Abilify, Not I : Adventures in Antipsychotics

Lately, I have written a series of posts over the last two months describing certain troublesome symptoms I associated with the worsening of Bipolar Disorder, or the potential for comorbid disorders.

In my last post, When Medications Go Wrong, I briefly wrote about my recent discontiuation of the pharmocological treatment using Abilify as part of my medication regimen:

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

I went on to describe some of the awful side effects I was experiencing as a result.  However, the list was truncated for the sake of keeping word count down.  The description is rather limited in terms of accurately depicting exactly what I was subject to.

  • Cognition Disturbances and Memory Fragmenting.  Originally, I wrongfully blamed Lamictal in Vitamin L : Medication Adventures for my aphasia-like symptoms.  The disturbances felt like aphasia.  At first, it was almost indescernable.  I started word dropping again, meaning I would be reaching for a word, but was unable to grasp it.  Instead, I would be able to get to every synonym around it, however, those words did not fit the exact context.  Eventually, it became a more severe form of word dropping, and I found myself dropping sentences entirely at the loss of any word or synonyms around it.  It progressed into entirely dropping conversations at the loss of a sentence.  Then, I found myself

    I started forgetting things again.  These were simple things, like losing my purse or shoes in the house.  It seemed like just a simple case of forgetfulness, maybe stress related.

  • Emotional Blunting and Partial Flattening.  I had never had too much trouble with emotional blunting in the past.  While I’ve found myself in times where it was difficult to express my emotions, this didn’t indicate a lack of emotional response.  I describe it as a partial emotional flattening, because it wasn’t an entire lack of reactivity.  It felt like my spectrum of emotions had been significantly reduced, although not completely removed.  There was a certain inaccessibility to certain strong emotions.  Rather than completely removing extreme emotions, it threw a wet blanket on top of them, leaving them to bubble under the surface.  So, the emotions still existed, but were muted and unable to be adequately expressed.

    At it’s worst, I began to lose most feeling entirely, with the exception of irritation and the sensation of boredom and fatigue.  I began to lose love and my attachments to meaningful people and my relationships with them.

  • Dissociation I touched on a summary of the dissociative symptoms that Abilify had brought on.  I have been writing articles on the experience throughout the last few months on the subject, describing the feeling in great detail, but remained unable to exactly identify is appropriately.  The dissociation probably occurred as a response to the prior bullet points.

    The dissociation cited was experienced as a removal of self and removal from my own life.  I had felt as if I had been separated from myself and my world.  It was a feeling of something being stolen from me, or something fundamentally inaccessible.  Like, I was being locked out of my own life, or becoming transparent and just fading away.

  • Worsening of Depressive States.   This is probably a direct result of the first three bullet points.  I started to disengage from my life.  I lost interest in just about everything.  Most things were considered to be either boring or tedious.  Important things started to lose meaning.  This was experienced as a part of the emotional flattening, but it caused a concerning and distressful reaction.
  • Exacerbation of Social Anxiety Since I had lost the ability to carry on a conversation and found myself completely disinterested in socialization, my social anxiety went through the roof.  I simply didn’t care about anything anymore, especially trivial things I used to find interest in.  Therefore, I found it difficult to carry on a conversation.  This caused extreme distress in social situations, and encouraged further isolation.
  • Disturbed Sugar Levels.  While I have no concrete proof in terms of tests, certain symptoms have come to my attention.  They are notated below in the next two bullet points as thirst and weight gain.
  • Loss of Sensation of Bodily Hunger, Thirst, and Fullness.  Within the last few years, I started to become more in tune with my body.  I was able to feel the sensations of hunger through my sugar level, which probably caused the loss of bodily hunger.  The disturbed sugar levels probably also caused an extreme thirst that could not be quenched.  At first, I craved water.  Eventually, I started to put the soda back down, which probably caused part of the weight gain mentioned below.  And I felt an extreme pressure in my stomach, which was also exacerbated by the influx of so much fluid.
  • Extreme Weight GainTruthfully, I don’t dare get on a scale at the moment, so I am unable to notate at this time exactly how much weight I’ve gained.  By the fit of my clothing, I will estimate that I have gained somewhere between ten and fifteen pounds in the last three months.  That is a substantial gain for me, especially since I was losing weight prior to the start of this medication.
  • Exacerbation of Eating Related Problems.  By all definitions, it’s completely possible that I am living with an undiagnosed eating disorder.  However, I am not entirely convinced, since it isn’t an ongoing and prevalent problem.  Therefore, I define it as eating related problems and difficulties.

    The concern for weight gain and the sensation of fullness caused a very terrible reaction of binging and purging.  I was unable to control my eating, as notated above, therefore the sensation of extreme fullness would cause me to perceive the overeating as worse than it actually was.  Unfortunately, this led to a very vicious cycle and encouraged further weight gain.

  • Disturbed REM Sleep.  I was waking up tired, and noticed that it felt like I had stopped dreaming.  This caused my mental state to take a considerable dive.  It caused extreme fatigue and excessive, unproductive sleeping.

