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Throw me a f'n diagnosis doc!


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;):):cussing: umm... triggering :wtf::cussing::cussing:

I swear I'm fucking loosing it... I'm crawling out of my skin and want to cut so bad right now I can't stand it. But I'm at work, and I might look a bit odd walking down the hall with blood running down my arm (not that I don't look odd with curious scars all over my arm).

But hey, according to my pdoc there's absolutely nothing wrong with me! WTF?!? How in the fuck can I feel constant, intense, fear, anger and saddness; cut the fuck out of my arm; take more meds than food; and nothing the fuck is wrong with me?!?

All I fucking wanted was some reassurance that I'm not out of my mind. I just wanted to know that everything I think I experience is actually fucking reality. But he tells me that he doesn't really think there's anything wrong with me and that my descriptions of my twisted thoughts and fucked up emotions could just as easily describe anybody. That's like saying that a major depressive episode isn't real because everybody feels sad sometimes!!

Is he trying to save me from the big bad "B" word? Affraid that it will upset my delicate little mind? Shit, he already diagnosed me as BPII four years ago, and that doesn't seem to fit for shit, what's so hard about confirming that, yes, in fact meeting every goddamn DSM and DIB-R critera for BPD does in fact mean that I am... shhh, here comes the bad word... BORDERLINE!!! Is it so wrong to actually put a name to it? And please, don't anybody even use that cliche ass phrase: "you're not your diagnosis". No, I'm not; but at least allow me the comfort of knowing that there is a reason I act the way I do. That other people (and not every-fucking-body) go through the same thing. Nope, I'm just a bunch of nameless emotions and inappropriate behaviors that apparently the rest of the population share with me. Man, what a fucked up world that would be.

Shit, if I wanted someone to tell me that what I'm feeling isn't what I think it is, I could just call home and save myself $200. Fuck it, I'm done. If I'm going to be not-fucked-up then I can do that on my own just fine.

Why in the hell would a competent psychiatrist ever tell somebody with invalidation issues that he really isn't feeling *that* bad? What is he trying to tell me? Does he think that if he tells me I'm fine that I'll all of a sudden just start believing it? That's like the stupid bitch pdoc I had in inpatient telling me that "only girls cut themselves". Oh, thanks doc, man I sure got that one wrong. Thanks for setting me straight.

God, I can't fucking stand this. I really, really NEED to cut.

But then of course I'll just be acting out. He's really doing it to get attention or to get back at his pdoc.

No, I'm doing it because I feel a deep inner sense of pride. lol. There, NOW they can tell me that I'm not really feeling that!

I don't even have a fucking blade... I can't even get non-fucked-up right. ARRRRRRRRGGGGHHHHHHH!!!!!!!!

Ok, back to pretending that everything is fine.

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Have you discussed the diagnosis issue with your doctor?

It's really not obvious from your post if you have or not.

Diagnoses are weird things. I find comfort in knowing that the doctor agrees with me, but at the same time, my last psychiatrist suspected I might have been "manic" when I saw him last and it pissed me off, so I stopped seeing him because I know I'm not bipolar.

So if you've discussed this with him and you're unhappy with how he handles you, then leave. You've given him four years, I think that's plenty. If you haven't discussed it, don't you think it's time?

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Have you discussed the diagnosis issue with your doctor?

It's really not obvious from your post if you have or not.

Diagnoses are weird things. I find comfort in knowing that the doctor agrees with me, but at the same time, my last psychiatrist suspected I might have been "manic" when I saw him last and it pissed me off, so I stopped seeing him because I know I'm not bipolar.

So if you've discussed this with him and you're unhappy with how he handles you, then leave. You've given him four years, I think that's plenty. If you haven't discussed it, don't you think it's time?

Heh, yeah; I guess clarity kinda suffers a bit when you're pissed off. My insane rant was in response to having had that discussion with him this morning. Actually it's been an ongoing discussion for a few weeks now. Today I was practically on my knees begging him to just confirm what I'm already pretty damn sure of (and was already diagnosed during one inpatient stay as "major depression with cluster B personality traits". Somehow it's important that *he* confirms this).

