling people what my BPD isn't... and start talking about what my BPD is (bearing in mind, of course, that my comorbid disorders bleed into BPD and each other).

• My BPD is a lack of self stability that shows itself in an uncanny ability to unconsciously chameleon. By this, I mean that without intending to, I often change myself according to the people I'm around. This change will include everything from words and mannerisms to thoughts and even beliefs. It's never being sure of who I am, or if I really like the things I like. It's constantly wondering how others see me, and trying to create a self-view based around that, because it's the best I can do.
  
  
• My BPD is excessive self-monitoring and criticism. Everything I do comes under the deepest of scrutiny by my own mind. Was that too blunt, too subtle, too rude, too ineffective? Is that appropriate to do/say/ask? One thing is of particular concern since my diagnosis: "am I acting in a way that reinforces BPD stigma?"
  
  
• My BPD is interpersonal hypersensitivity. It's never knowing whether what I'm sensing from others is their stuff, or my own. It's misinterpreting others' emotions and needs as being my fault in almost every situation.
  
  
• My BPD is intense relationships. It's needing to be part of everything, to feel included. It's always following along, feeling like a sheep or a lost puppy. It's over-involvement in other peoples' lives until I think they're sick of me, whereupon it's backing off and hiding away.
  
  
• My BPD is a preoccupation with, and terror of, abandonment. It's weighing up constantly what I can say and do to not lose the people I love. It's always being the one to say sorry, to shoulder the weight of fixing anything that goes wrong. It's the unconscious chameleon behaviours to fit in, to belong. It's being afraid to eat in front of the people I care about until I've done it enough times to be sure I won't screw it up so badly they don't want to be around me. It's terror of my friends' friends, because there's a perception that the opinion of those peripherals will influence the opinion of the people I care about. It's needing to be part of everything, to feel included. It's being a doormat, because if I give everything I have and am, then people will maybe have reason to stay.
  
  
• My BPD is emotional hypersensitivy. It's feeling everything in an intense way - as though I'm the equivalent of a burn victim, my emotional skin gone and the nerves laid bare. It's knowing that people think I'm a drama queen because everything is so out of proportion, and still not being able to control or damp down that intensity. It's loving so strongly it wants to explode out of me, and it's hurting so deeply I can't bear the weight of my own heart.
  
  
• My BPD is difficulty recognising and managing my emotions. It's being so afraid of my own anger that I am only just beginning to feel it instead of automatically transmuting it to a different emotion. It's crying silently and fighting it the whole time, because it feels so wrong not to. It's fighting every emotion, trying to run and hide from them, and failing every time. It's being overwhelmed almost constantly because I don't even know for certain what I'm feeling.
  
  
• My BPD is an overabundance of anxiety and depression. It's everything I already covered under terror of abandonment & emotional hypersensitivy, and so much more besides. It's fear of being imperfect, fear of losing control. It's shame, and guilt, and the weight of clinical depression bearing down on my shoulders. It's fear of, and difficulty adjusting to, change.
  
  
• My BPD is impulsivity. It's acting in the moment, despite my intentions to follow a different plan. It's spending hours scrutinising myself, and then out of nowhere blurting out something utterly inappropriate. It's writing out a shopping list, then ignoring it and spending all my money on junk food and craft material instead. It's taking out something for dinner, then deciding at the last minute to eat something else, and doing it on a regular basis.
  
  
• My BPD is self destructive behaviours. Sometimes, it's suicide attempts because I don't want to be here anymore, because I'm done and I just want out. Most of the time, it's self harm, alcohol abuse, disordered eating. It's mixing uppers & downers because I know it messes with my body. It's over-eating, under-eating, and it's eating foods that will make me uncomfortable. It's giving up just when I get near to reaching my goals, and it's pressing on [emotional] sore spots. It's making decisions based on what will cause me the most amount of harm/pain, because all I really want to do is destroy myself.

My BPD is a disorder and a disability. It's not the good kind of BPD. It's not the bad kind of BPD. It's just my kind of BPD. What's your kind of BPD?

Letter to the Person Living With BPD

I wrote this last year and shared it on my Australian BPD group. I came across it again today, and it seems like something that I should place here, as well. Although it's for 'the person with BPD', it may offer some small insight for those who don't have BPD as well.

To the person with BPD,

First of all, know you are not alone. There are men and women from all walks of life who can identify with those three letters, and though they may not always be people you would choose to have in your life, they are your allies and your kin. We walk these paths together; and as lonely as it can be, because of that we are never truly alone.

Know that when you research your condition, you will come across websites that call you evil; you will come across websites that claim you are narcissistic and lacking in empathy. Know that being diagnosed with BPD does not equate to these things. Being diagnosed BPD means many things, but know that it does not make you a bad person. No website calling all people with BPD 'evil', 'manipulative' or 'narcisstic', or calling for extreme avoidance of all those diagnosed, is professional or accurate.

Know that your future is not assured. BPD is, technically, incurable -- but it is not a life sentence. There is treatment available and life can get better. If you have done DBT and found it unhelpful, know that there is more than one option out there. There is no such thing as a one-size-fits-all treatment for BPD, no matter what anyone tells you.