While I am cleared of most dissociative symptoms, emotional flattening, and my depressive state is lifting a little, some side effects have remained.

  • Cognitive Disturbances.   The aphasia-like symptoms remain, but to a lesser degree.  I am back to just being a little forgetful, and have some minor word dropping.
  • Memory Fragmenting.   Some of my memories remain dull, but seem to be returning.  However, most of the last three months remains inaccessible.  It may never become accessible, due to the disruption in the formation of short-term memory.
  • Disturbed Sugar Levels.   I am still thirsty, but I am no longer engaging in carbohydrate seeking consumption behavior.  I figure it will take awhile before my sugar is regulated properly again.
  • Weight.   Thankfully, my weight does seem to be coming down.  I have only been completely off of the medication for less than a week, and my clothes are already fitting better.  I’m going to assume that in addition to the weight gain, I was retaining water and constipation.  My regularity has come back, and I don’t feel as puffy as I did

Unfortunately, I am experiencing a return of some of my milder psychotic symptoms.  In Imaginary Enemies, I described a cognitive disturbance I described as “The Voice”“The Voice” can be characterized as a singular persona, as I wrote about in Conscious, Subconscious, and Extraconscious, where I described a theory of a third consciousness that exists between the subconscious and the conscious mind.

The Extraconscious is postulated as where the persona(s) reside, laying in semi-dormant waiting, perfectly aware of the current reality that is being experienced.  “The Voice”, in more severe psychotic states, can be experienced as a separate entity entirely, detached from the consciousness.  That is the defining line between a cognitive distortion and an auditory hallucination, when a persona detaches itself from the extraconscious as an external sensation.

As an extraconscious persona, “The Voice” can best be defined as a quasipersona, lying somewhere between Dissociative Identity Disorder and psychosis.  It is experienced as a semi-active part of the conscious mind, as the dominant persona is well aware of it’s existence and there is a certain interaction that occurs between the dominant persona and “The Voice”.

That is the best theory I can offer as to the existence and function of the quasipersona, known to me as “The Voice”.

The mild auditory hallucinations and visual hallucinations have returned, probably defined better as a sensory disturbance, rather than a symptom of psychosis.  When experiencing a sensory disturbance, it’s not full on hallucinations as described in the definition of psychosis.  There are not entities separate from the body.  They are recognized as a disturbance in the current reality, distorting shapes, colors, and contrast in the vision.  In the hearing, it is experienced as a distortion in sound, causing sounds to be sharper, duller, muffled, or louder than they actually are.  It can only be sensed by a sudden shift in perception.

So, instead of hearing things at a normal sound level, the sound volume may increase to deafening levels or may become muted and difficult to discern from nonexistent static that occurs in the mind.  My visual disturbances may be perceived as viewing the world in high contrast, extremely bright colors, and / or extra high definition resolution.  Or, they may be seen as duller than usual, muting colors, distorting shapes, and / or clouding the vision with that appearance of a veil or foggy goggles.

Intrusive thoughts have returned, but not with the same extreme nature as experienced several months ago.  In truth, they were never completely removed by the Abilify, and at some points were made worse by the drug.  Instead of experiencing them as a truth in reality, I am now able to separate them using logic.  I can talk myself off of the ledge and separate them from the reality of a situation using DBT techniques of mindfulness and distress tolerance.  Prior to the cessation of Abilify, I was unable to utilize those techniques.

I don’t mean to put anybody off of treatment with psychiatric medications, but I felt this was important to document and have as a resource on the internet for anyone who is thinking about taking the drug.  Some of these side effects aren’t listed in the pamphlet, as they are probably isolated to a condition.  But, I feel they are still a distinct possibility for anyone who is being treated for similar conditions.  It is vital that this information be notated and readily available for medication education purposes.  This information probably should not be generalized to all psychiatric medications, especially in the class of antipsychotics.

 

When Medications Go Wrong

For years, I’ve pretty much been medicating myself.  I take my scripts home and medicate how I see fit for my situation.  I realize that makes me medication non-compliant.  The trouble I come to is my trust in doctors.  I have been burned so badly before that I find I have a lack of faith in them to know how they are really treating me.

When I was in my teens, and being treated for Major Depressive Disorder (misdiagnosis – strike one), I was put on high doses over a slew of medications for years with little result (overmedication – strike two).  I suffered extreme side effects, with little done to relieve them.  I took Zoloft in increasing doses over a three year period.  I continued to complain of extreme fatigue, anxiety, motion sickness, and periods of flu-like symptoms.

The doctor’s answer?  More medication.  It came to a head when I found that if I sat still for too long, I would drift off to sleep.  Sitting in school became impossible, and I was sleeping fourteen to sixteen hours a day.  Eventually, I was put on 300 mg of Zoloft with Provigil to combat narcoleptic symptoms.

