![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 44. Go back in thread:
Posted by Amanda29 on August 3, 2008, at 19:54:53
In reply to Re: Borderline Personality Disorder.., posted by healing928 on August 3, 2008, at 19:40:53
My therapist told me he wanted me to make a goal to be in a relationship by the end of August. My thing is this, who would want to be with me? I cannot hold a relationship with ANYONE. I have social anxiety I am scared to go out in public, I have a fear of rejection and abandonment..I am a walking mess...how can he expect that from me?
I am scared to be in a realtionship because I have been rejected so many times and I dont want to get in one, for him to find out how messed up I am ..and for him to leave me. I just wouldnt be able to handle it.I believe there is someone for everyone, but I dont know if it is true for me.
I hate to think that I will be alone the rest of my life and that I will die alone all because of my mental illnesses.
Posted by Looney Tunes on August 3, 2008, at 21:40:36
In reply to Re: Borderline Personality Disorder.., posted by Amanda29 on August 3, 2008, at 19:54:53
You know, I want to contradict something you keep implying. You keep implying that BPD is a learned disorder and that by simply changing your behavior, you can change the disorder.
BPD is a result of genetics and an invaidating environment. In the majority of cases, the invalidating environment is abuse or neglect. Because of abuse and neglect or other invalidation, the developmental process of the child is messed up. The child never learns object consistency, never learns appropriate attachment, does not separate from the care-taker properally, etc. All these developmental stages determine the outcome of how one relates as an adult. All these developmental processes determine one's ability to function "normally" in relationships.
If one never learns the object consistency (ie when someone leaves, it is not permentantly gone), as a child, they will have difficulty with it as an adult.
BPD is not learned. BPD is a result of development disruption. As part of this disruption, the child learns to cope in their own way. These coping mechanisms may lead to full-blown BPD symtpoms later.
DBT does attempt to make you learn coping skills, but it CAN NOT remove the developmental disruptions that make relationships so difficult for a BPD.
While I stated that the majority of BPD have been abused, there are also cases where the child might have been colically and cried all the time. The parents could not meet the child's needs all the time, as a result the child expereinced this as invalidation.
By stating that this disorder is something as easy as changing behavior, it is somewhat insulting, because I can guarentee that most BPD would change in an instant if it was that easy.
Posted by Amanda29 on August 3, 2008, at 21:46:23
In reply to Re: Borderline Personality Disorder..NOT learned, posted by Looney Tunes on August 3, 2008, at 21:40:36
This is just what I have been told by my therapist...I am not trying to imply anything I am repeating what I have been taught. I was told that if I change my behavior...the symptoms will go away and I wont be considered bpd. I am not TRYING to insult ANYONE that is bpd. I have been very insulted by my therapist and I am now having to deal with it on my own.
Posted by Nadezda on August 3, 2008, at 21:58:04
In reply to Re: Borderline Personality Disorder..NOT learned » Looney Tunes, posted by Amanda29 on August 3, 2008, at 21:46:23
To say that someone has an invalidating environment, is to say that they learned certain things from relating to their parents-- things that often undermined, or destabilized their sense of being okay, acceptable, loved or understood.
That is definitely learning-- not genetics. And while the disruption is in the past and therefore part of one's history, the behaviors, and rhythms of feeling and the beliefs about the world and about oneself can be changed, though becoming aware of, adapting to oneself, and practicing new ones.
So I have to differ with the idea that way of l iving that's called borderline personality disorder cannot be changed through learning about oneself and learning new ways of coping.
Nadezda
Posted by Dinah on August 3, 2008, at 22:09:03
In reply to Re: Borderline Personality Disorder..NOT learned » Looney Tunes, posted by Amanda29 on August 3, 2008, at 21:46:23
I'm sorry if your therapist, or I for that matter, gave you that impression. It isn't really fair or compassionate to yourself to think of it in those terms. If it were as easy as changing your behaviors, you'd have done it by now I'm sure.