Know that your feelings, as strong as they are, will dissipate if you allow them to. Your anger will fade; your sorrow will ease. Nothing lasts forever, and your feelings are not the exception to the rule. You are the emotional equivalent of a third degree burn victim but you have the ability to graft yourself with thicker skin. You can get through this.

Know that you can learn to control your behaviour. What you do in impulse now, you can learn to contain. Your angry outbursts, your uncontrolled spending, even your self harm can all become more controlled and can even be overcome entirely. It will take time and it will take a great deal of hard work, but it can be done.

Know that the world is not as black and white as you'd like it to be, but you can learn to be okay with that. Know that your instinct to cast people or events into categories on the extremes can be worked with. You will learn, in time, that nobody is all good or all bad, and that is okay.

Know that you will learn to know yourself, gradually. Maybe you will start with your favourite colour, or you will choose an animal to love. Maybe you will discover that you like your eggs scrambled, or you dislike jelly.

Know that sometimes people will leave, but it doesn't mean that you are being abandoned. Life is full of change; people move on, or are taken from us suddenly. Not everyone was meant to be a permanent fixture in our lives; some people will stay for a heartbeat, others will fill our hearts for years. Know that you can learn to be okay with the changing landscapes of friendships and loved ones, despite the pain.

Know, most of all, that there is hope. BPD is not a negative reflection on your personality and life can get better.

Returning from the mists -- & a question re friendships

Hello world!

It's been a long while since I posted, I know. I want to reopen this blog, but I'm not sure exactly what direction I want to take it in. I am, for the most part, doing quite well these days. I've been working very hard on myself and my issues. Don't get me wrong, I still have BPD symptoms that I need to get or keep on top of, but I'm not sure I even still meet the criteria.

My Sanguine Saturday posts have stopped, partially because I think I don't need them anymore, and partially because I just kept forgetting to post them once the internet was back on. A bit of shuffling may make these useful again, or I may abolish them entirely now that they have served out their usefulness.

My last episode of self harm, a minor cut to my shoulder, was in April (?) and it remains the only instance of self harm this year. That feels somewhere between a miracle and an amazement, and at the same time I'm a little bit proud. It's a big achievement for me. And although I have had a couple of drinks (few enough that the bottle of Vodka I bought at New Years still has alcohol in it even though I've shared it with both my partner and his adult daughter), my last problem-drink was in September.

Most of my problem behaviours have settled at least somewhat. As I said, I've worked hard.

My thoughts and emotions continue to need a lot of work, though, and although I've cut back on my therapy sessions, I have signed up to be included when DBT becomes available here. They're trying to make sure they have large enough numbers before they tell us when it's going to start, but I'm hopeful it'll be running by next year.

My partner and I are quite happy still, though of course we have our moments like any other couple. We have strong communication (I bet nobody expected I would be able to say I have strong communication with anyone!) and respect for each other - despite using nicknames like Bumface for each other. ;)

The one big thing missing, for me, is that I still have very limited friendships and "regular" support network. I have ceased contact with my father, and contact with the rest of my family has also been drastically reduced; and I simply don't have much in the way of friendships offline. I've been able to reconnect with one of the girls I went to school with, with whom I was close for a few periods after school, and that's been good, but I really need more friends locally.

My volunteer position didn't work out - I just wasn't ready yet - so I'm wondering if any of you have any suggestions on how I can meet and make friends, especially local ones? I spend some time at the local mental health community facility (with workshops and activities) but I'd really like to make friends with people who're functioning better in the real world than I am. There's a games store opening up locally that sounds like it'll run board game nights etc, so I'll check that out, too, but any other suggestions would be very welcome.

Final London Sanguine Saturday

Oh my, Saturday again already? Well, technically Sunday, but as I've only just got in, I'm going to count it.

Well, tomorrow's my last proper day here in the UK (I fly to Sweden on Monday, and although I'm back again after Sweden it's only overnight and then I've an early flight back to Australia), and I'm really quite sad to be leaving it. Happy, of course, to have the opportunity to go see my Swedish friend, but despite the crazy, despite some hard times, I've really enjoyed the UK and I've loved the people I've met. And especially these last few weeks, I've really done a lot of growing, which I think is something to be pleased about.



Success Stories:
No burning.
No drinking. In fact, as it's the 7th in Australia, I can announce that I'm now 3 months sober.
I've continued to push at my touch boundaries.
I've been practicing some new ways of interacting with people. (True, I get it wrong sometimes [a lot], but I'm trying, and that's important.)
I've done really well navigating myself around London.
I've done some scary but cool things -- like the London Tombs experience! (And oh my god was it ever scary for me!).
I've handled my money better than I expected to.



Gratitudes/Happy Things:
Friends.
Opportunities for growth and change.
Being brave enough to do some of the things I wanted to that I didn't think I could manage on my own.
Forehead kisses from safe people.
Zoos and squirrels.
Being called pretty (even though it was also very difficult to hear and created a lot of confusion and mixed feelings!)



Challenge and cheer-leading statements:
It's okay to ask for clarification if I think I might have misunderstood something.
It's okay to ask for touch, to accept touch, to enjoy touch. It's okay to share that with people I care about.
Sometimes it is okay/right/best to tell the person I'm with if I'm not okay.
It's okay to make mistakes and be imperfect.
I don't have to take on board every single thing that someone says about me. I can take it, see what fits and what is helpful, and I can leave the rest.
I don't have to fix everything *right now*. It's okay to prioritise and leave some things aside to work on at a later time.




