![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Fivefires on June 2, 2008, at 17:19:43
This is what I've heard, yes; but this is NOT all that is me. I am not suicidal and do not cut. I have responded to E-XR and even an SSRI in the past, and more.
Recently it seems 'atypical depression' fits me. T said 'no that's borderline too'. Also some ADD seems to fit. Even some OCD.
I was told I'm not being given an AD because it won't work because I'm borderline.
Earlier this a.m. phoned pdoc as to why I've never been on combination therapy, just monotherapy.
This was messaged to be delivered tomorrow when he is in.
THIS, TO ME, IS ALL WRONG.
They've pinned me down to borderline and I'm suffering more than ever before, and they're just chocking(can't find proper spelling in dictionary) it up to borderline!
I hate this and believe diagnoses like this are often way, way incorrect.
To me, it doesn't explain why I can switch from a low mood to a 'good/higher mood' when something good occurs, small or large, or when someone shows me an act of kindness or love. I told this to my T and T said still symptom of borderline.
So between pdoc and therapist, light bulb moment, 'this is all they think when they see me' and this totally wipes me off the slate of 'maybe this med will help' or 'maybe that med will help', and, this is prob' why pdoc said not too long ago, 'don't know what I can do for you'!
It's clear now why I've been left to wither away w/o an AD. They won't consider anything because they are 100% sure I'm borderline!
BTW, I have never, ever, been on combotherapy; only monotherapy. (Correct me pls if mono is not one.)
Nardil tapped into, 'barely' ... because the side effects were so strong, 'the old assertive but not aggressive me' 'the confident but not show off me' 'the feelings and actions and statements appropriate to the situation me', but, I was refused HELP to tolerate the side effects of the beginning regimen of 15mg 3 x a day.(?) I read your weight should be taken into account when beginning Nardil? T said this is not true.
Anyway, also read somewhere an MAOI, whether effective or not, can be an indicator of whether or not one has TRD.
tks, 5f
AND HEY: My inbox is NOT RECEIVING FOLLOWUPS. Notiiced followups to a previous post of today (I saw them just now as am posting this.) by Phillipa and ClearSkies are they're NOT in my inbox. Post subject: bedridden, (whoops, left out 'lost') 9lbs, truly too weak to help self.
5f
Posted by Phillipa on June 2, 2008, at 19:51:32
In reply to Borderline so no AD will help so pdoc/T give up!?, posted by Fivefires on June 2, 2008, at 17:19:43
Ever tried to hurt yourself overdose or split one person against another called splitting? Or threatened to do above as that would point to an Axis II of borderline. Need Axis one as two is personality. Usually an atypical antipsychotics is used for it? But other meds too. Don't see why no antidepressants can you get another opinion and assessment? Love Phillipa Hey I'd do a google search of borderling personality and see what is suggested.
Posted by Phillipa on June 2, 2008, at 19:52:29
In reply to Re: Borderline so no AD will help so pdoc/T give up!? » Fivefires, posted by Phillipa on June 2, 2008, at 19:51:32
Just remembered DBT theraphy is used a lot. Love Phillipa
Posted by Racer on June 2, 2008, at 20:42:34
In reply to Borderline so no AD will help so pdoc/T give up!?, posted by Fivefires on June 2, 2008, at 17:19:43
>
>
> I was told I'm not being given an AD because it won't work because I'm borderline.
>Hm... That's quite interesting, since many of the articles I've read say that ADs are helpful for BPD... Other medications are, too, of course, but various SSRIs are usually mentioned when discussing medications appropriate and helpful in treating some of the symptoms of BPD.
> They've pinned me down to borderline and I'm suffering more than ever before, and they're just chocking(can't find proper spelling in dictionary) it up to borderline!
First of all, the word is "chalking," just in case you ever need it again. ;-)
And yes -- there's a problem, because there's a huge difference between saying, "Oh, well -- this is nothing more than BPD," and "the suffering you're experiencing is caused by BPD, so you'll work on that -- and this medication will help with your pain while you do so." Guess which one I think is more appropriate?
>
> I hate this and believe diagnoses like this are often way, way incorrect.They can be helpful, as a roadmap to your treatment. And they can be used punitively, as well.
I realize this isn't what you want to hear, but can you open yourself to the possibility that this dx is correct, and that the problem isn't with the dx, but with your current treatment team's response to it? I'm not saying that it fits you, only asking if you can separate the two -- if it does fit, being open to it may help you find more appropriate treatment options.