The diagnosis may be defined behaviorally, but that doesn't mean you can just change it. As I understand it, behaviors are an attempt to cope with or regulate strong emotions. It's not just a question of stopping. It's a question of learning new ways to cope with the intensity of your emotions. It's learning new ways of emotional regulation.
http://behavioraltech.org/downloads/dbtFaq_Cons.pdfThe above link may be helpful. I know of this website because I've ordered some of her materials. I haven't read this particular FAQ, but I know that Marsha Linehan's conceptualizations have helped me an awful lot. I hope they're helpful to you.
You're the same person today you were before your therapist told you these things. There is nothing that needs to be done today or tomorrow. You have time to look into it, and find out all you can.
You might find out that your therapist is the one who can help you with this, or you might find that he isn't. His own issues have a lot to do with whether he is or not, so I hope you aren't blaming yourself for what are his emotions and his responsibility.
As strange as it may seem, you're more or less doing your job as client. You are bringing your issues to therapy. You're trying to understand and work on them. How he responds is up to him. I hope he responds in a helpful manner.
Posted by Amanda29 on August 3, 2008, at 22:12:31
In reply to Re: Borderline Personality Disorder..NOT learned » Amanda29, posted by Dinah on August 3, 2008, at 22:09:03
Thank you. He is a wonderful therapist, it is just right now I am having such a hard time with this and he isnt responding how I want him to. But I know he wants to help me, I just need to be patient.
Posted by Dinah on August 3, 2008, at 22:18:59
In reply to Re: Borderline Personality Disorder..NOT learned » Amanda29, posted by Dinah on August 3, 2008, at 22:09:03
Also, I've found it useful to think of my behaviors as helpful or not helpful as opposed to right or wrong. Beating yourself up over something you've done doesn't do as much good as evaluating whether the behavior achieves its desired goal. If not, are there behaviors that would be more helpful in achieving your desired goal?
What is your goal with your therapist right now? What behaviors of yours are most likely to achieve that goal?
If you do have borderline personality disorder, what are your goals now that you know? What behaviors can you engage in to meet those goals?
And down to the shortest timeframe, it would appear that you're feeling pretty upset right now. What has worked for you in the past to reduce the intensity of your distress? Do breathing exercises help? Have you had any success with meditation or yoga or exercise? It may sound silly, but I remember a time when watching Fawlty Towers was remarkably effective at reducing my level of distress. The other day when I had an anxiety attack, I found substantial relief by talking to friends and distracting my mind.
What helps you?
Posted by Amanda29 on August 3, 2008, at 22:23:35
In reply to Re: Borderline Personality Disorder..NOT learned, posted by Dinah on August 3, 2008, at 22:18:59
Honestly, in the past, I would abuse my anxiety pills to make me feel better...(ended up going to rehab because of it) so now that is not an option...but, I used to swim...I stopped that and have since then gained 30 pounds...I cannot talk to my family about this because they just dont understand...but I do have a cousin who used to be a counselor and she and I are going to meet for dinner or something this week and I am going to talk to her...(hey, it is good..FREE THERAPY) :) I have tried breathing exercises, and guided imagery and those don't work. I also just go to sleep and try and forget everything, but that leads to making me depressed..so that is not a good coping skill.
Posted by Nadezda on August 3, 2008, at 22:24:45
In reply to Re: Borderline Personality Disorder..NOT learned » Amanda29, posted by Dinah on August 3, 2008, at 22:09:03
Another thing-- any therapist who works with BPD (any therapist, really) will emphasize that it's not your fault that you have these problems.
It's very very important not to move into self-blame-- because that's part of the invalidating way of thinking that can be really hurtful to you-- and because you don't deserve that. None of this is your fault-- you didn't choose your biological sensitivity and you didn't choose your environment.
I'm sure you therapist, even if he finds the work challenging and even draining at times-- finds it very meaningful and worthwhile to work with you. Otherwise he doesn't have to do it-- he could choose not to work with certain people-- but he seems to prefer to have you in his practice. I think what he means is that some of what you do to yourself and to him isn't necessary, in the future-- that there is hope that you can work, over time, to change your life significantly.