He's extremely reluctant to actually give me the diagnosis that I want though. I'm guessing about half the people reading this will wonder why the hell I'd *want* a BPD diagnosis... I suspect the other half knows exactly where I'm coming from. In a word; validation.

There are precious few things in my life that I actually have any confidence in, this is one of them. I've been taught pretty well not to trust almost anything I think or feel... and I guess I was a pretty good student. As strange as it may sound it is absolutely devistating having that called into question. I feel like all of the craziness I see in my life is seen as something trivial, nothing on the order of people with "real" problems. I end up feeling like I'm this freak that's just looking for attention (which is probably partly true too).

He has said he thinks my need for a diagnosis is a desire to perpetuate my role as the fuck-up in the family. Maybe so, I'll be the first to admit that my self esteem isn't exactly the highest. Nevertheless it is still really important to me to know that someone else actually sees what I see. I guess he doesn't want me to have the view that he sees me as the fuck-up. Like this is the point where I'm supposed to move past that... I can't. Not yet.

The really shitty part is that aside from this (and a few other minor issues), he's actually really good. He actually does give a shit about me. That does count for something, especially since my last therapist booted me for being "resistant to therapy". I don't want to leave him, but I can't handle this anymore. I don't know what to do. :)

As twisted as it sounds I actually find myself longing for the days when I was completely dysfunctional. In some weird way there was something comforting about it. It fit. Now I'm actually working and being otherwise "functional", and man it is so much harder.

For the longest time after my last inpatient I would go to weekly therapy and as soon as I was out of the office I would immediatly put it all out of my mind. Not that I was able to escape anything, but I wasn't actively attending to any issues. No surprise, I also didn't make any progress.

For the last month or so I've been deeply involved in introspection and as a result I'm heading downhill fast. This isn't subjective either, this is based on my behavior (eratic attendance at work, missing deadlines, leaving early without notice, just not showing up...). This is in stark contrast to my behavior a month ago, and it hasn't gone without notice. I've had "the talk" with a couple of my supervisors.

I really miss the people I was with in partial (partial hospitilization program). It was nice being around people I could actually identify with. When you're in group with the same people for 6 hours a day you get past the superficial crap real quick and get to know the real person.

Wow, how far have I strayed off topic? Not even sure I clarified anything. lol. ;)

Ok, I'll stop blabbing now.

Thanks for the response Whiskey! :cussing:

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I understand your need for a dx, but pdoc has his reasons, I'm sure. Insurance maybe? It could be certain meds can be prescribed for other dx's and not BPD. Or he doesn't want to label you so early. How old are you? Bipolar also overlaps some criteria. Also, having a BPD dx may make it harder to find a pdoc/toc in the future. The stigma being that borderlines are hard to treat, manipulative, etc..(Not saying that you have these qualities, but some therapists assume the worst.)

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I understand your need for a dx, but pdoc has his reasons, I'm sure. Insurance maybe? It could be certain meds can be prescribed for other dx's and not BPD. Or he doesn't want to label you so early. How old are you? Bipolar also overlaps some criteria. Also, having a BPD dx may make it harder to find a pdoc/toc in the future. The stigma being that borderlines are hard to treat, manipulative, etc..(Not saying that you have these qualities, but some therapists assume the worst.)

Yep, he did say that even if he were to change my dx, he wouldn't change it "officially", especially for insurance issues. The label of BPII is 7-8 years old, and I'm 31; so I doubt that it has to do with any waiting period. Actually, the fact that this dx is so old, and many combinations of meds have been tried, and therapy has been given for so long, and I haven't improved substantially, that I am tending towards an axis II disorder as opposed to the axis I I've already got.

That said, there is also a very high comorbidity of BP spectrum disorders with BPD. I may well have BPII, I do react positively, to some degree, to meds which would lend credibility to that dx. But BPD is about learned behaviors, and I believe it is very possible that I've been shaped and conditioned enough to fit that description, even if that learning has been in the context of BPII.