Apologies for the lack, but no outward links again this week. I think I probably will post less links while I'm away, but feel free as always to link in a comment to my SS posts if you do your own version! I still want to read and I'm sure others do, too!



Take care of yourselves until next time, and may we all find our own small fences along the way.

Following Up From Turbulent Waters

Two weeks ago, I wrote a post about what happened when my GP and I tried to get me back into the mental health clinic here. I received some supportive responses (both here and elsewhere) and I received one comment that has been on my mind.

I thought about replying to this on the original post, but most of what I have to say feels appropriate as its own post. I won't lie and say I didn't have an emotional reaction to the comment - in truth, I had an extremely strong one. I felt rejected, dismissed and invalidated; my knee-jerk reaction was to quit and never write here again. Obviously I've chosen not to take that path, but then I had other paths I could take. Should I let the comment stand? Should I treat it as gospel and take it to heart or should I dismiss it entirely?

After a couple of weeks reflecting, I decided to do neither. It's important that I don't simply take on board whatever anyone says about me - but it's equally important to me that I'm open to criticism and don't deny something simply because I don't like hearing it. So I reflected; I thought about what was said, and about the beliefs I have around the statements used, and I read my own post through several times.


So, in response to,

"Anonymous said...

You have to see it from their point of view - if after all that help you're still not much better, why would they invest more time and money in you? They've already invested a lot in you and it didn't do a whole lot, so they are now giving other people a chance. Don't go playing the victim."


I would like to start by saying that I don't believe, in this situation, I am "playing the victim". That term, to me, is about not making use of the power that you have. I am, in actual fact, powerless over what decisions the Mental Health clinic makes about my care once my part is done. Their decision was not in my power - what was/is in my power is my reaction. That, I accept responsibility for entirely -- what I choose to do with and about their decision is in my power (within my own limitations) and nothing to do with Mental Health.

However, that "within my own limitations" is important. It's not an excuse to say "to Hell with it" and give up - but it is important for me to remember that I deserve to give myself leniency for things I legitimately cannot help. Everyone has limitations and nobody is perfect. One of my limitations is that DBT was not enough to stop my self harm.

Whether "anonymous" intended it or not, the implication behind the comment was that because, after investing so much time and effort into me (I assume through my course of DBT), I was not better "enough", I do not deserve further treatment. In my view, this is wrong. Everyone deserves health care. Everyone.

If we apply this logic to physical health concerns, it becomes much more clear. If a skin graft operation is unsuccessful for whatever reason, the surgeon does not simply cross the patient off and move on. He or she sits down and thinks about what to do next - and then puts the options into place. Sometimes this means that the procedure is repeated. Sometimes it means that alternatives are explored. If a surgeon simply threw up his hands and refused further treatment because the patient was not "better enough" there would be an outcry.

Why 'would' (or 'should'!) they invest more time/effort/money in my health? Because they haven't tried everything. Because there are avenues that have not yet been explored. Because DBT is not, and was never intended to be, a one-size-fits-all cure. The fact that DBT has not helped me "enough" doesn't mean I am not trying, it doesn't mean that I am beyond help, and it should not stop me, or anyone else, from receiving further treatment.


And yet... this is what is happening in the mental health industry, especially when dealing with those with Borderline Personality Disorder. I don't mean just locally to me, either, this is happening all over the world. Mental health problems are just as valid as physical health problems, and there should not be barriers to receiving treatment and care based on the fact that you are not "well enough" after completing a particular treatment.


There were two other things I'd like to address from that comment.

First, I'd like to dispute that DBT didn't "do a whole lot" -- I think most people who know me well have seen massive changes in me since DBT. Not curing me is not the same as not doing much.

Second, I'd like to say to everyone that although I have allowed anonymous comments so that those without an account can still comment, I would very much appreciate knowing who leaves comments. As long as things are kept respectful, I don't mind people having opinions that differ from mine, and I'm okay with being called out on things... but I don't think that doing so anonymously is generally respectful. In my opinion, if you don't believe in your opinion enough to stand by it as yourself, then you don't believe in it enough to say it with good intentions.



Take care of yourselves until next time, and may we all find our own small fences along the way.

Turbulent Waters: I'm Really Not After A Miracle!

It's no secret that life's been a bit of a rough trot here, lately. Part of that is due to circumstances in my life right now/recently, part of it is not having medication that works properly, and another part is not having a large enough support network offline.

Whatever the reasons, though, the end result is the same: I've been struggling for a while, and things aren't getting better on their own. After yet another bout of what's being termed "severe self harm", my doctor last week decided to push for me to be seen at the free mental health clinic again. I told myself I wouldn't allow myself to hold out too much hope for a better outcome than last time, I told myself that I would be okay if/when nothing came of it.

Everyone else was so sure something would come of it. Surely. Surely, they had to see that I wasn't making it on my own now. It's been just under a year since I was closed off the books, a year since I did DBT. I've been using my skills, even this blog itself is proof of that. I fight every day to be okay. Surely they had to listen now. I started to let my hopes rise. And then I was given an intake appointment.