So even if you're going through a very hard time now-- there is a lot of potential, if you stick with the work, and try to see more clearly how you're reacting to situations, internally and externally-- and to try to move toward emotional regulation and interpersonal effectiveness-- as Dinah was suggesting--
It's hard to do-- but it can be done. For the moment though-- don't blame yourself, or think that your therapist is blaming you, or wishing he'd never seen you-- or anything like that. He's said he's committed to you-- and I think you should take him at his word.
I'm sure he wouldn't want you to blame yourself, or to think worse of yourself because of the things he said. Maybe he was too strong and confrontational in how he said that-- therapists can do that at times-- but I think he would say that that certainly wasn't what he wanted.
Nadezda
Posted by Dinah on August 3, 2008, at 22:28:53
In reply to Re: Borderline Personality Disorder..NOT learned » Dinah, posted by Amanda29 on August 3, 2008, at 22:23:35
If swimming helped for you, you might try things in the area of physical activity. Do you have a yoga tape? Or can you do some stretching exercises? Stretching is not only a physical exertion, but it would also force your muscles to relax.
Can you start swimming again?
My husband is one of those people whose emotional state improves a *lot* when he gets regular exercise. Maybe you're like him.
I think it's great that you're staying away from destructive coping mechanisms!
Posted by Amanda29 on August 3, 2008, at 22:33:22
In reply to Re: Borderline Personality Disorder..NOT learned » Amanda29, posted by Dinah on August 3, 2008, at 22:28:53
Well, dont congradulate me just yet...I did this weekend have a lapse and used vicodin and valium. I am ashamed at myself because I was doing so well. But i am hurting SO MUCH. I Cannot stand to live with myself. I know I probably sound like the biggest baby...but im not handling being mentally ill and I have been like this pretty much all my life...and but now that it has been officially diagnosed, I am a mess. My last therapist terminated me because she said I was too messed up to receive help from her or my psychiatrist...so I am scared to death that my therapist is going to eventually say that....
Posted by Nadezda on August 3, 2008, at 22:41:35
In reply to Re: Borderline Personality Disorder..NOT learned, posted by Nadezda on August 3, 2008, at 22:24:45
I 'm in a DBT group, by the way, and I was just looking through the section on distress tolerance.
Some of the suggestions they make are things like distracting yourself-- with activities or things that you enjoy, listening to music that's upbeat and calming, thinking about things you're grateful for (there must be some, after all), just encouraging yourself-- saying to yourself : even if this is hard now, there is hope for the future, and I can do it- and many things like that.
They also say that changing your physiological state is very helpful. They suggest exercise-- even taking a walk or jumping in place-- breathing of course, creating intense physical sensations (one in particular they recommend is putting ice or cold water onto your face), squeezing a rubber ball really hard, taking a hot or cold shower, and things like that.
I know from experience that doing these things is incredibly difficult when you're really upset-- so maybe you'll find yourself not wanting to do them. If so-- don't feel bad-- it really is hard and takes practice.
But it's amazing how you'll find that over time-- when you think better thoughts, or just relax your muscles that are most tense, or concentrate on a sensation for a while-- you really do start to feel better. And you begin to realize too that saying bad things to yourself will actually be part of a cycle of feeling worse.
If you say-- it's hopeless--- you'll feel more hopeless; if you say to yourself, there's hope, I will get better-- you'll feel a little hope creep in. I know it sounds mechanical-- but I find that this really works for me.
Everyone has to find the things that work for them- and it's different for everyone-- so these may not be the right ones for you. But I thought maybe something would strike you as helpful.
Nadezda
Posted by healing928 on August 3, 2008, at 22:55:32
In reply to Re: Borderline Personality Disorder..NOT learned, posted by Looney Tunes on August 3, 2008, at 21:40:36
I am sorry if I upset you. I DID NOT say it was a learned disorder. I do agree that BPD is mostly caused by abuse, neglect and invalidation. We There are many variations of BPD from mild to severe; if we remove the symptoms, you remove the dx. I have done this for long periods of time, but never had a therapist I trusted. Until the last 15 months. Lifestyle changes are also the key. When I feel emotions coming on and do something healthy like going to the gym that helps.