>
> To me, it doesn't explain why I can switch from a low mood to a 'good/higher mood' when something good occurs, small or large, or when someone shows me an act of kindness or love. I told this to my T and T said still symptom of borderline.Actually, she's right -- that sort of emotional reactivity is often a symptom of BPD. It can be associated with Atypical Depression, but it can also be associated very strongly with BPD.
>
> It's clear now why I've been left to wither away w/o an AD. They won't consider anything because they are 100% sure I'm borderline!Which is part of the problem -- the bottom line of this is, you are suffering. It is not humane to allow you to continue suffering in this manner. There are options out there for you -- and even if you are borderline, this sort of attitude doesn't seem as though it would be particularly helpful for your treatment. I can't imagine that the therapeutic alliance you've got going with either pdoc or T would be all that effective.
> I read your weight should be taken into account when beginning Nardil? T said this is not true.
According to RxList, weight isn't taken into account in starting Nardil.
>
> Anyway, also read somewhere an MAOI, whether effective or not, can be an indicator of whether or not one has TRD.
I'm not sure what you mean by this?Do you mean that response or lack of response to an MAOI would indicate whether or not your depression is treatment resistant? If so, I don't know that I'd believe that. I do respond to various ADs to one degree or another -- but I responded badly to the one MAOI I tried. If you mean that MAOIs indicate whether or not your depression is the Atypical variety, that might be backwards -- Atypical Depression often responds well to MAOIs, according to the various studies, but Atypical depression also responds to other ADs. Mileage varies.
I tend to agree that combination therapy would probably be helpful for you. From what you're writing, I'm guessing that your current state is as much about anxiety as depression -- and probably also about the anxiety surrounding the treatment you're currently receiving. I don't know your situation -- can you change doctors? If so, I think that would be my first recommendation. If you can't, that's harder. If you're receiving treatment at an agency, perhaps appealing to the administration would help? Or, if it's a county agency, contacting the department responsible for them might help.
If you do have to contact an administrator or county department, please let me help you. I had to do that, and learned some things about it...
Posted by Molybdenum on June 2, 2008, at 21:25:13
In reply to Borderline so no AD will help so pdoc/T give up!?, posted by Fivefires on June 2, 2008, at 17:19:43
Hi,
have you considered changing pdocs? We all think that "ours" is good. I am sure that's just what we need to think in order to believe we are going to get better. Truth is, many docs out there barely passed their exams & have problems of their own that can affect their work. I mean statistically, some are going to be at the bottom of their class & really not be very good at their jobs - just like any other profession.
I just think that we take it for granted that our doc is "above average", when in reality, this can't be true as often as we hear.
Just my 2c worth - try someone else :)
And re your babble notifications not working, check at your ISP to see if you have "spam filtering" turned on. Your babble e-mails might be getting inadvertently marked as SPAM & therefore not being delivered. I had that problem initially. Once you log in to the web interface to your e-mail & mark the sender as "not SPAM", it'll be fixed.
Just a possibility.
Good Luck :)
Molybdenum.
Posted by Phillipa on June 3, 2008, at 0:11:32
In reply to Re: Borderline so no AD will help so pdoc/T give up!? » Fivefires, posted by Molybdenum on June 2, 2008, at 21:25:13
FF here's an article by NIMH that explains BPD and treatments. Kind of long. Love Phillipa
Borderline Personality Disorder
Raising questions, finding answers
Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women.1 There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases.2,3 Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.4 Yet, with help, many improve over time and are eventually able to lead productive lives.Symptoms
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.5 These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
Treatment
Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.6 Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.7Recent Research Findings
Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children.8 Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver.9 Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.10 The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.11
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.7
Future Progress
Studies that translate basic findings about the neural basis of temperament, mood regulation, and cognition into clinically relevant insights which bear directly on BPD represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.References
1Swartz M, Blazer D, George L, Winfield I. Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 1990; 4(3): 257-72.2Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 1994; 8(4): 257-67.
3Gardner DL, Cowdry RW. Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatric Clinics of North America, 1985; 8(2): 389-403.
4Zanarini MC, Frankenburg FR. Treatment histories of borderline inpatients. Comprehensive Psychiatry, in press.
5Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harvard Review of Psychiatry, 1998; 6(4): 201-7.