And you are, of course, absolutely correct about the stigma amongst the mental health care proffessionals with respect to BPD patients. I've seen that happen to some good people, so unnecessarilly. It is truly sad. It's hard to say that I fault the MHCP for their bias, as they're only human too and have no doubt met with a considerable amount of frustration working with "resistant" BPD patients. I think we expect them to be devoid of feelings, thoughts and opinions unfairly. We hope that they are better able to keep them in check than the average person though. And it is still very sad when the one person who can actually help you with your situation sees you as a lost cause.

Thanks for the response Scatty!

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Karuna, you rock ;) . You've got some great insight, I really appreciate you sharing (and no, I'm not at all pissed about your response to my blog).

I am unsure as to what your pdoc said to you. Did he question what you were feeling? Because yes, that is invalidating and I can see how angry that would make me, and how angry it makes you. Or did he question the idea that you had BPD? I think there is a key difference here.

Well, it's a bit of both really. The question about dx came about as a result of a comment he had made during a previous session that I had brought back up. He said that he "didn't believe that I was terribly mentally ill". Of course that comment can be interpreted in any number of ways (relative to his other patients? what do you consider "mentally ill"?).

This was what upset me the most. It wasn't the idea that I *wanted* to be mentally ill (and this seemed to be a point I just couldn't seem to express clearly to him), it was that this statement was completely incongruent with everything I believed; my history within mental health care programs and facilities; diagnoses made by other pdocs; the number and dosages or friggin meds (most at max); my history of parasuicidal behavior (both SI and suicidality). To me, the statement felt blatantly manipulative and/or completely invalidating of my daily personal experiences. It was also intensely painful coming from someone who, at my age, is the closest thing I have to a parent-child relationship. It was like reliving my childhood in one hour. It was all the more painful as this was coming from someone who knows full well how and why I would respond to such a statement. It felt cruel.

It was during our discussion of this point that the importance of getting him to accept a diagnosis that I identified with became all important. This was the thing I needed to reasure me that I was being understood. And it was not forthcoming.

He addressed the issue of invalidation and assured me that he did not make light of my pain nor question it's relevance to my daily life. He said that he didn't think there was anything "wrong" with me as my reaction to such pain was perfectly normal. It was a nice sentiment, but it didn't ring true.

First, as far as childhoods go I think I had it pretty easy*. With the exception of two specific incidents I could never claim that my parents physically abused me. I'd even say that my emotional abuse was fairly minimal (but read the * below for clarification). Yet my reaction to it seems to be very extreme, while (some) others who had comparitively horrific childhoods seem to be far better adjusted than I. So how is my response "normal"?

Second, even if I did have a horrific childhood and my pain was well founded; my behavior in response to it is undeniably not the norm. I just cannot be convinced that self injury, frequent suicidal ideation, major depressive episodes, highly eratic extremes of anger expression and highly impressionable (empathetic) response to moods in others are normal behaviors, especially given the frequency of their occurance. It just doesn't add up.

So the importance of the diagnosis was not so much in the diagnosis in and of itself. If was that this became the object I was seeking to regain a sense of security. It's my own issue, no doubt; but that doesn't make it any less real to me.

First off, I am another of those students. And I have sat in many pdoc offices trying to justify what I felt and convince them. It's no fun. I don't think that, if your pdoc is as good as you say he is later in your post, and he is making an effort to dx and treat you, that he is dismissing all your experiences. He is interpreting them differently, but he is not dismissing them. Is it possible that some of this is the way that he talks to you, and also your fears about not being believed and being labeled an 'attention seeker' coming into play here?

Yeah, good points. I do recognize that it is unrealistic to expect that everyone sees things the way I do (in fact I really hope most people don't see things the way I do). My concern is that if we are in disagreement with what the problem is that we are working towards fixing, are we going to be working against each other without being on the same page?

