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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 51. Go back in thread:
Posted by Racer on March 7, 2004, at 15:05:36
In reply to Re: It does help, but brings up another ??, posted by Apperceptor on March 7, 2004, at 14:45:04
You said a lot I agree with. Was it Tolstoy who wrote, "All happy families are alike, all unhappy families are unhappy in their own unique way?" I think that fits well here, don't you?
Thank you.
Posted by Racer on March 7, 2004, at 15:08:44
In reply to hysterical personality, posted by shortelise on March 7, 2004, at 14:33:42
Thank you very much. Your dr sounds very good, and very sensitive. I'll add those qualities to my general standard of adequate medical care, in hopes of finding a dr who can provide it by having a better way of recognizing what AMC consists of. Right now, my definition is pretty simple: treat me as well as my vet treats my cats. Doesn't sound so hard, does it? They don't even have to pet me under the chin or kiss my forehead, either. I'm not a stickler for those details, although I'm glad my vet does it.
Thanks again.
Posted by terrics on March 7, 2004, at 15:20:08
In reply to Re: It does help, but brings up another ??, posted by Apperceptor on March 7, 2004, at 14:45:04
I was given that dx. with one obvious criteria. I cried for hrs and hrs. after. I am in the medical field and knew what it meant. Up to that point I was always dxd as depressed. It is not a kind thing to tell someone. It is like saying,
you are the dregs of the psychologically ill.So here it is. The one criteria, and probably the most defining of BPD. I cut. Along with this I am running into a severe problem where I want to cut down to organs. This is something new. I used to just run the razor over my skin to cause bleeding. Now I keep running the blade over the same incision to make it straight and deep. It has become a driving urge. My abdomen looks like a mess right now from all the practice. This unfortunately is gory, but I would like to hold the slimy sticky insides in my hands. I think something has gotten out of control. I would like to understand why someone would do this. Just a little side note; I cut when I was nine after my father died. I had NO idea about cutting then and often wonder how such a thing can start without a prompt. terrics p.s. I keep this secret well. So it is good to be able to share it anonymously.
Posted by Dinah on March 7, 2004, at 15:28:30
In reply to Re: It does help, but brings up another ??, posted by Apperceptor on March 7, 2004, at 14:45:04
There is a somewhat positive side to understanding yourself, if you have a sensitive therapist, in thinking in terms of BPD. My manner of presenting myself is such that no one ever had seriously considered I might be borderline. And I really don't have enough of the criteria to meet the diagnosis. But when I read Linehan's "Cognitive-Behavioral Treatment of Borderline Personality Disorder" I grabbed a highlighter and started highlighting. It did so much to help me understand why I did the things I did. And find words to use to describe my feelings. It was such an "ah-hah" experience.
Since then, my therapist has come to the conclusion that I have borderline traits, but I'm the one that brought the idea to him. Since so much of borderline personality disorder is defined in terms of behavior, he might not have understood what drove me nearly as well if I hadn't brought up the possibility of the diagnosis to him.
So he now thinks I've got schizotypal traits on the outside, wrapped around an inside with borderline traits. :))
But then, I'm firmly convinced that Axis II should be done away with and the underlying biological sensitivies and resulting clusters of coping mechanisms should be seggregated. So more like splitting borderline into an Axis I disorder that consists of poor affect regulation and slow return to baseline. Possibly due to a poorly regulated cholinergic system. http://www.biopsychiatry.com/acetph.htm
And then something similar to Axis II, but not called "personality disorders" but rather more like "defense structure" where the clinician can have a mutually agreed upon way to classify symptom clusters that often occur together, but that are (IMHO) responses to biological vulnerabilities.
I'm tired and I'm not sure I explained it well. But wouldn't it be great to be on the DSM committee?