6Koerner K, Linehan MM. Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 151-67.
7Siever LJ, Koenigsberg HW. The frustrating no-mans-land of borderline personality disorder. Cerebrum, The Dana Forum on Brain Science, 2000; 2(4).
8Zanarini MC, Frankenburg. Pathways to the development of borderline personality disorder. Journal of Personality Disorders, 1997; 11(1): 93-104.
9Zanarini MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 89-101.
10Davidson RJ, Jackson DC, Kalin NH. Emotion, plasticity, context and regulation: perspectives from affective neuroscience. Psychological Bulletin, 2000; 126(6): 873-89.
11Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation - a possible prelude to violence. Science, 2000; 289(5479): 591-4.
Posted by crazybeautiful on June 5, 2008, at 15:12:42
In reply to Re: Borderline so no AD will help so pdoc/T give up!?, posted by Phillipa on June 3, 2008, at 0:11:32
I actually thought I was borderline for quite some time & to tell you the truth, I still don't know what my REAL diagnosis is. I don't cut or abuse myself either. However, I am very irritable & angry, even to the point of abusing others. The littlest thing can set me off. It could start with a simple argument over my boyfriend leaving his dirty dishes in our bedroom & then manifest into something huge, where I start bringing up other crap that he does that bothers me. Eventually, I've done so much screaming & slamming doors that I'm exhausted, can't breathe, & forgot what I was even angry about. Then I just start crying because I don't want things to be this way. I don't think I really have typical manic depressive symptoms, but I don't know. If I do, they are mild & I think they're probably rapid cycling because I can go from happy to screaming mad & then crying & sad all in one day, several times a week. The only real thing that seems to make me sad/depressed is my anger & social phobia. And my sad times usually happen immediately after an argument & don't last very long. My happy times don't seem to be that abnormal. I still sleep the same amount. Although, I do have more motivation & energy than normal, but it doesn't really seem like it's overkill. I'm not spending hours upon hours cleaning my house or anything like that. I don't have much energy or motivation to begin with. I never have. So the amount I have during my happy times just seems normal. Does any of this sound familiar?
I do believe there's hope for you in taking anti-depressants. There are many helpful meds out there, you just have to find the right one(s). Currently, I take Lexapro 20mg & Wellbutrin SR 75mg. The Lexapro has been wonderful, but I'm still not sure we've found my magical cocktail just yet.
Posted by Fivefires on June 5, 2008, at 16:06:06
In reply to Re: Borderline so no AD will help so pdoc/T give u » Fivefires, posted by Racer on June 2, 2008, at 20:42:34
> >
> >
> > I was told I'm not being given an AD because it won't work because I'm borderline.
> >
>
> Hm... That's quite interesting, since many of the articles I've read say that ADs are helpful for BPD... Other medications are, too, of course, but various SSRIs are usually mentioned when discussing medications appropriate and helpful in treating some of the symptoms of BPD.
>R: Yep. Heard same. And, it almost seems like a cop out to say nothing will work so we're doing nothing.
> > They've pinned me down to borderline and I'm suffering more than ever before, and they're just chocking(can't find proper spelling in dictionary) it up to borderline!
>
> First of all, the word is "chalking," just in case you ever need it again. ;-)
>
> And yes -- there's a problem, because there's a huge difference between saying, "Oh, well -- this is nothing more than BPD," and "the suffering you're experiencing is caused by BPD, so you'll work on that -- and this medication will help with your pain while you do so." Guess which one I think is more appropriate?
>R: Can't guess; cognition suffering. Bedridden a week. EMTs said if took to hosp. and I was this lucid they'd toss me out. Lost another 2lbs., now just 108. Tell me pls, what I should be able 'to guess'?
P: Don't know what splitting is? Also, did have some attempts, one just to get into hospital, others due to the black hole w/ some SSRIs (I think it was SSRIs.) when could not think clearly tomorrow another day ya' know. Hasn't been an intention of mine for a long time.
I wonder tho' if it is a subconscious intention at the way I am withering away here? Put food in, comes right out. Walk like 95-yr-old. Feels like body is 'shutting down'.
> >
> > I hate this and believe diagnoses like this are often way, way incorrect.
>After seeing pdocs for 10yrs or so, w/ never a mention of borderline, it was 'a caseworker' who said to me once out of the blue, 'have you ever been diagnosed borderline?'.