So I began to get more invested in the outcome. I began to believe that I had a chance at getting real help again. And then the call didn't come when I expected it.

I felt let down, but I told myself that maybe they were just busy. Maybe I misinterpreted what Intake had said, that I'd got it wrong and that they would call at a later date. A few days after I had originally expected the call, I was about to head out when my mobile rang.

"Hi C, it's [old case manager] here from mental health."

My heart skipped a beat. This was the case manager I'd worked with prior to DBT; the one I'd worked really well with and trusted. I thought she might be calling to say she'd be my case manager again.

"I just wanted to let you know what the Intake team have decided about your case. Now, you've done DBT. You clearly don't want to stop self harming, there's nothing more we can do for you. You know there's no miracle cure, medication isn't going to fix you. We have decided not to take you on."

I was gutted. Crushed. The crushed hopes were bad enough alone, but to have them crushed like that by [old case manager] was like being told by Santa Claus that he wasn't even going to bother leaving you coal. A few minutes of silence followed where I fought my tears before she added insult to injury with,

"What did you even expect to come of this? What do you want?"
"I... I don't know. I-"
"Exactly. So, bye then. Good luck with everything."

I was hurt. Betrayed. Crushed. Gutted. Afraid. For a little while I was even furious. Not just angry but actually furious! How could they? I have fought so hard for so long. I try so hard, I have made so many changes. My feelings were a confused jumble of negative emotions and I cried fairly hard at first. I pulled myself together and left for my appointments, but the emotions didn't go away. They're still right there, because this is a big hurt.

It got bigger when I went to report back to my doctor and found that mental health had got there first and read him the riot act about how manipulative Borderlines are. My formerly supportive doctor greeted me with "do you even want to stop self harm? How much?" then proceeded to tell me again that there is no miracle cure, and told me that since I have done DBT mental health are not interested in wasting their time or mine.


I am tired of being told that there is no miracle cure. I am not looking for one! I'm not afraid to put in the hard work, I've been doing that. It's not working (enough). I know medication makes a difference for me, when it works. I know that. Why won't anybody in a position to do anything about it listen to that?

Dear mental health professionals,
Please, stop assuming that because I happen to have a label with a bad rap, I fit what that label means to you. Please stop assuming that wanting medication that works for me is synonymous with "I want a miracle cure". Please stop assuming that because I'm struggling to stop self harm it means I don't want to. Please stop assuming that I have manipulated my GP into advocating for my treatment. Please just stop making harmful assumptions about me!

I'm asking for help, not a cure. If I didn't have the BPD label, you would be falling all over yourselves to help me. Your labels are supposed to be there to help, not hinder, my treatment.


And now, since mental health is again a non-option, we're back to square one. Where do I go from here? It's so tempting to give up - all the professionals have, why shouldn't I?

Because when I give up, there'll be no chance for it to get better. And because I deserve better than that. I am getting a psychologist referral, and I will take my 6-12 free sessions and do what I can with that. It's better than nothing.

And so I go on putting one foot in front of the other and doing my best to get through each day however it comes. Imperfectly, certainly, but until I can move (something that I can't do until I receive the money from my settlement over my knee which is currently held up due to an error) it's my best option.


Challenge and cheerleading statements:
* Things are not as hopeless as they seem. This isn't forever.
* This situation does not reflect my value.
* I deserve better than to give up on myself.


Take care of yourselves until next time, and may we all find our own small fences along the way.

Trusting My Intuition

Intuition. Going with your gut. I wonder if that's a concept that others with Borderline Personality Disorder commonly struggle with, as well. I can see how it could be tied into various aspects of living with BPD; the lack of belief and trust in yourself, the lack of (knowledge of) a self to trust in... I can see that.

If you'll forgive my segue into something that may (at this point) seem completely unrelated, I remember once reading that people who have Borderline Personality Disorder are particularly sensitive to the moods of others. By that, I hasten to add, I don't mean in terms of the well known Borderline hypersensitivity to rejection; rather, in terms of recognising general emotions in others, and being able to identify when others are being false about their emotions. I wish I could find that article again because it was fairly interesting, even if, at the time, I disagreed with a lot of what was said. I mention it now because a recent situation in my life has given me cause to really ponder some of the ideas behind that.

You see, when I came back from Canberra, I sensed that things in my circle of friends weren't 'right'. Something felt off. I told myself that I was just being paranoid; that I was misinterpreting the situation and that I was being silly.

My friends started doing more and more things without me; things we had previously done together. I felt excluded, but I told myself that it was just that they had made the plans when I wasn't there, and just hadn't thought to let me know/invite me; or that they were preparing for my intended move; or that they were giving me time and space to prepare for the move.

When we did hang out, I felt waves of dislike coming from my friends, and especially from one friend in particular. I told myself over and over again that I was just projecting my own dislike for myself onto my friends. I told myself that they wouldn't invite me to hang out with them if they didn't like me, if they didn't want me there. I tried to talk over the top of the little voice in my head that suggested that maybe I was right, maybe something really was wrong in these friendships.