Posted by pegasus on March 7, 2004, at 15:57:48
In reply to ???s about Borderline dx, posted by Racer on March 7, 2004, at 13:10:24
I think diagnoses are so tricky, because they can be helpful, as Dinah described, but also very destructive, as in the way your old pdoc used them. The way I understand it, the most compelling reasons for using diagnoses are to communicate with other clinicians - especially for the purposes of research. For example, if someone is going to study the effects of some drug on depression, there has to be an agreement about what constitutes depression.
But I think we also get hung up on diagnoses, because we're so used to medical diagnoses. Medical disorders are a very imperfect analogy for mental disorders. Because different people can arrive at similar mental symptoms through such different pathways (life experiences, biological issues, etc.). And the diagnosis of mental disorders is completely dependent on the presence of certain symptoms. I mean, the diagnoses are defined by the symptoms. Which isn't the case for physical illnesses. A doctor can misdiagnose you even if they understand all of your phyisical symptoms. Because there is usually a real physical "right answer" about the cause.
But for mental disorders, the symptoms define the disorder, whatever the cause. Which a lot of people think means that the diagnoses are kind of arbitrary or meaningless.
I've been taught not to use diagnoses unless I have to (for insurance purposes, say). But on the other hand, sometimes different people have a lot in common in terms of their mental experiences, and it seems useful to me to consider what we can learn from one person that extends to another.
Sorry for the rambling, but that's my 2 cents.
- p
Posted by fallsfall on March 7, 2004, at 16:21:08
In reply to ???s about Borderline dx, posted by Racer on March 7, 2004, at 13:10:24
I have been diagnosed Borderline, but I don't fit the typical model - I'm not impulsive, and I don't get angry (maybe NOT getting angry is my problem...). Terrics, I disagree that SI is the hallmark of Borderlines - I think that splitting is - black and white thinking. I do a lot of splitting.
When I was interviewing new therapists, I would walk into their office and say "I have depression and BPD - but I'm not really a typical BPD...". One reason I did this was because if a therapist was going to have problems dealing with someone who was "BPD", then I knew they couldn't handle me. I wanted to know right off the bat.
Racer, if you ever read Psych books that are written for therapists, I would highly recommend Linehan's book "Cognitive-Behavioral Treatment of Borderline Personality Disorder". There is also a skills training manual, "Skills Training Manual for Treating Borderline Personality Disorder". The skills training manual has a few chapters at the beginning that summarize what is in the book - so if you only want to read a little, you could start there. These books describe how Linehan believes BPD is often triggered by the environment, and really capture (at least for me) what it feels like to be borderline.
Like Dinah, I had an "ah-ha" moment reading Linehan's books. The therapy that she describes is called DBT - it is a variant of CBT. I think that DBT could be helpful to lots of people who aren't Borderline (though many DBT programs are limited to patients with BPD). I did 6 months of DBT skills training, and my CBT therapist was very interested in reading Linehan's books.
For me, however, DBT and CBT did not go far enough. They were helpful in getting me to a place where I had enough coping skills to stay out of the hospital most of the time (I've been in twice, once before the DBT, once five years after). But they left me frustrated that the *cause* of my anguish wasn't being addressed - I was just learning to live better in spite of it. I'm now in Psychodynamic therapy, which does seem more able to get to the causes. I don't know if I could have survived my current therapy if I didn't have the DBT/CBT stuff first.
I have heard that with patients who have similar behaviors, that women are diagnosed with BPD, while men are given Anti-Social Personality Disorder diagnoses. My understanding is that Anti-Social PD is as rare amoung women as BPD is among men.
My take is that a diagnosis is helpful only if it helps you or your therapist understand you better, and create a more effective treatment plan. I think that there are a significant number of experienced therapists who aren't scared by the BPD diagnosis, and those of us who have even some tendencies in that direction will do ourselves and the therapists of the world a favor if we find out who they are, and stay away from the "unenlightened".