I am very frustrated that people take BPD as a death sentence. (Including professionals)
BPD is an IMPUSE CONTROL DISORDER. DBT IS A BEHAVIORAL CONTROL therapy to help our emotional regulation.We have to learn effective and healthy ways to cope with this disorder. The core of DBT is mindfulness, which address emotional regulation, and acceptance. I am not saying a full recovery from BPD will happen overnight, but it is possible.
http://www.unimaas.nl/default.asp?template=werkveld.htm&id=PEP31055QXI5531J7I0S&taal=en
Posted by Cecilia on August 3, 2008, at 23:57:45
In reply to Re: Borderline Personality Disorder.., posted by Amanda29 on August 3, 2008, at 19:54:53
Your therapist told you that HE wanted you to make a goal to be in a relationship by the end of August?!!!! You're in therapy to meet YOUR goals, not his! I would think seriously about whether this therapist can help you or whether you should look for someone else. Cecilia
Posted by Amanda29 on August 4, 2008, at 5:58:01
In reply to Re: Borderline Personality Disorder.. » Amanda29, posted by Cecilia on August 3, 2008, at 23:57:45
I know. I put that goal to rest because there is no way that i would be in a realtionship feeling the way that I feel right now. MY goal is to help myself to fee; netter
Posted by Amanda29 on August 4, 2008, at 10:43:48
In reply to Re: Borderline Personality Disorder.. » Amanda29, posted by Cecilia on August 3, 2008, at 23:57:45
This is what we were doing...one of my goals was to work on my image..and so I went and got my hair done and went and got a make over...and I was trying to become more attractive to men..and it worked but then I got severly depressed and well, I stopped trying to impress people and I have fallen in a rut and cannot get out. So while all that was going on..he told me that he thinks a goal of mine should be to be in a realtionship by August...but I laughed because I didnt think that would be possible...I am just so unstable..I never know how I am going to be from one minute to the next...literally one minute...it is crazy.
Posted by raisinb on August 4, 2008, at 12:10:17
In reply to Re: Borderline Personality Disorder.., posted by Amanda29 on August 3, 2008, at 17:21:45
I am about to sound just like my therapist here (and I hate it when I say things that she'd say--that I hate!)
But I happen to believe this. Just because he thinks you fit the criteria for a certain diagnosis does NOT mean he doesn't like you or care about you. As clients, we tend to feel very judged when we get certain labels. But to therapists, I think it's much more of a helpful category that they can use as a basis for analysis. I don't know that it necessarily means anything about how he sees you as a person.
Think about it from your end. I have a close friend with post-partum depression (let's call her "jane"). I don't think of her as "the PPD person." I think of her as "jane," who has been there for me countless times. With differences (because it's a different relationship) I'm sure our therapists are at least as capable of seeing our complexities as people.
Posted by Amanda29 on August 4, 2008, at 15:43:59
In reply to Re: Borderline Personality Disorder.. » Amanda29, posted by raisinb on August 4, 2008, at 12:10:17
He has told me that he "likes me" as a person. But I am constantly questioning him...and questioning him as to WHY he likes me..what is it that makes him like me...(because I have such low self esteem I honestly cannot see what he OR ANY OTHER PERSON for that matter would like about me.
I emailed him today and asked him why he wants to continue helping me..because apparently I am really messed up. My previous therapist let me go because I was too messed up to help. (didnt make sense to me) but whatever.He hasnt responded to any of my emails from yesterday (i was really upset) so it makes me wonder what he is thinking...if anything.
Posted by Amanda29 on August 4, 2008, at 19:41:23
In reply to Borderline Personality Disorder.., posted by Amanda29 on August 2, 2008, at 18:40:59
'You are clearly having a hard time with yourself and Im sorry youre having to go through all of that.
