Wednesday, June 30, 2010

Your heart's a mess, You won't admit to it.

The last 2 weeks (or so) have been turbulent, most of my life has been up and down but lately everything has been so extreme. One moment i'll be in tears, the next i'm on cloud nine. These both ends of the spectrum have been a regular thing lately.

Missing my medication for almost a week now has probably made everything much more intense particualry with my already abnormal mood swings. I'm crying more often and about almost everything, even when i've been happy i've cried. Mostly because sometimes my happiness scares me, it's not a feeling i'm used to and it never lasts long.

I may look like i'm strong to some people. But truth is i'm a small, fragile person and when life throws rocks at me. I get scratched and cut, most people can bandage themselves up but me, I just keep bleeding.

Songs on high repetition:
- Lost girls by Tilly and the Wall
- Jump in the Line by Harry Belafonte
- Fireflies by Fleetwood Mac
- Bad Moon Rising by Rasputina

Wednesday, June 23, 2010

Borderline Personality Disorder

Crazy isn't being broken or swallowing a dark secret. It's you or me amplified. If you ever told a lie and enjoyed it. If you ever wished you could be a child forever.
Girl, Interrupted by Susanna Kaysen

What causes Borderline Personality Disorder?

Linehan theorizes that borderlines are born with an innate biological tendency to react more intensely to lower levels of stress than others and to take longer to recover. They peak "higher" emotionally on less provocation and take longer coming down. In addition, they were raised in environments in which their beliefs about themselves and their environment were continually devalued and invalidated. These factors combine to create adults who are uncertain of the truth of their own feelings and who are confronted by three basic dialectics they have failed to master (and thus rush frantically from pole to pole of):

  • vulnerability vs invalidation
  • active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart)
  • unremitting crises vs inhibited grief.

Kernberg's Borderline Personality Organization

Diagnoses of BPO are based on three categories of criteria. The first, and most important, category, comprises two signs:

  • the absence of psychosis (i.e., the ability to perceive reality accurately)
  • impaired ego integration - a diffuse and internally contradictory concept of self. Kernberg is quoted as saying, "Borderlines can describe themselves for five hours without your getting a realistic picture of what they're like."

The second category is termed "nonspecific signs" and includes such things as low anxiety tolerance, poor impulse control, and an undeveloped or poor ability to enjoy work or hobbies in a meaningful way.

Kernberg believes that borderlines are distinguished from neurotics by the presence of "primitive defenses." Chief among these is splitting, in which a person or thing is seen as all good or all bad. Note that something which is all good one day can be all bad the next, which is related to another symptom: 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.

Other primitive defenses cited include magical thinking (beliefs that thoughts can cause events), omnipotence, projection of unpleasant characteristics in the self onto others and projective identification, a process where the borderline tries to elicit in others the feelings s/he is having. Kernberg also includes as signs of BPO chaotic, extreme relationships with others; an inability to retain the soothing memory of a loved one; transient psychotic episodes; denial; and emotional amnesia.

About the last, Linehan says,
"Borderline individuals are so completely in each mood, they have great difficulty conceptualizing, remembering what it's like to be in another mood."

Gunderson's conception of BPD

Gunderson, a psychoanalystfocus tends to be on the differential diagnosis of Borderline Personality Disorder, and Cauwels gives Gunderson's criteria in order of their importance:

  • Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.
  • Repetitive self-destructive behaviour, often designed to prompt rescue.
  • Chronic fear of abandonment and panic when forced to be alone.
  • Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
  • Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful (somewhat similar to Herman's statement that, while survivors of intense long-term trauma may have unrealistic notions of the power realities of the situation they were in, their notions are likely to be closer to reality than the therapist might think).
  • Impulsive behaviors that often embarrass the borderline later.
  • Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.

The Diagnostic Interview for Borderlines, Revised

The DIB was revised in 1989 to sharpen its ability to differentiate between BPD and other personality disorders. It considers symptoms that fall under four main headings:
  1. Affect
    • chronic/major depression
    • helplessness
    • hopelessness
    • worthlessness
    • guilt
    • anger (including frequent expressions of anger)
    • anxiety
    • loneliness
    • boredom
    • emptiness
  2. Cognition
    • odd thinking
    • unusual perceptions
    • nondelusional paranoia
    • quasipsychosis
  3. Impulse action patterns
    • substance abuse/dependence
    • sexual deviance
    • manipulative suicide gestures
    • other impulsive behaviors
  4. Interpersonal relationships
    • intolerance of aloneness
    • abandonment, engulfment, annihilation fears
    • counterdependency
    • stormy relationships
    • manipulativeness
    • dependency
    • devaluation
    • masochism/sadism
    • demandingness
    • entitlement

The DIB-R is the most influential and best-known "test" for diagnosing BPD. Use of it has led researchers to identify four behavior patterns they consider peculiar to BPD: abandonment, engulfment, annihilation fears; demandingness and entitlement; treatment regressions; and ability to arouse inappropriately close or hostile treatment relationships.
DSM-IV criteria The DSM-IV gives these nine criteria; a diagnosis requires that the subject present with at least five of these. In I Hate You -- Don't Leave Me! Jerold Kriesman and Hal Straus refer to BPD as "emotional hemophilia; [a borderline] lacks the clotting mechanism needed to moderate his spurts of feeling. Stimulate a passion, and the borderline emotionally bleeds to death."