Posted by Apperceptor on March 7, 2004, at 17:00:46
In reply to Re: ???s about Borderline dx » Racer, posted by fallsfall on March 7, 2004, at 16:21:08
DBT is currently being systematically evaluated for use with depression and anxiety, with encouraging preliminary results. I also am very close to some psychologists who use it for these and other concerns in their own practices. I've used it once, in a DBT group for people with Bipolar I. It seemed to help, particularly "wise mind." It is my sincere hope that the word gets out that DBT, the supposedly "Borderline Therapy" is effective for other concerns, and perhaps this will help destigmatize.
I've had the pleasure of seeing Dr. Linehan speak, and her manner and approach is utterly engaging. She's a very "no bulls***" type person and her genuineness and lack of "clinical distance" is beautiful.
I hate the term "personality disorders." In my program, we are being told not to use it. The term we're using is "Characterological Disorders" (or "Characterological Maladjustments" among the more dynamically oriented faculty). Same thing, but I think taking it a little out of the vernacular might help a bit. Still a long ways to go, unfortunately.
Posted by Dinah on March 7, 2004, at 17:31:19
In reply to Re: It does help, but /MAY TRIGGER***, posted by terrics on March 7, 2004, at 15:20:08
Terrics?
I hate to sound like a mom here, but I can't help it. I am a mom. Are you making sure you're getting proper wound care? Embarassment isn't fun, but neither are a host of nasty bugs that you can get from an untended wound.
What does your therapist think of your increasing urges? Have you changed medications recently? I found that I had a lot more trouble on Luvox than off. It must have been disinhibiting for me somehow.
Posted by Apperceptor on March 7, 2004, at 18:18:20
In reply to Re: It does help, but /MAY TRIGGER*** » terrics, posted by Dinah on March 7, 2004, at 17:31:19
Please excuse my ignorance, I feel like I should know this, but could somebody tell me what "trigger" means? I've seen it in various places and I'm wondering.
I'm guessing it's got something to do with exacerbating urges or feelings...if this is the case and an answer to my question would be a trigger in itself, please don't hesitate to say so and I will figure it out some other way :-).
Posted by Dinah on March 7, 2004, at 18:26:33
In reply to Re: It does help, but /MAY TRIGGER***, posted by Apperceptor on March 7, 2004, at 18:18:20
It just means that people who are prone to self injury, or have issues with sexuality, or have suicidal ideation may find a post disturbing or it might exacerbate their problems
I suppose it maybe should be more specific? SI trigger? or suicidal ideation trigger? or abuse trigger?
Posted by Apperceptor on March 7, 2004, at 18:40:20
In reply to Re: It does help, but /MAY TRIGGER*** » Apperceptor, posted by Dinah on March 7, 2004, at 18:26:33
Thank you!
I think it can be applied to an even wider range of issues...I know that I've been "triggered" in the past (both online and in real life) with my obsessive-compulsive (primarily rumination) issues.
Wouldn't it be nice if we had "trigger warnings" in real life?
Posted by Apperceptor on March 7, 2004, at 18:58:13
In reply to ???s about Borderline dx, posted by Racer on March 7, 2004, at 13:10:24
Racer-
I'd like to suggest the book _Imbroglio: Rising to the Challenges of Borderline Personality Disorder_ by Janice M. Cauwels (ISBN: 0-393-03349-X). It addresses a lot of the issues you're confronting, and includes a great deal of feedback and contribution from individuals who carry a diagnosis of BPD themselves.
Posted by noa on March 7, 2004, at 19:47:40
In reply to Re: ???s about Borderline dx, posted by gardenergirl on March 7, 2004, at 13:43:10
My philosophy has come to be that diagnoses are not real things in and of themselves. They are man-made constructs to help organize symptoms into clusters to try to make sense of them in order to provide treatment.
Sometimes, new biological research comes along to support the idea that there is an underlying biological basis for validating one construct or another. But I think for the most part, the psychiatric diagnoses are all still waiting on that.