The one piece of advice I can give is that you need to continue to challenge yourself to focus on what is acceptable
stop obsessing about what the internet says about whatever it is you think you have. Thats a complete waste of energy'
This is directly from an email I just received a few minutes ago from my therapist. I get the impression he feels like I am just trying to FIND THINGS that are wrong with me...I emailed him back and told him that I am having a hard time, that I wasnt just trying to find something to be wrong with me on the internet, that BPD is what is wrong with me. I told him that he was the one that diagnosed me with everything and I didnt understand how he could just let the label go. To me, and this is wrong I know...but to me the labels are what makes me me. And this however bad it may be, is something that I have to deal with...but he seems to be pretending that it isnt that big of an issue. He deals with the symtoms...not the label. That is what he told me.
Posted by Amanda29 on August 5, 2008, at 18:09:16
In reply to Borderline Personality Disorder.., posted by Amanda29 on August 2, 2008, at 18:40:59
1. "I didnt diagnosis you with Borderline Personality Disorder
2. Initially after the testing, for what its worth my diagnoses were: Major Depressive Disorder, Recurrent, Moderate to Severe were Generalized Anxiety Disorder with features of OCD
3. Lately I have been using Mood Disorder due to chronic hydrocephalus and multiple shuntings with Mixed Features (depression and irritability) because I still think those early brain difficulties and neurosurgeries are the root cause to your mood instability and Generalized Anxiety Disorder with OCD features I try to stay away from personality disorder diagnoses as I believe they are too constraining and negative. So I didnt diagnosis you with that.
4. Regardless of what you call it in psychiatry and psychology a label describes a symptom pattern. You can always learn to better manage the symptoms you have using your own thinking and behaviors and taking medication."
These are the exact words from my therapist to me about ten minutes ago. WHAT THE HECK. I have been led to believe that I have BPD and NOW after 3 years he is telling me that he never diagnosed myself with it. He thinks that I have been just researching things and labeling myself with them because I like to be sick. (I DONT).eVERYTIME I HAVE TALKED ABOUT BPD IN THERAPY he agrees that it is me...and yet now he is saying he didnt diagnose me with it because it is too devastating and negative...and that he tries to steer clear of personality disorder labels.
IM SO F 'ING confused right now I dont know who I am..I dont know what to believe or who to believe.
IM SO MESSED UP IT IS CRAZY/
Posted by Amanda29 on August 5, 2008, at 20:23:55
In reply to Re: Borderline Personality Disorder.. » Amanda29, posted by raisinb on August 4, 2008, at 12:10:17
This is the thing, now that my therapist is saying that I am not Borderline, he is also saying I am not bipolar...which is what I have been on medication for since I was 23...Im 29. SO..my feeling is this, personally I am extremely hurt because for the past six years I have been on every medication known to man for bipolar disorder and borderline persoanlity... I am now on 3...Lithium, Lamictal and Rozerem. I have been on the Lamictal the longest and I know that is a mood stablizer. So I want to come off of it. Because If I dont have bipolar or borderline..why the heck be on the medication. The lithium is a mood stablizer AND antidepressant...so that would cover my depression. Because I was addicted to anxiety medications...I cannot have anything to control my anxiety ..which clearly sucks....so, all I really feel like i need to be on is the lithium.
It just really hurts that I have been led to believe that I have these things...that have really hurt me mentally..and now, I dont have them. I was talking to my sister about it and she said that I should look at it as something positive...like now I dont have it. I COULD look at it positively but, the whole issue is that I have been led to believe that I have it. And I dont. I was told when I was 23 that I had depression, anxiety, OCD, and BiPolar disorder. When I switched to my new therapist, he told me I had borderline, that I was bipolar, that I had PTSD for something that happened to me a long time ago, I have severe anxiety, and mood swings ...that were from the bipolar disorder....NOW..I supposedly only have depression and anxiety and ocd. GO FIGURE.
I am so confused and hurt. You might be asking why I am hurt but imagine being told you had something for years...some kind of illness and all of a sudden you dont anymore. I have researched everything that I have been diagnosed with because I love psychology and mental health and studying about the disorders but, my thrapist is thinking that I ENJOY BEING SICK and that I am looking up things to be WRONG WITH ME!!!!
WHO ON THIS EARTH ENJOYS HAVING A MENTAL ILLNESS?
I am so hurt.