Traits involving emotions: Quite frequently people with BPD have a very hard time controlling their emotions. They may feel ruled by them. One researcher (Marsha Linehan) said,
"People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement."

1. Shifts in mood lasting only a few hours.

2. Anger that is inappropriate, intense or uncontrollable.

Traits involving behaviour: 3. Self-destructive acts, such as self-mutilation or suicidal threats and gestures that happen more than once

4. Two potentially self-damaging impulsive behaviours. These could include alcohol and other drug abuse, compulsive spending, gambling, eating disorders, shoplifting, reckless driving, compulsive sexual behaviour.

Traits involving identity 5. Marked, persistent identity disturbance shown by uncertainty in at least two areas. These areas can include self-image, sexual orientation, career choice or other long-term goals, friendships, values. People with BPD may not feel like they know who they are, or what they think, or what their opinions are, or what religion they should be. Instead, they may try to be what they think other people want them to be. Someone with BPD said, "I have a hard time figuring out my personality. I tend to be whomever I'm with."

6. Chronic feelings of emptiness or boredom. Someone with BPD said, "I remember describing the feeling of having a deep hole in my stomach. An emptiness that I didn't know how to fill. My therapist told me that was from almost a "lack of a life". The more things you get into your life, the more relationships you get involved in, all of that fills that hole. As a borderline, I had no life. There were times when I couldn't stay in the same room with other people. It almost felt like what I think a panic attack would feel like."

Traits involving relationships 7. Unstable, chaotic intense relationships characterized by splitting.

8. Frantic efforts to avoid real or imagined abandonment

  • Splitting: the self and others are viewed as "all good" or "all bad." Someone with BPD said, "One day I would think my doctor was the best and I loved her, but if she challenged me in any way I hated her. There was no middle ground as in like. In my world, people were either the best or the worst. I couldn't understand the concept of middle ground."
  • Alternating clinging and distancing behaviours. Sometimes you want to be close to someone. But when you get close it feels TOO close and you feel like you have to get some space. This happens often.
  • Great difficulty trusting people and themselves. Early trust may have been shattered by people who were close to you.
  • Sensitivity to criticism or rejection.
  • Feeling of "needing" someone else to survive
  • Heavy need for affection and reassurance
  • Some people with BPD may have an unusually high degree of interpersonal sensitivity, insight and empathy

9. Transient, stress-related paranoid ideation or severe dissociative symptoms. This means feeling "out of it," or not being able to remember what you said or did. This mostly happens in times of severe stress.

Miscellaneous attributes of people with BPD:
  • People with BPD are often bright, witty, funny, life of the party.
  • 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.
  • They frequently have difficulty tolerating aloneness, even for short periods of time.
  • Their lives may be a chaotic landscape of job losses, interrupted educational pursuits, broken engagements, hospitalizations.
  • Many have a background of childhood physical, sexual, or emotional abuse or physical/emotional neglect

Monday, June 14, 2010

I was born -- I hate this part.

Since Saturday I've been in Warrnambool with my parents and brother & sister, It's been so dull here but at least i've gotten a bit of reading done, i'm half way done reading Jane Eyre.

Today it was my brothers birthday, I woke up to pancakes with maple syrup and at 2pm we all went down to Grandma's to have afternoon tea with my aunty, uncle and cousins. I ate too much cupcakes, cake & cookies but got to play with my cousin Ashley's puppy Pippy. After singing happy birthday and talking with everyone, we left to get ready to go out for dinner.

We orginally were going to the thai restraunt but it was closed so instead we went to the local restraunt/pub, I ordered diet coke and ham & cheese pizza that I shared with my sister, Rose. Dad bought an expensive bottle of champagne and ended up drunk by the end of the night, which is always an entertaining to see.

Songs currently on repeat:
The Last of the Famous International Playboys -
Take it off -
The Donnas
Paint it black -
The Rolling Stones
Violet - Hole

Sunday, June 6, 2010

Alone in suicide, which is deeper than death.

Lux is the pivotal role, as she is the only girl which the boys obtain sufficient information about, her emotions and overall feelings can be layed onto the remaining sisters, each; although seemingly toned down, would have much similar frustrations. She keeps the boys in touch with the group of girls, as much as possible without physical interaction. She is both the subject and contractor of the main events within the story.

If I was a lisbon girl I'd be a cross between Cecilia & Lux. Cecilia for her emotional instability and strangeness & Lux for her lack of self control and need for closeness. Suicide is in their blood and sometimes I feel like it's in mine because like them I just keep going through the motions and in circles of self destruction through whatever means possible.

Today I cried in my session with the psychologist for the first time ever, I was crying previously but held many of my tears back. As soon as I came in the room and she asked how I was I bursted into tears and couldn't pull myself together till 5 minutes later.

The past couple of days I've been sick with the worst headache i've had in my life as well as a sore throat. It kept me up till 2am last night and lying in bed is not fun when you have a throbbing headache and tend to ruminate about everything that surrounds your life.

Songs currently on repeat:
Rapper's Delight - The Sugarhill Gang
Instant Pleasure - Rufus Wainwright
When Doves Cry (Cover) - Damien Rice
Little Red Corvette - Prince