The problem with personality disorders are that they are deep seated. It can take years of therapy to overcome them, in some cases. It's about the way you were raised and react to situations, and while you can learn how to behave in more helpful ways, your initial 'training' will be hard to replace. Once you slot yourself into a BPD mold, it can be a way of giving up, it can get bleak. Working at getting better is hard, and scary. I applaud you for doing it. But do you think the insistence to have the BPD diagnosis and the rage at not getting it might be linked to your fears about getting better and what that means for your life and your identity? If you are the 'fuck up' of the family, can you square your new ability to live in a positive way with that? Or will BPD define you again and get you stuck in the mire?

Hmm... I don't really know. I definitely have a difficult time "letting go" of feelings such as depression. It can be so incediously comforting because it is familiar; it feels "safe" (what an ironic use of the word).

I don't see a dx of BPD as a way of giving up at all, just the opposite really. My dumb ass went and threw out all of my meds after that session as some childish form of retaliation (thankfully my wife was a little more level headed and retrieved them for me). I feel very much like giving up now because I feel like I have no direction or means by which to measure my progress. It's like I'm in the middle of the ocean. There's no land (safety) in sight so you don't know which way to go. There's also no frame of reference to measure if you're even moving at all.

I feel like a dx would clarify what the problem is and would then suggest a course of action to be taken and some standard (symptoms) by which to measure progress. To me, it would be helpful, not a death sentence, so to speak.

With respect to the comment about lengthy recovery; this is already a reality for me. It has already been 7 years or so of treatment, and being dumped by one tdoc for being resistant to therapy that lends itself quite well to notion of typical BPD therapy/recovery experiences.

It's definitely worth noting that there is an added sense of urgency to make some substantial progress in a pretty short period of time. In seven months I'm going to be a father to my first child. I need to be there for both my wife and my child more than I feel I am capable of (though who knows how one will actually respond when in such a situation. we often surprise ourselves with what we can do).

I'm painfully aware that despite any parent's best efforts/intentions, their behavior will both positively and negatively impact their children. I just want to do everything I can to minimize that damage. I don't want my child to grow up with the pain and resentment that I did. I don't care what it means for me, I will do anything to make my child's environment as nurturing as can be. But it scares the hell out of me.

<snip> It's about the way you were raised and react to situations, and while you can learn how to behave in more helpful ways, your initial 'training' will be hard to replace. <snip>

Yes, exactly. My argument is all about how I was raised to think in a certain way about myself, and how I behave now in response to situations in which these thoughts are brought to mind.

I think that this is the hard thing about beginning working on yourself, all the destructiveness comes to the fore, and you think 'hang on, this is what getting better looks like? No thanks!' However if you can figure a way to deal with it, with the support of meds, therapy, crisis lines, peer support, pdocs appts, deals with your boss, it will improve.

Too true. The thing is though, this is not the first time I've tried this sort of introspection. The last time had disasterous consequences, landing me in a psych ward following a suicide attempt. After that I ceased all introspection completely for fear of the potential consequences. Now, as I wrote above, I feel like I have to start down this road again if I'm going to get any better. But so far it seems to be following the same pattern, and it's terrifying.

What I really want to know is, how is he actually treating you, and is it working? Your post indicates that it is to some degree, because you have started working on yourself. However he needs to address this difficult time, and maybe this is where some of your frustration comes from.

It's so hard to say really. He can come across as condescending at times, but this is usually when the conversation is more casual and he is truely joking around. At other times, though he is joking, I'm not in the right frame of mind to look past it as such. For example, one time I told him that for the previous month I had been carrying around a razor in my pocket. He said something like "you never know when that'll come in handy". A joke or course, I just wasn't in a joking mood and it pissed me off. It was a fucking security blanket, don't make light of that.

I don't really know if it is working on the whole, as I don't really have a good frame of reference. I don't doubt his sincerity and effort (at least I don't think I do...), I'm just wondering if this might be a case where we're just not a good match. I think our next session will be pivotal.