Posted by Dinah on August 5, 2008, at 20:52:27
In reply to Re: Borderline Personality Disorder.., posted by Amanda29 on August 5, 2008, at 20:23:55
Mood stabilizers aren't all that uncommonly diagnosed for things other than bipolar. I'm not bipolar, or if I am at all, it's bipolar III or whatever it is that only is an issue because of medications or perhaps sleep deprivation. But I'm on Lamictal. The main reason is migraine prophylaxis, but I do find that it is helpful to me for other reasons.
Is your therapist your psychiatrist? Whoever is prescribing you medication may have a different diagnosis for you, or may not, or may have some other reason for prescribing those meds to you that your therapist would not really know about.
Diagnosing in this field is nothing like diagnosis in many other areas of medicine. (Many, not all.) When I had vertigo, they were able to do a series of tests that showed exactly what the problem was, how long it was likely to last, and what I could to to get better. Mental health isn't like that. There is a lot more leeway in many areas. There might be a fair amount of agreement on schizophrenia or Bipolar I, but for the rest of it, it's not so much a hard science as an art.
What your therapist seems to be suggesting is that you think about the issues that are causing you difficulty in life, and address those issues. Use medication as your prescribing doctor sees fit to address those symptoms. Work on those areas of therapy that can help you deal with those symptoms. If I'm understanding correctly? In the end, aren't the things that are causing you difficulties in day to day life more important than the diagnosis? The problem with mental health diagnoses is that an awful lot of people fit some of the qualifications for many disorders. Few people fit neatly into any one or another.
I do understand wanting a diagnosis. I was obsessed with figuring out why I did the things I did. In the end, I got a pretty good idea. But the answer did not fit into a diagnosis. It was unique to me.
CBT and DBT offer skills that can be helpful in anxiety, in mood disorders, in any number of things. Other types of therapy can be helpful in any number of disorders.
You are you. A complex mix of any number of characteristics, some of which might fit one or another diagnostic criteria. But no diagnosis defines you. You are far too complex, as are we all, to be neatly slotted away.
Your therapist sounds quite sensible, although I understand why you feel distressed. Why don't you ask him what it is that he thinks you need to address in therapy? He might be better able to address that. He may frame his answer in terms of symptom reduction or strength enhancement. He may or may not be completely right.
Oddly enough, I found out far more about myself by trying to explain to my therapist what was wrong with me, than by having him tell me what was wrong with me. If you think he's wrong about anything he tells you, think about it and tell him why. It's amazing what can come up when we keep our minds inquisitive. I frankly shock myself sometimes when I discover exactly why I'm doing what it is I'm doing.
Posted by healing928 on August 5, 2008, at 23:22:35
In reply to Re: Borderline Personality Disorder..UPDATE, posted by Amanda29 on August 5, 2008, at 18:09:16
You see that is why I was getting to upset in my previous posts. So many people with BPD and even t's have a problem with the dx. It is just a label to treat the symtoms. My t trains other t's and he says it is very common in the field that t's don't want to make that dx. BPD comes in many vaiations mild to severe. I just wish everyone was more aware that people with BPD do recover! and it is not a death sentence...
Posted by healing928 on August 7, 2008, at 0:42:26
In reply to Re: Borderline Personality Disorder.., posted by Amanda29 on August 5, 2008, at 20:23:55
Just wanted to add; i was on lamictal and I didn't see a difference. I was going to a pdoc that dx me as Mood disorder NOS. He would not dx me with BPD even though I met the criteria... When I told my t i stopped taking the lamictal because it was making me have extreme dizzyness he said, that is because i am not bipolar. It is used to really treat the mania, so if you don't have the mania i don't see what benefit you would have.
Posted by Nadezda on August 7, 2008, at 8:45:33
In reply to Re: Borderline Personality - lamictal » Amanda29, posted by healing928 on August 7, 2008, at 0:42:26
Lamictal can also be used as an adjunctive to an anti-depressant to enhance the effect. It's not used only for bipolar.
The best person to address changes is medication is your pdoc, because he may have specific reasons for using combinations of meds.
Nadezda
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.