Harriet M. Welch

I think I’ve mentioned my fear of this diagnosis. Isn’t that weird? Diagnosis phobia – wonder if there is a fancy word for that. Here are the criteria, with my remarks interspersed:

Borderline Personality Disorder DSM IV Criteria

A pervasive 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:

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

Frantic – what do they mean by that? I do have self protective behaviors to avoid abandonment. I close myself off from people, isolate, etc. Is that frantic? The word frantic seems so subjective. Here is how they explain it:

The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this “abandonment” implies they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.

I would say I am not frantic given this explanation.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

I don’t particularly idealize or devalue anyone. I have had friendships that have lasted for over 25 years. Until recently that is. Now my relationships are unstable, due to my isolating behavior which began a little over a year ago.

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

My self-image is very negative, but I wouldn’t say it is unstable. It’s pretty much negative 100% of the time. Sense of self? I don’t have that at all. I am constantly wondering who I am, why my outside is so different from my inside, why no one can see the real me. So I have to give this one a 50%.

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 behavior covered in Criterion 5.

I do have episodes of spending, but they are usually planned. I have a list of things I want to buy, then when I get paid I rush right out and buy them. Is that what they mean by impulsive? Or do they mean I just have a whim and run around the stores buying things even if I have no money?

Substance abuse – well, sometimes I drink a little too much. I don’t abuse my prescription drugs, but I do stash them.

I tailgate really badly. That can be reckless.

I don’t binge eat.

So maybe a 50% for this one?

5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

Suicidal behavior – I have the supplies, I went to a store to buy them, and that is behavior.

Suicidal gesture – what is that? Do they mean attempt? I have not made an attempt.

Suicidal threat – is that suicidal ideation? Or is it more like, “If you don’t empty the dishwasher I am going to kill myself?” I don’t do that.

Self-mutilating behavior – I do that.

I give myself a 75% for this one.

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).

Is my affect unstable? I do have episodes of feeling bad, which I suppose qualifies me for intense episodic dysphoria, I do have irritability big time, definitely anxiety, but it can last more than a few days. Are these due to a marked reactivity of mood? Possibly, but I don’t know. Isn’t everyone’s affect due to their mood? This one is confusing here is their explanation.

The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the individual’s extreme reactivity troubled by chronic feelings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger (Criterion 8). They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.

I think I give myself 100% on this.

7. chronic feelings of emptiness

100%

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

I do have intense anger and difficulty controlling it, but I rarely display it and it is not constant. I would say once a month or so I have a display of anger consisting of yelling at my kids, or throwing things. Not sure if the anger is inappropriate, because it is in response to something. I’ll have to say 50% here.

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

0%

I need 5 of these to have the diagnosis.

1. not sure
2. 0% up until last year, now not sure
3. 50%
4. 50%
5. 75%
6. 100%
7. 100%
8. 50%
9. 0%

So out of 9 I have a score of 4.25. Does make me a borderline Borderline Personality Disorder? Or is the 5 a distinct cut off point? It also says this disorder shows up in young adulthood and can get better as the person ages. Nothing in there about suddenly developing it in middle age. I don’t know what to think.

Tags: borderline personality disorder

I’m thinking about what I wrote yesterday, about how I really liked the silent moments during my therapy session on Tuesday. I remember about 10 years ago I began therapy with a psychiatrist. I didn’t know anything about therapy or the different types of therapy, or even that there was a difference between psychiatrists, psychologists, social workers, etc. This particular pdoc didn’t talk at all. And since I didn’t really talk we sat in silence for a good 50 minutes. I kept asking him what I should talk about, and he said, “Don’t worry, when you get good at therapy you’ll know what to talk about.” I didn’t want to “get good” at therapy, and I didn’t want to wait around to see how long that would take, so I just quit. Didn’t show up one day and never went back.

I guess that was too much silence for me.

But I’ve written before about how much J, my current t, talks. I know it’s bothered me sometimes because I’ll be trying to process something that I’m thinking or feeling and he just barrels on. But mostly I thought it was good that he talks so much because it leaves less time for me to figure out what to say and how to say it.