> They can be helpful, as a roadmap to your treatment. And they can be used punitively, as well.
>
> I realize this isn't what you want to hear, but can you open yourself to the possibility that this dx is correct, and that the problem isn't with the dx, but with your current treatment team's response to it?>I suppose. Team: had one of those in other county. Here don't. Can't get out of county. Could afford pdoc on other ins. but NOT MEDS. Benzos are not even on the formulary of other ins..(?)
>I'm not saying that it fits you, only asking if you can separate the two -- if it does fit, being open to it may help you find more appropriate treatment options.>
>
> >
> > To me, it doesn't explain why I can switch from a low mood to a 'good/higher mood' when something good occurs, small or large, or when someone shows me an act of kindness or love. I told this to my T and T said still symptom of borderline.
>
> Actually, she's right -- that sort of emotional reactivity is often a symptom of BPD. It can be associated with Atypical Depression, but it can also be associated very strongly with BPD.>T said BPD is same as Atypical Depression.
> >
> > It's clear now why I've been left to wither away w/o an AD. They won't consider anything because they are 100% sure I'm borderline!
>
> Which is part of the problem -- the bottom line of this is, you are suffering. It is not humane to allow you to continue suffering in this manner.>Do feel like they're treating me like a total nobody, or an animal would receive better treatment! I'm scared to death. I wish to keep living and walking and smiling and 'being' again.
>There are options out there for you -- and even if you are borderline, this sort of attitude doesn't seem as though it would be particularly helpful for your treatment.>
When she said that, I immediately thought need new T! She had never been sort curt, shallow, uncaring, and then to say would be out of office for a while! This 'you're already sunk so you might as well give up attitute doesn't work for me'. Made me very fearful and sad.
>I can't imagine that the therapeutic alliance you've got going with either pdoc or T would be all that effective.>
Yes, if T is saying this to pdoc, pdoc might be following suit.
> > I read your weight should be taken into account when beginning Nardil? T said this is not true.
>It's in a post here on meds called Nardil Best AD Ever, something like this.
>According to RxList, weight isn't taken into account in starting Nardil.>
>
> >
> > Anyway, also read somewhere an MAOI, whether effective or not, can be an indicator of whether or not one has TRD.
>
>
> I'm not sure what you mean by this?This was also in the above post.
>
> Do you mean that response or lack of response to an MAOI would indicate whether or not your depression is treatment resistant? If so, I don't know that I'd believe that. I do respond to various ADs to one degree or another -- but I responded badly to the one MAOI I tried. If you mean that MAOIs indicate whether or not your depression is the Atypical variety, that might be backwards -- Atypical Depression often responds well to MAOIs, according to the various studies, but Atypical depression also responds to other ADs. Mileage varies.
>And the Nardil was working cognitively, but side effects intolerable; why thought 45mg a day to begin might have been too high. And, have taken other ADs in past w/ success. But, like I said, NEVER ON COMBO, except for an AD and a benzo.
> I tend to agree that combination therapy would probably be helpful for you. From what you're writing, I'm guessing that your current state is as much about anxiety as depression -- and probably also about the anxiety surrounding the treatment you're currently receiving. I don't know your situation -- can you change doctors?
Yes, but this pdoc is supposed to be best in county per casewkr who fled w/o notice. There is an older one who prob' be retiring soon and then it seems not much to pick from. I think I've mentioned spoke w/ county next to me who said, get out of that county as fast as you can.
>If so, I think that would be my first recommendation. If you can't, that's harder. If you're receiving treatment at an agency, perhaps appealing to the administration would help?>
Think have tried and been re-routing back to pdoc.
>Or, if it's a county agency, contacting the department responsible for them might help.
>Have so couple times; now being re-routed back to pdoc from them.
> If you do have to contact an administrator or county department, please let me help you. I had to do that, and learned some things about it...
Can you pls babble me. Maybe my approach wrong.
If I've not yet, can't stay online long or may miss the way too long-awaited call from pdoc. But, I know what will say, 'what do you want me to do for you?' Isn't this backwards?
Isn't this backwards?
Tks ... better sign off.
5f
Posted by Fivefires on June 6, 2008, at 1:20:20
In reply to Re: Borderline so no AD will help so pdoc/T give up!?, posted by Phillipa on June 3, 2008, at 0:11:32
Tks Phillipa. Ya' know, this really doesn't sound that much like me. I mean, there might be a bit of it like me, but not at all this extreme.