I spent three months in this daily fight with myself, trying to drown out that "unhelpful voice" that was telling me that something wasn't right. I wasted three months. Eventually, something happened and a conversation occurred between one of my friends and I. I told her how I had been feeling, she told me what had been going on. It turns out, you see, that I wasn't just paranoid. My initial thought, my recognition that something wasn't right, turned out to be spot on. Something really had been going on in my friendships, and I had wasted three months telling myself that my recognition of that was wrong, that it was the unhealthy and unhelpful voice of paranoia.

Things with some of that group of friends are back on track, now. They're not back where they used to be, but I'm more okay with how things are. That first friend I talked to, she apologised. I apologised. There were a lot of miscommunications; a lot of misunderstandings and, yes, plenty of mistakes... on both sides of the coin. And the day we started to talk about it, we both began to heal those wounds. It was not an easy day for either of us; but (and I speak here for myself, only, I cannot say whether these words ring true for any other people) I think it was certainly a worthwhile one.

I wouldn't wish for it to happen again, but there was value in that experience. I learned some very important things that I would not otherwise have learned yet.

Not only did I re-learn the importance of honesty and clear communication in my friendships, but I learned that my "unhealthy voice of paranoia" is my own intuition; insistent but unpracticed and generally unrecognised. I learned the importance of trusting that intuition and of acting on that in responsible ways.

I also learned that maybe there is something to the idea that, as someone with BPD, I might be more sensitive to mood changes in others. It makes sense, after all. As a child, my survival depended on being able to judge a situation or a person's mood, it makes sense that as an adult, I am still able to tap into that skill; however unintentionally or subconsciously I do it.

The trick, then, in understanding how such a concept might work, came in recognising for the first time that being able to detect changes in another person's mood, means just that. It doesn't mean I'll get it right every time; it doesn't mean there won't be misunderstandings. In fact, it is probably this sensitivity that leads to those misunderstandings, such as in the following scenario:

We are walking together and as we walk, we chatter. Suddenly, you see a car go past that reminds you of your ex-husband's car. Your mood drops.

I notice that your mood has changed, but I might decide that it's because I've said the wrong thing, or that you are wondering why you hang out with a loser like me. My intuition has recognised that change ... but my disordered thinking has misinterpreted the facts.

I can trust my intuition! It's necessary to remember not to blindly act on the specifics of it, but if I sense something change, if it's important, it's okay to trust my intuition and check in with the other person! In fact, it's more than important, it's downright essential.


Take care of yourselves until next time, and may we all find our own small fences along the way.

Mucky Monday: Rejection & Abandonment

I've had a rough couple of days. Then again, sometimes it seems like I bounce from one bad day to the next. First of all, I struggle to be okay with being okay (more on that in another post, I think); and then, of course, life keeps happening, and I struggle with the ability to find my feet there.

When mental health closed my file, I was told to make an appointment with my GP and connect with him. I was told to see him approximately as often as I had been seeing my psychiatrist (I am curious if she ever listened to a word I told her about the extent of my self harm - I see my GP a couple of times a week in regards to that) and check in with him in regard to how I am doing.

Let me preface this by saying that as much as I'm about to use powerful words such as "knew", this is mainly conjecture. To start off this new plan, I had organised an appointment with my GP for today to discuss the letter and make sure he was happy enough with the plan. I knew, as soon as I mentioned it, that he was not happy. We are staying with that plan, for now, but he made comments along the lines of "we will find an alternative if you continue to deteriorate". I am not hopeful that there are any alternatives left; but that is not a bridge to cross today, so I am choosing to leave it. Perhaps if/when it does become relevant, there will be new avenues to take that are not currently open to me. The future, after all, is not set in stone.

As he provided the necessary treatment, my GP mentioned to me that he is planning to leave for a month. He stressed that it is absolutely imperative that I begin to see one of the other GPs in the practice while he is still there. His concern is that if I do not, and I need to see a GP while he is away, the situation will end in my needing hospital. I agree that this is not at all a favourable outcome (and my heart secretly wants to beg him not to leave, thus solving the entire situation).

So, on the heels of mental health closing my file, and my ex husband's new fiancée giving birth to his daughter, the sexual violence counsellor I managed to attain after leaving DBT (unfortunately I was not able to hook back in with my old counsellor, but the new lady is one I am familiar with through various art activities run through the centre) is going to be away through all of my upcoming major trigger dates/events, the nurse that I see for wound dressings was away... and now my GP is also leaving. Is it any wonder my normally high fears of abandonment and rejection are so high they're staring down at the stars, at the moment?

Like most people with Borderline Personality Disorder, I am hypersensitive to abandonment and rejection. Usually to decrease the chances of it happening, I will people please to an extraordinary degree. In this situation, there's very little I can do along those lines. No matter how much I try to be 'good', my GP is still going to take his holiday. My counsellor is still going to be away. Mental health are still finished with me. I feel at a loss, as I fear that everything I have put faith in to be there and sustain me is fast disappearing. Soon all that will really be left is me, myself and I.

Knowing those fears are there, though, doesn't mean I have to bow down and give in to them. I have a choice, now: I can choose to see this as yet more rejection and abandonment, and throw in the towel; or I can choose to see that these events are not necessarily connected. It's a hard path to take, to choose to see that these events may have nothing to do with me or each other; and I imagine I'll fall down a lot along the way, but I much prefer the place to which that path leads.

I am choosing to tell myself that it will be okay, that I can learn from this and grow, that I have the capability to live through this and come out the other side a better person.