But on Tuesday he didn’t talk very much. I’m not sure what was different, why he chose to stay more silent. And I’m not sure why I liked it either.

I’m wondering if I should tell him about how I feel about this. I don’t know if I’ll be having therapy with him anymore, my “trial” appointment with the new t is next week. Maybe there is no point in talking to him about it. And I’m curious to see how the new t handles silence.

It seems sad that J and I have been together for about a year and a half, and it’s just now that I am making this realization about liking the silence. Maybe things would have been different if there had been more silence all along. Or maybe it’s just that I need it now, and didn’t before. I don’t know.

How do your t’s handle silence? Do you like it?

Tags: pdoc, silence

….or I’d be dead by now. I started calling pdoc at 4:31PM yesterday, but they close at 4:30PM. I tried at 8:15AM, but they don’t open until 8:30AM. I called at 8:45AM and talked to the office manager, told her I wasn’t feeling well and that I thought I need a prescription for klonopin. She asked if I would like the pdoc to call me back, and I said yes. It is now 4:45PM and he hasn’t called. I did take one of my son’s valium at 11AM, and that seemed to do something for me. I have a lot of those, my son takes them when he gets his teeth cleaned, which he does about three times a year, and his dentist gave us a prescription for 25 of them. So we have extra. Still don’t want to dip into my klonopin stash. It’s so irrational.

Tags: klonopin, pdoc

Today were my meetings with my new life coach and my routine meeting with my psychiatrist who I see every three months or so. I was a bit anxious about meeting the life coach, K, since I wasn’t sure what would transpire. I had a motivated morning and ran two miles on the treadmill, then showered and got ready. I’m still in the SI mode from two days ago, however. I was fighting that urge with all my might. I decided in the shower that maybe I would just do a little, kind of like a compromise. It didn’t quite work out that way, it’s like potato chips – you can’t have just one. Actually I don’t like potato chips, but that’s what I hear about them.

So I performed my SI ritual, which is comforting in a sick demented way, and yes I realize that. Then I left to meet K. She is extremely nice and seems very positive and encouraging. I had met her through a convoluted path of twitter, blogs, and email, so I really had to trust my intuition that she would be what she claimed to be and not just any old person claiming to be a life coach. It’s not like being a neurosurgeon you know? There are no degrees and licensing boards. I had originally contacted her to have an MBTI assessment, but after we discussed that on the phone we decided that I’m fairly certain of my MBTI type and we can move forward from there. My goal in working with K is to determine what to do with the rest of the my life. Not a small feat, is it? So today we discussed the process, talked a lot about the INFJ personality type, talked about my strengths that were determined from the “Discover Your Strengths” test, and talked a bit about things I like to do. We meet again in two weeks and in the meantime she wants me to focus on how I am using my 5 strengths in my everyday life – in my work, my volunteer work, and my personal life. I felt very positive about the meeting.

Then I sat at the mall with a coffee and some magazines and books for an hour to decompress before having lunch with a friend. This is also someone I work with, who is a very empowering person to me. She is always telling me how talented, creative, smart and important I am. And it seems like she really means it when she says that. I love working for her and being her friend. So I felt even more positive after lunch.

Then I went to see the psychiatrist. He had annoyed me the last time I was there, I can’t even remember why. I just have to remember that I need him to write my prescriptions, and that is it. He has to pathologize everything, but I guess that is to be expected since he is a doctor. He thinks I should do Cognitive Behavioral Therapy – as he says “What is the point of figuring out why you feel something, the important thing is to change your thinking.” To me I think that if I went that route I would always feel like I’m missing something. Yes, for certain things I agree there is no point in searching for a reason. Generalized anxiety, for example. That is just a part of me, nothing happened in my life to cause me to be an anxious person and it is very helpful to learn coping strategies to deal with anxiety. But what about my feelings of self hate, low self esteem, poor body image, guilt, distrust, etc. I really want to know why I am this way. Sure, it would be helpful to learn how to change my thinking and my belief systems, but I think it would be easier to make those changes if I can figure out why I feel that way to begin with. Maybe I’m totally wrong though?