-ad

* Though I was sexually abused by a babysitter, my parents never did much of anything in the way of physical abuse. The emotional abuse was not very overt which I think makes it all the more damaging. I wasn't constantly told I was a worthless pile of shit; it was little responses or lack thereof that subtly suggested it.

I think that this kind of subtle abuse it so damaging because you don't know that it's happening. You may recognize that you feel angry, guilty, ashamed or what have you, but you have no idea why you feel that way.

If dear old dad beats you when he's drunk (and I am so not diminishing the impact of such a thing), there is a certain logic to it. You can put a label on it because you can see with full clarity what it is. Dad beats me when he is drunk. He's drunk often and it sucks. I don't know why he's drunk so often or why he chooses to beat me when he's drunk, but I can see a clear chain of causality.

When the abuse is so subtle that you cannot see it, you cannot label it. Without being able to identify it there is no hope of ever making any sense of it. Without any idea that you are being taught a certain pattern of behavior or that your feelings are being dictated for you, it then becomes very easy to find yourself at fault for any negative thoughts or emotions. "Mom must be right, therefore I'm wrong for being upset with her. I'm a bad son and should be ashamed of myself". And so it goes. When you are finally mature enough, and removed from the environment, you can see what had happened, but it is still confusing, especially with regard to intent.

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Affect,

I truly dreaded your response, and had other mods check my response to you for signs of idiotness. So glad we haven't fallen out!

Your last paragraph struck a chord with me. My parents are good people and very loving, but they do have a way of relating to me that says on one hand 'express yourself' and also 'you're emotional/over reacting/too much/getting it out of proportion'. I was also forced to grow up very early. They never physically or sexually abused me, or verbally insulted me, though like you someone outside the family did so and they weren't around enough and alert enough to notice. So I get how you can grow up with an unstable self and way of relating to the world without having gone through something you'd assume was needed for BPD. I also remember from a introduction to DBt for BPD patients that I went to, that the environment might not even be invalidated, it is just that the child interprets stuff as them being invalidated. I kinda hated this concept, my mum was like 'maybe you're just a kid who took it all the wrong way.'

Sheesh!

The thing is, I still think that your view of what is a 'normal' reaction to what you went through is not doing you any favors. I can see where your pdoc comes from when he says that, given what you grew up with, who wouldn't feel like you do? However I also see that being in your shoes, you can appreciate that you relate to the world in a different way to other people around you, and you want this change this, because it does your head in. In my opinion, this is what your pdoc needs to see and plan on helping with. Forget what is normal, or what is in the DSM-V. If you are unhappy, if you think you want to get your head together for your baby (kudos for that, I like to see good fathers here) then you need some assistance, I suspect that something like DBT would do wonders for you. Where I am (the UK) they'll do NHS DBT on anyone they think it might benefit, BPD or not. I don't know how open your pdoc is going to be about this concept.

Maybe the miscommunication here is that your pdoc sees a BPD diagnosis = giving up and you see it as BPD = a chance to sort your shit out, and neither as yet, the two have not converged. I'd drop the DX stuff if it was me, and try to point out how the modules of DBT, such as emotional regulation and distress tolerance would benefit someone with BPII, and complement meds. If he wants to get stuck on BPII, I'd let him, so long as I got the treatment I ultimately think I needed. That is just how I play the game, over here, psychiatry is a game. And since the Pdoc has the prescribing pad the referral sheet, I have to start where he is.

If the dx matters, it matters. But I'm about the treatment, that is what will make the difference.

Sorry for the late response; had a particularly rough couple of days. I think you're dead on in your analysis there Karuna. The dx ended up becoming the focus of my attention, but really it all came from a need to know that he and I are both working towards the same goal (and not working against each other); that I have some frame of reference to judge my progress (or lack thereof); and that I was being understood (and communicating myself clearly).

I guess I figured that all of those things would be confirmed by a dx (and I'm not so convinced that they wouldn't). But you're right, the underlying issues are the important ones; the dx is secondary.

I'll post to my blog about the last couple of days... there's a lot to do with this whole thread.

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