Today's thought challenges/cheer-leading statements:
If my GP chooses to take a vacation, that does not mean he is personally rejecting me.
A slip is not a failure. I now have a new chance to try again.
The past does not dictate the future. Just because people have left in the past does not mean that people will always leave me.
I am not a bad person.
If someone is upset by actions I have taken, it does not mean they cannot like or love me anymore.



Take care of yourselves until next time, and may we all find our own small fences along the way.

Even amidst my disappointment, there is growth

Although I had originally intended to follow through on my individual criterion focus this week, in sitting down to actually do it, I discovered that I could not get it to just "flow" quite right. In fact, everything I write tonight sounds either stilted or whiney. I'm scatty and I seem to lack any semblance of an attention span, but I've written and rewritten this entry a dozen times over, and I just cannot find my comfortable Blogging voice.

Today has been a difficult day for me.

After DBT ended, I knew that the plan was for me to be released from Mental Health, but when I spoke to my psychiatrist and let her know my concerns, she said she would talk to the team, and then we would discuss what was to happen at my next session (today). At that session I also made a completely unsuccessful attempt to be placed on a different medication. I resolved that I would work harder to get my point across this time. I did a bit of cursory research and came up with two alternatives that we've not yet tried. I made notes reminding me to use my DEAR MAN skills and to stand my ground. I also included a note and phone number to remind me to have her call my GP, as per his request from the last time I'd seen him. I assumed that once all of that was done, we would finish up and that would close my file, and I surprised myself by finally being more okay with it than I'd expected.

So, when I turned up for my appointment today, I was prepared. I held my folded paper in my hand, a tangible reminder of the work I had done, and the importance of being effective. I shook in my boots as I entered that room, but I worked to Appear confident. (Those of you familiar with DEAR MAN will recognise the A from "MAN" - everyone else, please just be assured I have not decided to begin random capitalisation!)

Before I had a chance to even begin to Describe the situation, my psychiatrist spoke. "I closed your case yesterday and sent a letter to your GP."

I froze; all of my false confidence deserted me. Where was the discussion she'd spoken about last month? I had come to terms, in part, with being transferred solely into my GP's care - but I still wanted discussion. I wanted to discuss the medication issue. I understand that medication won't solve my problems with self harm; I know that medications won't stop me from feeling. On the other hand, I have experienced (briefly) what it is like when the medications are working, and I would like to experience that again. And perhaps most of all, I wanted my GP to air his concerns to the psychiatrist so that she could reassure him, because my reassurances mean very little. I, after all, am the patient who presents regularly with what he terms "severe" self harm; the one who reassures him she's fine, only to turn up with new injuries a couple of days later.

I was humiliated when the next question she asked was "what happened to your face?" I am a skin picker. I don't view it as self harm (although throughout DBT, Sandy tried to tell me it was) and I feel that my reasons behind picking are very different to my reasons behind self harm; it is closer to a compulsion than an urge, and I am even more deeply ashamed of it than I am of self harm.

She spoke to the air for most of the time I was in that room. I nodded occasionally, said "yeah" a few times, and stared at a fixed point. I didn't bother bringing up the medication; without any prompting she launched into a speech about how I know the skills, I'm simply not using them; and another speech about how no medication will help me at all. I did make an attempt to have her call my GP, but she dismissed it, telling me she had written him a letter. Mostly what ran through my head was "don't cry don't cry don't cry don't cry don't cry". I feel dismissed and rejected; I feel abandoned. I feel an extremely strong urge to self-destruct. Those are not emotions. I felt sadness, disappointment, guilt and anger. I feel fear that my GP will not believe that I tried to get her to call him.

I find that, also, I am disappointed that I went to pieces so quickly, disappointed that I didn't make better use of my DEAR MAN skills; and yet even in this I can see signs of change.

I allowed her to see that I was upset. I didn't talk to her about it, but for once, the emotions I displayed were congruent with the things I had been telling them.

I did attempt my DEAR MAN skills. This is growth, many's the time in the past I would let everything slide rather than ask for anything.

I identified and expressed the emotions I'm feeling about the situation.

I didn't listen to my urges to self destruct.

Apologies for the lack of thought on this entry, and the over abundance of whine. Perhaps tomorrow my brain will work better again.


Today's thought challenges/cheer-leading statements:
These feelings are unpleasant, but they will pass.
The urge to self-destruct is just an urge. I do not have to listen to or follow any urge.
I am adjusting. It will get easier. I am doing okay.
I have a good GP. If I explain to him that I asked her to call and she felt she had said everything that needed saying in the letter, then he will understand. If he does not understand, I have the skills to handle that situation.
This is not a sign that I am not worth helping, that I have been thrown away or that I am not good enough. This is a vote of confidence in my ability to manage myself for a while.


Take care of yourselves until next time, and may we all find our own small fences along the way.

Breaking Down The DSM

After being inspired by someone else, I thought tonight I would take a look at how the DSM criteria fits me - both now, and how it fitted/impacted me pre-DBT. (I'll apologise now, I'm retyping each of these as I go, so you'll need to forgive me for changing the spellings to the accepted Australian equivalent!)