Take for example whether my depressive illness is unipolar or in the bipolar family. Who knows? At one point, my previous pdoc hypothesized that it might be, I think in part to explain the recurrences, but also in part to point to a new strategy to try---augmenting with lithium. But at the same time, he also said that lithium could help with depressive symptoms whether I had bipolar II or not. So in the end what difference did it make for me how to conceptualize my diagnosis? Most of psychopharm is trial and error anyway!
And therapy? I think they did studies that show that different kinds of therapy are actually more alike than different and that the healing aspects of therapy were those that are shared across the methods.
But sometimes I guess having a diagnosis could lead to a particular approach to treatment and that is when the diagnosis is the most relevant and useful.
Some of these diagnoses are based on concepts organized at an earlier time in the history of psychiatry, and therefore influenced by one school of thought or another, and that needs to be taken into consideration, as well.
OK, so all these different people, a rather diverse group, are clustered together because they share some symptoms. Perhaps this is a valid way to group them, perhaps not.
The biggest question for me is whether grouping them this way is helpful. Is the particular diagnosis helpful? Will it lead to a treatment plan that will work to help the person with their symptoms and problems?
Otherwise, diagnoses are rather useless at best, and can be used harmfully, as you related to us from your experience.
Some people find comfort in having a diagnosis and they feel better understood. But others feel shamed by it. So I say, if it helps, it is useful. If not, it is just an idea dreamed up by a bunch of psychiatrists sitting around a conference table decades ago. That is all it is. There is no evidence that conceptualizing things in this way is biologically valid.
I think sometimes MH people like to use the Borderline dx when they are working with challenging patients--it helps them distance themselves from the patients and helps them explain away their anxiety about being challenged.
But other times, it seems from what I've read here, the dx can be used with genuine care and professionalism, and with empathy for the patient's diagnosis.
If it is used as a weapon, obviously it isn't useful. If it helps someone feel understood and hopeful about finding relief--then to me, it is a valid and useful diagnosis.
BTW, there are some researchers who see BPD as falling into the bipolar spectrum, with rapid cycling explaining some of the emotional ups and downs. And some see hormones as a factor, too.
Posted by noa on March 7, 2004, at 19:58:21
In reply to Re: It does help, but /MAY TRIGGER***, posted by terrics on March 7, 2004, at 15:20:08
Terrics,
I appreciate your bravery in disclosing this. I know it must be hard to break the secret.
I think when I read Levenkron's book "Cutting", if I remember correctly, he doesn't necessarily equate cutting with borderline. But it's been a while since I read it. Anyone else know?
Cutting is a serious problem in itself. Do you find that the diagnosis of Borderline PD helps you and your therapist to understand your cutting behavior better?
Thanks.
Posted by noa on March 7, 2004, at 20:01:23
In reply to Re: ???s about Borderline dx, posted by pegasus on March 7, 2004, at 15:57:48
Pegasus--that was a very helpful explanation. You sound like a very compassionate therapist. Thank you.
> I think diagnoses are so tricky, because they can be helpful, as Dinah described, but also very destructive, as in the way your old pdoc used them. The way I understand it, the most compelling reasons for using diagnoses are to communicate with other clinicians - especially for the purposes of research. For example, if someone is going to study the effects of some drug on depression, there has to be an agreement about what constitutes depression.
>
> But I think we also get hung up on diagnoses, because we're so used to medical diagnoses. Medical disorders are a very imperfect analogy for mental disorders. Because different people can arrive at similar mental symptoms through such different pathways (life experiences, biological issues, etc.). And the diagnosis of mental disorders is completely dependent on the presence of certain symptoms. I mean, the diagnoses are defined by the symptoms. Which isn't the case for physical illnesses. A doctor can misdiagnose you even if they understand all of your phyisical symptoms. Because there is usually a real physical "right answer" about the cause.