5f
and: No pdoc/PCP call backs, everything eat goes right through me, almost fell over tonight/dizzy, bad for a long time now, don't get why professionals not helping me.(?)
Posted by Fivefires on June 6, 2008, at 1:41:07
In reply to Re: Borderline so no AD will help so pdoc/T give up!? » Fivefires, posted by Molybdenum on June 2, 2008, at 21:25:13
Molybedenum and Crazy Beautiful:
Tks for sharing here.
Changing docs is something I'm trying to work on, but $ prob', but w/ seeing them, but w/ the costs of the scrips prescribed by them.
As far as your description Crazy Beautiful, I think you sound diff' in that 'my downs last a looonnnggg time'. Or, at least they do now. They didn't used to. Since my father passed away, I've worsened. Right now, it's as if my body is just 'shutting down'.
I too never fit a bipolar dx per pdocs, and think I already mentioned it was a casewkr who asked me about borderline.
You are doing well on meds so this is good. I think I shouldn't be left alone w/o them trying anything this way.
I am feeling quite ill and hopeless, but appreciate your help.
tks, 5f
and: Sorry if missed anyone. When receive mail, get 2 or 3 of every one(?), so might have accidentally deleted one.(?)
Posted by Racer on June 6, 2008, at 11:22:07
In reply to Borderline/atypical; no AD help; pdoc/T give up?, posted by Fivefires on June 5, 2008, at 16:06:06
> > >
>
> R: Yep. Heard same. And, it almost seems like a cop out to say nothing will work so we're doing nothing.Is it a cop out for them to say that they're going to do nothing? That question might not be all that helpful right now. What might be more helpful is this question: What can you do to help yourself right now?
> > And yes -- there's a problem, because there's a huge difference between saying, "Oh, well -- this is nothing more than BPD," and "the suffering you're experiencing is caused by BPD, so you'll work on that -- and this medication will help with your pain while you do so." Guess which one I think is more appropriate?
> >
>
> R: Can't guess; cognition suffering.What I was trying to say is that I think it's more appropriate for them to try to help reduce your pain WHILE ALSO trying to work on the underlying BPD -- if that's what it is -- rather than just saying, "Oh, that's just BPD -- we can ignore your pain."
There's a medical parallel here, by the way. For many years, accepted wisdom was to treat pain conservatively. Treat the underlying condition, rather than treating the pain, which was only a symptom. Turns out, that's wrong. The pain itself has to be treated as well.
So, your doctors seem to be saying, "we'll address the underlying condition -- but we won't treat the symptom." Problem is, if they don't treat the symptom -- your pain -- they're not going to get far in treating the underlying condition.
>
> P: Don't know what splitting is? Also, did have some attempts, one just to get into hospital,Don't worry about "Splitting" -- it's a defense mechanism common in BPD, but if you do it, you probably won't know you do it. Also, it's not diagnostic, so it doesn't help work out if it fits.
>
> I wonder tho' if it is a subconscious intention at the way I am withering away here? Put food in, comes right out. Walk like 95-yr-old. Feels like body is 'shutting down'.
>
>
> After seeing pdocs for 10yrs or so, w/ never a mention of borderline, it was 'a caseworker' who said to me once out of the blue, 'have you ever been diagnosed borderline?'.If you had been diagnosed as borderline, you probably wouldn't have been told. It's not necessarily helpful to disclose Axis II diagnoses, unless it's directly relevant to treatment. If you're getting into DBT, it might make sense to tell you, otherwise they probably wouldn't.
>
> T said BPD is same as Atypical Depression.And I think we both know that the two are very different things.
Are you seeing this T through the same agency that provides the pdoc? And can you discuss changing Ts?
> When she said that, I immediately thought need new T! She had never been sort curt, shallow, uncaring, and then to say would be out of office for a while! This 'you're already sunk so you might as well give up attitute doesn't work for me'. Made me very fearful and sad.
Is that what she said?
Linehan had a description of her view of the etiology of BPD that I really liked. It was very compassionate. I forget the exact description, but she described a child asking for attention, being ignored by the parents until the child went over the top -- and the parents suddenly gave full attention. In other words, she described a child being trained to escalate rapidly. After all, if you need attention, and the only way you have ever gotten it is to escalate, you'll learn fast to skip the lead in and go straight to the top, right? Unfortunately, that leaves you in a very bad position right now -- if you express how bad off you are, your treatment team are likely to see that as the sort of escalation typical of BPD. From your perspective, of course, saying, "I am not 100%" just doesn't convey the extent of your pain. So, not a good situation.
