So, I’m Crazy…Nothing New

I’m saying this is the South. And we’re proud of our crazy people. We don’t hide them up in the attic. We bring ‘em right down to the living room and show ‘em off. See, Phyllis, no one in the South ever asks if you have crazy people in your family. They just ask what side they’re on.

— Julia, Designing Women

I saw the psychiatrist yesterday and I’m still processing in what he had to say. Basically he said that he looked over the tests for ADD and decided that I have such a mild case of it that it’s not worth pursuing therapy or medication for. I’m really not sure I agree with him after making my way through half of Women With Attention Deficit Disorder, by Sari Solden, which I intend to finish reading because I think I’ve gotten some insight from it so far.

He also asked me if I’d talked to my regular therapist about increasing my therapy sessions. Apparently he’d mentioned this to me last time, but I don’t recall it. He things going 3 to 4 weeks between sessions is too long and he feels I need more regular sessions — at least every other week. So, I made a note of that to discuss it next week when I see her. Plus, I’ve agreed to mention to her how upset I was with our last session.

I was also reminded that I should be using my light box therapy every day now that it’s September and I haven’t used it in weeks. My excuse has been that I can’t seem to get out of bed in time and have been oversleeping in the morning since I have problems sleeping at night. So, he told me to take the thing to work and use it on my desk. So it now sits on my desk and shines blue light in my face as I get started in the A.M.

He also gave me a new diagnosis of Borderline Personality Disorder, which sounds kind of ominous to me. I, of course, have been researching it and have ordered a book on the subject. I’m going to try to put into plain English what I’ve got so far:

• Borderline Personality Disorder (BPD) is a mental illness primarily characterized by pervasive instability in emotions, extreme “black and white”/”good and evil” thinking, and chaotic relationships.
• The general profile of the disorder also typically includes a pervasive instability in mood, interpersonal relationships, self-image (what an individual thinks other people think of him/her), identity (how an individual views him or herself both as a person and in relation to other people), and behavior, as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.
• 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.
• Individuals with this disorder display impulsivity in at least two areas that are potentially self-damaging. They may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with Borderline Personality Disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Completed suicide occurs in 8%-10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common.
• Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last).
• Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships.
• 2% of the population suffers from BPD and 75% of that is disproportionately women.

O.K. Well, I don’t consider myself suicidal nor do I think I have a particularly addictive personality. Granted, I know I could be a bit obsessive temporarily about some things, but I’ve never been one to abuse alcohol or drugs or binge on food and I’m not sexually active so engaging in unsafe sex is out. I don’t think I drive recklessly either. I’ve also never been into self-inflicted pain — heck, I don’t like it when other people do it either. I guess I can see some of the other things though. To get an official diagnosis, you need to have at least 5 of the 9 following criteria from the DSM-IV-TR:

1. Frantic efforts to avoid real or imagined abandonment such as lying, stealing, temper tantrums, etc.. [Not including suicidal or self-mutilating behavior covered in Criterion 5] Well, I don’t think I’ve done it lately, but I suppose temper tantrum could be used to describe it, I’m sorry to say.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. I can see this one.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self. I can see this one too.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, substance abuse, reckless driving, overspending, stealing, binge eating). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5] I think he dinged me for overspending, but isn’t that the American way?
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior. Nope.
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). O.K.
7. Chronic feelings of emptiness, worthlessness. O.K.
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights, getting mad over something small). I can see getting mad over small things.
9. Transient, stress-related paranoid ideation or severe dissociative symptoms. I’ll agree to paranoid idea creation, yes.

So, I see 6 I could agree to mostly 95%, 2 I might sorta agree to, and one I know I’m not. Interesting. I think I’ll still ask my regular therapist what her opinion is.

Anyway, he requested that I suggest to my regular therapist that we try Dialectical Behavioral Therapy (DBT) — derived from cognitive-behavioral techniques, which I’ve already tried with very marginal success, but emphasizes an exchange and negotiation between therapist and client, between the rational and the emotional, and between acceptance and change (hence dialectic); the learning of new skills is a core component - including mindfulness (a Buddhist technique in which a person becomes intentionally aware of his or her thoughts and actions in the present moment, non-judgmentally), interpersonal effectiveness (e.g. assertiveness and social skills), coping adaptively with distress and crises; and identifying and regulating emotional reactions. I have to admit that I almost impulsively bought a workbook on this from Amazon.com this morning, but decided it would be better to wait until I spoke with my therapist — I think that’s some form of achievement, right?

And the last and final thing: He wanted to do a wait and see how things go with my light therapy and the DBT before adjusting my meds, but I put my foot down. I told him that my depression has been pretty bad for months and that at this point I don’t want to rely on the light therapy box and the possibility of increased therapy sessions and maybe DBT. I need some sort of adjustment to my anti-depression meds because they aren’t working and it’s just too difficult to keep trying to pretend that every thing’s alright to the world at large and keep trying to do everything when I feel like I’m drowning in things that need to be done.

So, he’s added a daily dose of Wellbutrin to my daily dose of Effexor. The Wellbutrin could turn out to be affective for my Seasonal Affective Disorder, my depression, and even my mild ADD, while the Effexor is only good for the depression and anxiety and honestly it hasn’t been working very well for ages. Of course, he gave me the list of possible side effects and I always laugh at the one where it says “may cause weight loss” because that never happens.

Anyway, so far as I can tell, all this means is that I now have a bright blue light on my desk for 30 minutes in the A.M. and I have another pill to swallow in the A.M. for the next 2 weeks and then I get to add another pill in the evening too. I almost feel like a simple ADD would have been an easier diagnosis because I kind of get what it is and at least it makes sense to me with my overwhelmedness. BPD doesn’t explain my disorganizedness or my trouble with lack of deadlines or any of the other things I’ve been able to relate to in reading Women With Attention Deficit Disorder, but maybe it’s just normal people disorganizedness and normal people lack of deadline procrastination. I mean, I looked around and there didn’t seem to be any BPD books on organizing. Maybe it’s not a common flaw. Oy.

Sources: Wikipedia: Borderline Personality Disorder, Borderline Personality Today, NIMH: Borderline Personality Disorder

Tagged as: ADHD, BPD, DPT, Effexor, Wellbutrin