The DSM-IV criteria for Borderline Personality Disorder states that there must be "a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following". Before I elaborate on the indicators, I'll make a few comments on this. I still don't think the psychiatrists had enough information about me to diagnose me when they did, but I have to admit that it's certainly true that I was exhibiting signs of poor mental health by at least the time I was 3. That, I think, certainly falls under "by early adulthood".


1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.

To me, this depends how much meaning we're attaching to the term "frantic efforts". What does that even mean, anyway? Are we talking physically holding on and begging them not to leave? I've never threatened to do anything drastic because someone was thinking about leaving. I don't recall screaming or pitching a fit to keep someone from leaving. I did, however, cling desperately to my friend's husband's hand when he had to take me to the doctors, and again when he had to take me to the hospital. I've made attempts to reduce the likelihood of abandonment by doing things like not admitting to liking something, or wearing the guilt for something they might have done wrong, or going back on my values, though. That one, I have to admit, is accurate for both now and the past - but I'm pleased to report that, post-DBT, I'm now less likely to resort to these behaviours.


2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.

I freely admit, I've always been terribly guilty of placing people upon pedestals that are far too high, and becoming devastated when they eventually tumbled. I'm not sure I would categorise myself as having a pattern of unstable relationships characterised by that, though - some, certainly, but I believe that the majority of my relationships with people were fairly stable pre-DBT, and even more now. One thing I've come to understand is that, pre-DBT, when I idealised someone, it took quite a bit for them to fall. Usually if there was anything that might have knocked them from their perch, I took responsibility for that, and thus kept the other person "pure". Post-DBT, I've become more able to hand responsibility where it belongs, and so people are falling from their pedestals a little more frequently. Interestingly, the pedestals I'm building now also seem to be shorter.


3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

All my life I have been a chameleon. Whoever I was with, that's who I became. If someone wanted a certain type of person, I would do my best to fit that mould. My self-image in that time has remained fairly stable, but my sense of who I am has not. Having done a full course of DBT, I'm finding myself a little less unstable in my sense of self - I'm beginning to find a niche for myself that feels right; beginning to get an idea of who this person who goes by [dawni] actually is. Feedback from others still helps make up the basis of what I know about myself, but I'm slowly learning to match that feedback with what others have told me, with what 'feels right'. I have learnt that I like photography a lot, that I am avoidant and that I am a difficult read. I have decided for myself that my favourite colour is blue and my favourite animal is the giraffe; I have given myself permission to choose these things for myself.


4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.

Impulsive? For a long time, that seemed more like something that would apply to my ex husband than to something that applies to me. In general, I'm not a particularly sexual person and I don't drive at all, so I think we can safely leave those two aside for now.
I am quite impulsive with my spending, probably more now than pre-DBT, but I've never spent so wildly that I've put myself in serious financial hardship.
My eating has been pretty shocking for years. Particularly in the lead up to my diagnosis, I occasionally binged, but more often starved myself. Admission to hospital set me back on the path of eating, but this time I moved back into binge eating. Post-DBT, my eating disgusts me. Despite knowing that it is a choice, I seem to have little control over my binging, and I am mortified at the amount of weight I have gained. This, too, is a side effect of my medication: extreme cravings, particularly for carbohydrates and food binges - one of the reasons it is described by those who've taken it as "legal marijuana".
As for substance abuse, I suppose it's time I admitted it. I was well on the way to becoming a drunk, pre-DBT. I'm ashamed to admit that I probably turned up at work still slightly drunk on more than one occasion; ashamed to realise how many times I went with what would have been a hangover, if I got them. During DBT I got this one, at least, under control. I went from several times a week drunk to drinking only once every month, or couple of months. Unfortunately, when DBT ended, the first thing I did, was to go back to drinking heavily. (I'm pleased to note, though, that in 8 hours, I will have been alcohol free for 9 days. It may not sound like a lot, but it's something, and that counts.)


5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.

This one rings true both pre and post DBT, but the suicidal thoughts  and attempts have lessened. In the six months before I began DBT, I had about a dozen hospital stays of varying length either after a suicide attempt, or to circumvent suicide urges. Post DBT, the hospitalisations have lessened (in fact, I've only had a few one or two nighters in the entire 13 months since DBT began). One thing that does both fascinate and frighten me, however, is that although at this point, my self harm has decreased slightly in frequency, there has been a marked increase in the severity of incidences. (And I'm pleased to note that although I have had one possible slip [that I am choosing not to count], and three minor wound interferences, I am coming up on 9 days since my last incident of "real" self harm.)


6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

Ah, finally, one that actually doesn't apply to me, either pre or post DBT. One of the reasons I fought the BPD label so long was that I lack the short term see-saw of emotions I feel this describes. My moods don't up/down that way, for the most part, and I don't really believe they ever have. When I experience an emotion, it tends to stick around for a long time - and here I'm talking more like weeks than hours. That said, I do struggle with emotion identification, so it's possible I may be way off base saying this one doesn't now, and never has, applied to me.


7. Chronic feelings of emptiness.

I denied this one, in the past, but I'm starting to wonder if it may have fitted after all. How do you define or describe a feeling of emptiness? I currently link it, in my mind, to that unstable sense of self: but is that accurate? Is it that search for self, that search for something that will complete you? Because if that's what they mean by feelings of emptiness, I'm already on board that train.