>
> But for mental disorders, the symptoms define the disorder, whatever the cause. Which a lot of people think means that the diagnoses are kind of arbitrary or meaningless.
>
> I've been taught not to use diagnoses unless I have to (for insurance purposes, say). But on the other hand, sometimes different people have a lot in common in terms of their mental experiences, and it seems useful to me to consider what we can learn from one person that extends to another.
>
> Sorry for the rambling, but that's my 2 cents.
>
> - p
Posted by terrics on March 7, 2004, at 20:26:26
In reply to Re: ???s about Borderline dx, posted by gardenergirl on March 7, 2004, at 13:43:10
gg, you are kind not to mention the diagnosis to your clients. terrics
Posted by Racer on March 7, 2004, at 20:37:22
In reply to Re: It does help, but /MAY TRIGGER***, posted by Apperceptor on March 7, 2004, at 18:40:20
Posted by Apperceptor on March 7, 2004, at 21:05:28
In reply to Re: ???s about Borderline dx, posted by noa on March 7, 2004, at 19:47:40
!!!!!!
Noa has said everything I'd like to say on the topic of diagnoses, but more eloquently and comprehensively.
Thank you, Noa! Your type of thinking is a great asset to mental health.
Posted by Apperceptor on March 7, 2004, at 21:47:34
In reply to Re: ???s about Borderline dx » Racer, posted by Apperceptor on March 7, 2004, at 18:58:13
I saw a suggestion from Dr. Bob Up There ^ about giving people easy access to books. I suggested "Imbroglio" in this thread, so let's give it a try.
Dr. Bob, you owe me :-)
Posted by emmaley on March 8, 2004, at 2:41:48
In reply to ???s about Borderline dx, posted by Racer on March 7, 2004, at 13:10:24
I react strongly when I hear about instances such as what you described with your pdoc. No one deserves to be coerced, not even when it's "deemed" in their best interest.
I am so sorry you were put in that position, and I agree wholeheartedly with what gardengirl posted, and many others. So glad that you posted this to check it out. Awesome.
Posted by Racer on March 8, 2004, at 2:47:15
In reply to Re: It does help, but /MAY TRIGGER***, posted by terrics on March 7, 2004, at 15:20:08
Have you talked to your therapist or pdoc about this? I hate to sound like a Mom here, especially since I'm not one, but that does sound pretty dangerous to me. Wound care, if nothing else. I hate to think of how bad that must feel for you, and how frightening that must be for you.
Have you told your T about the new aspects of it? The first rule in veterinary medicine is that, when confronted by new behaviors, rule out any physical cause for them before assuming it's behavioral. That sounds pretty reasonable for human care, too, as far as I'm concerned. Rule out something like hormonal changes, or a subclinical infection, or something weird like maybe an inflammatory syndrome starting up.
You don't have to give any details at all, but are you aware of anything new in your life that might have triggered this change? More stress than usual? I guess what I'm asking is this: are you aware of what changed, whether you are ready to talk to your T about it yet or not?
Last, and this is one of those personal questions I can ask and you have no reason to answer if you don't want to, does your T ever talk about this as a behavior, rather than a dx? You know, talking about finding other outlets for the pain? I'm really just curious about what the current treatment is like, not asking for any details about you that you might not want to get into.
Best good luck to you.
Posted by emmaley on March 8, 2004, at 3:08:44
In reply to ???s about Borderline dx, posted by Racer on March 7, 2004, at 13:10:24
Somehow, this thread brings back memories of watching the film, "The Hours," when Virginia Woolf (Nicole Kidman) said the following lines in a scene where her husband Leonard was so desperate for her to follow the doctors' prescriptions of staying in the countryside when she wished to return to London:
Leonard Woolf: If I didn't know you better I'd call this ingratitude.
Virginia Woolf: I am ungrateful? You call ME ungrateful? My life has been stolen from me. I'm living in a town I have no wish to live in... I'm living a life I have no wish to live... How did this happen? I'm dying in this town.