Unfortunately, that being the case, the more you try to get across to them that you're feeling as though they're not taking your seriously, the more they will ascribe your behavior to BPD and refuse to take you seriously. And, unfortunately, although they're the professionals and supposed to be able to take control of this situation in a professional and effective manner -- they just don't have the incentive you do to change the dynamic here. It will be hard to change the dynamic, and you're not in any sort of shape to take something like that on right now -- and you're still the best person to do it.
>
>
> Yes, if T is saying this to pdoc, pdoc might be following suit.From my experience, it's more likely the pdoc telling this to the T...
>
> Have so couple times; now being re-routed back to pdoc from them.Your county will have a formal complaint process, and using that process will at least get someone else to listen before routing you back to the pdoc. The usual process is to start by sending you back to the pdoc to work things out; if that doesn't work, they'll send you to the administrator for that pdoc (who'll probably send you back to the pdoc to work things out); and only after that will the county step in. And even if they step in, they may say that there's nothing to do because they don't have any other doctors.
Here's another suggestion: See if there's a PHYSICAL medical doctor you can see. It's not ideal, by any means, but honestly -- sometimes the county GPs are much better than the county pdocs, even for psych meds.
> I know what will say, 'what do you want me to do for you?' Isn't this backwards?
I hope you heard back from him, and that he was more responsive than you feared.
I've already sent you some suggestions, but here are a few other thoughts:
Write a script to use when you speak to the pdoc again. Something like this:
1. Even if you do have BPD, you're still in a great deal of pain.
2. If you do have BPD, that's something you'll address in therapy -- but to do that, you need to address the pain more directly, in order to give you the resilience to do the work.
3. You did experience a certain amount of benefit from Nardil -- but the side effects made it intolerable. That suggests that another medication may be helpful AND more tolerable.
Realistically, it still may not work. I strongly urge you to contact your local NAMI office for help.
Also, a lot of doctors are annoyed by patients showing up and saying, "I've read about this medication, and think it's a good choice." Regardless of what we think of that attitude, it's worth keeping it in mind when you talk to this guy.
Good luck.
Posted by Fivefires on June 6, 2008, at 15:03:56
In reply to Re: Borderline so no AD will help so pdoc/T give up!?, posted by Phillipa on June 3, 2008, at 0:11:32
Phillipa - Cannot stay online long .. still hoping PCP/pdoc might call.
Can u pls post NIMH description of PTSD here?
So ill, eating Imodium like crazy.
Very much appreciate.
5f
Posted by Fivefires on June 6, 2008, at 15:26:38
In reply to Re: Borderline/atypical; no AD help; pdoc/T give u » Fivefires, posted by Racer on June 6, 2008, at 11:22:07
Racer I've got that, author unknown, print, and gotta' get offline. Plan to call NAMI. Children too busy today to do so. I gave them auths to speak w/ a lot of my supposed care givers, insurance, facilities, etc., which I can withdraw at any time.
tkssomuch, 5f
Posted by Phillipa on June 6, 2008, at 19:20:35
In reply to Re: Borderline/atypical; no AD help; pdoc/T give u, posted by Fivefires on June 6, 2008, at 15:26:38
Five Fires don't know if a google search will yeild Nimh PTSD diagnosis will try. Love Phillipa
Posted by Fivefires on June 6, 2008, at 23:19:29
In reply to Re: Borderline/atypical; no AD help; pdoc/T give u, posted by Phillipa on June 6, 2008, at 19:20:35
Tks Phillipa. I am quite a wreck!
No one responded, tho' did go through NAMI, and was directed to a advocate in my county. Left messages w/ people all day. No one working I guess. Will be a long weekend.
Hope yours is good, 5f
Posted by Phillipa on June 7, 2008, at 0:34:58
In reply to Re: Borderline/atypical; no AD help; pdoc/T give u, posted by Fivefires on June 6, 2008, at 23:19:29
Well it will be long here too l00 degress. We could keep each other company write. Love Jan
This is the end of the thread.
Psycho-Babble Medication | 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.