8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

Difficulty with anger is certainly something that I struggle with, but in my case, it takes the opposite form: I struggle to allow myself to feel or express anger at all. Pre- or post- DBT, I think this is another one I can just cross off the books.


9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

I've heard 'psychotic' symptoms included in this box, as well, so I'm going to include that in my response. Dissociation is certainly applicable, both now and pre-DBT, though, again, the dissociation has lessened since DBT. I do suffer a small amount of paranoid ideation, and minor 'psychotic' symptoms such as hallucinations and 'voices' during times of particular stress; all of which has lessened since doing DBT.


In all, I can see from this that DBT has made a difference. It's hard to see, with just the criteria looked at in this way, how huge the changes have been for me, because the biggest ones have been in areas that aren't really covered by the DSM criteria. Things like learning how to ask for things, and building confidence. Things like being able to look someone in the face, or tell someone, "I feel angry today"; they don't show on the DSM criteria.

I'm considering making this my focus for the next week and going back over each criterion a day at a time, in order to highlight what I am doing, and what I can do, in order to continue minimising the effects of each on my life. I'll sleep on it and see how I go tomorrow.

In the meantime, I welcome those of you who knew me prior to DBT, and those of you who know me now, to share thoughts on what I have written, or what you may or may not have seen change in me regarding these criteria.


Today's thought challenges/cheer-leading statements:
I am not drowning. I am adjusting, and I am doing fine. I will be okay.
I am not a bad person.
My husband and I had some good times, and we had some bad times, and that's okay. Those times are over now and that's okay. That's how life works.
I am not responsible for someone else's emotions or choices. I am only responsible for mine.
It's okay to feel whatever I'm feeling. No emotion is wrong or bad.


Take care of yourselves until next time and may we all find our fence eventually.

Mixed Messages: How Are You?

Today I got to thinking about my relationship with my emotions. It’s not something I usually avoid thinking about, but it’s also not something I am particularly constructive with, either, most of the time.

Several hours ago, I was logged in when a friend signed on and asked a question that sent my anxiety levels through the roof. Did she ask what to do if a prowler is in your home? What to do about some sort of medical emergency? No, it was nothing like that; nothing that big or important. In fact, all it took were a few simple words: “how are you?”

Some days, I just don’t know. Even after a year of DBT, my emotions are a relative stranger to me. I still label them incorrectly; I still struggle to see them at all; I’m incongruent; and I definitely still try to deny and hide them. I hide my emotions so well, in fact, that our DBT coordinator commented on it. “[dawni] is hard to read, yes. She’s a very good cloaker. I think, actually, she’s the best cloaker I’ve ever met.” There was a lot of power in that; I could fool a therapist I respected a lot, without even trying. Of course, the flip side of that was that, without even meaning to, I was treading on my own toes - how could anyone help me get better if they didn't have a clue what was going on?

And that is what brings me to why, today, “how are you?” set off my nerves.

If I know what I’m feeling, I’ll try my damnedest to hide it from you. Hell, I’ll try my damnedest to hide it from myself. On the other hand, I don’t like to lie. If you ask me how I am, I will feel compelled to answer you honestly – while at the same time I will feel compelled to not reveal what’s going on. If I’m lucky, I’ll have something physically going on I can hide behind. “I’m a bit tired” is probably my ‘favourite’, but “my knee hurts” gets a pretty good workout as well, these days. When my physical health isn’t an issue, though, there’s not much I can do except answer or avoid. And as much as I know that simply avoiding the question, especially after the second or third time you’ve asked, is its own answer, I am often too caught between the two answers to give a decent answer. And buried in there, underneath it all is the little thing that sparks it – fear.

I always vaguely suspect that people don’t believe me when I tell them how I am; what makes this so frustrating is that the thought is strengthened by the very behaviours it causes. Of course you’ll have trouble knowing what to believe if my words say “I hurt” and my face and body say “everything is fine”. It gets worse when, as a protective coating, out comes my humour. Now my body’s saying “I’m fine”, my face is saying “I’m fine” and my words are saying, “I’m not fine, but let’s all laugh it off”.  Talk about mixed messages! But doing otherwise, allowing my body to tell its share of the tale? That leaves me vulnerable – not just to you, but to the one thing that frightens me most of all-- myself.

If I admit, honestly, to you what is going on here in my head, I have to admit it to myself. I’m not so good at that. I seem to believe, down in my core, that if I can’t see it, it’ll go away and I’ll feel nothing. For years now, I have been on a quest to simply cease feeling. I am, if you’ll pardon the Star Trek reference, the anti-Data. He spent years trying to attain the ability to feel – I spend them trying to avoid it.

The first step, I’ve heard, is recognising the problem. If the second is to find the why, then I’m well on the way. It’s pretty easy to figure out, this one: the answer is fear.  Are you picking up on a common thread, yet? I’ll probably talk a lot about fear in here – it’s one of my big hurdles.

What does fear have to do with my relationship to my emotions? Everything! I'm afraid of my emotions - including my fear of them. Maybe even especially that one. It seems that I have a few core beliefs about emotions and/or expressing them, that still need challenging.

It is okay to feel. Whatever I feel.
It doesn't matter what lengths I go to, I will continue to feel things.
It is sometimes okay to tell others what's going on for me.