Leonard Woolf: If you were thinking clearly, Virginia, you would recall it was London that brought you low.
Virginia Woolf: If I were thinking clearly? If I were thinking clearly?
Leonard Woolf: We brought you to Richmond to give you peace.
Virginia Woolf: "If I were thinking clearly, Leonard, I would tell you that I wrestle alone in the dark, in the deep dark, and that only I can know. Only I can understand my condition. You live with the threat, you tell me you live with the threat of my extinction. Leonard, I live with it too. "
"This is my right; it is the right of every human being. I choose not the suffocating anesthetic of the suburbs, but the violent jolt of the Capital, that is my choice. The meanest patient, yes, even the very lowest is allowed some say in the matter of her own prescription. Thereby she defines her humanity."This scene at the train station always gets me. I always weep uncontrollably for it is so beautifully said, and with such courage. For some reason, it always pulls at my deepest core.
Should the client not have some say in the matter of their own prescription?
I am not great at diagnosing. I see the necessity for its existence and the potential benefits and harms. It's something that I struggle with still.
Posted by emmaley on March 8, 2004, at 3:28:12
In reply to Re: It does help, but /MAY TRIGGER***, posted by terrics on March 7, 2004, at 15:20:08
I want to really support what Racer, Dinah, and noa posted, terrics, and I want to support you. Like Racer asked, have you discussed this new development with your therapist? I so wish that you travel this path with loving companions that can support you, instead of feeling alone.
Take gentle care,
Posted by fallsfall on March 8, 2004, at 7:10:36
In reply to Re: ???s about Borderline dx, posted by emmaley on March 8, 2004, at 3:08:44
I just saw "The Hours" for the first time this week. Unfortunately, I couldn't watch it straight through as the phone kept ringing and I ended up needing to finish it the next day.
I also liked that scene. Mental Illness does not mean that we have no valid thoughts; it does not mean that we have no preferences.
Posted by gardenergirl on March 8, 2004, at 10:18:52
In reply to It does help, but brings up another ?? » gardenergirl, posted by Racer on March 7, 2004, at 14:03:00
>
> I guess I wonder what you believe about the validity of the diagnosis? If you think it's over or under reported? If it really is being used inappropriately by doctors as a way of avoiding difficult patients?I think there are some who use the term as a derogative name for people, like your pdoc threatened. I do think it's a valid diagnosis, although like Dinah, I think it seems to fit better under mood disorders than personality or characterological disorders. I'm not really sure if it is under or over reported. No data to go on in my head.
And can you tell me more about it in general? (I guess I'm looking for reassurance here, like "that doctor was not right, because a) you don't fit the dx, and/or b) BPD means [x], it does not mean that there's no hope for patients who fit the diagnostic criteria."
Here is a site that gives info about BPD. http://www.bpd.net.nz/dsm.html
It lists the DSM-IV criteria among other things. I would not presume to try to affirm or deny such a difficult to make dx for someone here, but you might be able to do that for yourself when you read the criteria.The reassuring thing is that even if you do fit the criteria, that does not mean there is no hope for you. Haven't you made progress already in therapy? Besides DBT and psychodynamic therapies have shown to be effective with people with BPD.
Someone earlier posted about feeling like DBT only went so far, and that psychodynamic is better now. I wonder if the program she was in takes DBT through all four stages? The first stage is very crisis and problem solving oriented. This is usually when skills training happens. Once the person is stronger and is utilizing skills effectively to prevent the more troubling symptoms, stage two then focuses on trauma and emotional processing. I'm guessing a lot of programs just provide stage one stuff. Three and four move towards actual happiness and self-esteem. A lot of therapies do not go that far.
> Thanks GG! Them's part of my initials, did you know that? My husband's initials, too! Must be why we 'click', huh? Just the initials, nothing else needed...Cool!
gg
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