The psychiatrist thinks I need to talk to the psychologist and tell him I need CBT and ask if he can provide that for me. I do think it would be a good idea to discuss the type of therapy that we are doing, and what would be best for me to reach my goals.

Another thing the psychiatrist does that annoys me is asks me things like “How is your OCD?” And I always say, “I don’t have OCD.” Then we talk about intrusive thoughts and how that means I have OCD, blah blah blah. Then he says, “I just want to ask if you are depressed.” And I say, “I don’t have anything to be depressed about.” And he says, “You don’t need something to be depressed about, it’s a matter of brain chemistry.” And I say, “I’m not depressed.” And he says, “I just wanted to throw that out there.” And he starts to mention SSRI’s, and I say, “I’m not taking any SSRI’s.” And he says, “You didn’t even let me finish.” And I say, “I just want to be sure you remember – I’m not taking any SSRI’s.” And he says, “OK” and writes my rx for klonopin and says come back in three months.

I guess I’m not being very nice – he is a very nice man and very patient. I guess the whole field of psychiatry annoys me, and the fact that insurance companies would rather pay for meds than therapy annoys me, and I take it all out on him. What’s that, projection?

So it wasn’t such a bad day. Just a little bit of SI, but mostly good. It feels good to feel even a little bit good.

And for eshoe, here is a photo of my purse and what is in it:

That would be my glasses, wallet, car key (which isn’t really a key, it’s a fob), lip balm and lip gloss. If I don’t have a pocket my phone would be in there too. I’m a minimalist, I also detest carrying a purse.

This is somewhat of a lie, however, because I carry a huge tote bag with pens, pencils, meds, lotions, mints, hairbands, books, papers, notepads, etc. I leave that in the car and just carry the wristlet. Sometimes I even take the fob, wallet and phone and put them in my jacket pockets and then I don’t even carry the wristlet.

Tags: anxiety, cutting, guilt, infj, intrusive thoughts, klonopin, life coach, myers briggs, pdoc, projecting, running, trust, work

I am a guest blogger on another blog, come see: The MBTI Blog. If you’ve been reading my blog you’ve already read this, but it’s still kind of exciting to me.

Tomorrow I meet for the first time with my new life coach and I’m somewhat apprehensive about what we’ll talk about. Then in the afternoon I meet with my psychiatrist. I wish I could tell him some things that I’ve talked about with my psychologist so I can get a feel for whether he thinks my psychologist is any good, but I don’t want to reveal too much to my psychiatrist. I’m not sure yet what I’m going to do about that.

I’m feeling very flat right now. Last night I was spiraling, out of control, and I did something I shouldn’t have done. But tonight I just feel flat, like I have no affect. I’m going to bed I think.

Tags: blog, infj, life coach, myers briggs, pdoc

Yesterday I saw my psychiatrist. I normally love my psychiatrist, he is a great guy. Our appointments are only 15 minutes and he gives me my prescriptions. Yesterday, though, he irritated me. No matter what I talked about he would say something like “Obsessive people tend to think like that” or “That’s a characteristic of obsessive thinking”. He believes I have OCD, and I don’t like to think so. He wants me on meds, and I don’t feel like being on meds right now. I’ve finally gotten off of all of my anti-depressants, and all I currently take is klonopin every night before bed, which I half heartedly am cutting back on. I do wake up in the middle of the night sometimes with panic attacks, so I guess I’m depending on the klonopin to prevent that.

So he is a psychiatrist and his job is to diagnose people and give them meds to make them better, and I guess that is what he is doing. But it was irritating yesterday. We talked about my therapy, and some of my issues and feelings. He would say “But, Harriet, when you think about these things rationally don’t you see that they are not true?” I practically barked at him “What the hell does rational have to do with it, when I actually believe something due to 40 years of thinking this way?” Hello? Am I daft here? He did concede that he is glad that I am in therapy and I am going even though it gives me major anxiety and that the process is slow. Well, thanks for that, Doc. Now let me go get my rx filled.

Tags: anxiety, intrusive thoughts, klonopin, obsessive, pdoc