It was at the doctor’s suggestion that I continue to exceed maximum dose and go to 350 mg that my mother finally put her foot down.  “Put her on something else.  We’ve put three years into this, and it clearly isn’t working.”  And much to my doctor’s chagrin, I was switched to Lexapro.

Wrong answer.

Immediately, I started to have dissociative symptoms.  I recall laying in my room, laying on the floor, and staring at my ceiling in the dark.  My mother stood in my doorway, just observing me.

“What are you doing?” she asked.

“Nothing,” I answered blankly.

Yes, I was finally awake.  But, every moment was torturous.  I lost my sense of self, and started to drift away.  My memory began to fragment, and I sunk into a deep, desperate depression.  I was frantic and crazed, while feeling numb and blank at the same time.  I became paranoid, and started to assert that everyone was doing things against me.  They were intending to harm me, and I started to give meaning to harmless comments and phrases.

I attempted suicide several times in the first month.  The cutting became so bad that I was doing it in rather public places.  I was caught one time at my boyfriend’s house, and I had a dull exacto set ripped off of me and immediately chucked into the local creek.

We were unaware of all of the side effects at the time, because all of the medications I was placed on were brand new.  When a pharmaceutical representative left her office prior to my visit one day, it became clear that I had become an experiment to brand new medications.  I was taking expensive, largely untested medications for her financial benefit.  Strike three.

I had gained thirty-five pounds over a six month period.  I was 4’11” and 165lbs.  That put me at a BMI of 33.3, and in the obese range.  And despite all of my best, and even worst, and unhealthy efforts, I still couldn’t manage to get my weight below 145lbs.  I was starving myself on 900 calories a day, and I still hovered around obesity.

I couldn’t afford my medication once I was kicked off of my parent’s insurance, and I just decided that since it failed to ease my symptoms, I would stop taking the medication entirely.  They failed to mention that if I attempted to stop the medication cold, then I would be stricken with the worst withdrawal I had ever known.  It was a good thing my parents had been through this before with my father, because they knew how to ween me off.

It took me years to get the rest of that weight off.  But, by then, the medication had already done long lasting damage far worse than just weight.  I had begun to develop a drinking problem.  I had engaged in risky sexual behavior due to hypomania.  And it sent me walking with bad eating habits.

After that, I distrusted doctors and medication entirely.  I had lost faith in mental health treatment.  I was left with a feeling that I didn’t have a disorder at all, and instead, it was just me.  I was convinced that I wasn’t treatable.

It took a lot to make me realize that I was in desperate need of treatment.  I had taken psychology courses and was suggested by several psychologists in my college to have bipolar disorder.  I knew my behavior wasn’t “normal”, just as I had always suspected.  It took the my marriage, my depleting mental health of my husband, and the birth of my son to encourage me to start treatment again.

Three years, four doctors, and a another slew of medications later, and here I am, again the victim of overmedication and bad medication choices.

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

Suddenly, I was able to think again.  I started to feel more like myself.  I became more aware of what I was thinking and feeling, and I finally started actually living in the world around me.  It actually felt like living again.  And that’s when I noticed the weight I had put on.  I had fell victim to Abilify’s weight gain, among other things.

I can blame the dissociative symptoms on Abilify.  It had created an emotional flattening, and I started to dissociate from myself and my world.  It had robbed me of my ability to write and care for my family appropriately.  I wasn’t feeling, so I wasn’t caring.

The anxiety?  Well, I recently started to run out of a supply of Wellbutrin I can’t really afford right now.  I started to cut back to make ends meet, and I discovered that was starting to subside.  Other than rebound depressive symptoms, I was feeling better.  It didn’t matter to me anyway.  I was still going through crying jags, whether I was taking the Wellbutrin or not.  The difference was between whether they were loaded with distressful urgency to cut or not.  I decided that I would prefer to keep my near streak of four months without cutting.

I don’t blame my doctor.  He’s an old school doctor who works off of the biological model and treats symptoms.  I have declined therapy several times, though my requests to be seen since have not been honored.  All of my symptoms point to mild psychosis in general, aggravated by extreme life stressors.

I blame myself for not listening to myself and taking action sooner.  Treatment happens on both ends, and I have not been holding up my end of the bargain.  I have not been mood charting, and I have not been notating subtle symptoms.  It has become abundantly clear to me since my extreme meltdown and psychotic break during the summer that I had been probably Bipolar 1.5 all along.

Though I don’t experience full on mania, I do experience mild psychosis, practically all of the time.  I have not been pressing the issue about invasive thoughts, paranoia, “The Voice”, or any of the mild hallucinations that I experience.  Only when I had my break did I bring it to my doctor’s full attention.  And I was met with extreme medication.

Personally, I’m at a loss as to what to do.  I’m damned if I do, and I’m damned if I don’t.  I noticed last night that “The Voice” has returned, even if it’s benign (right now).  I don’t want to be overmedicated, and I can’t risk gaining anymore weight.  The weight is worse for my mental health than anything else.

And it completely screws up my bodily function.  Now, I’m experiencing weight related problems again.  My knees and back hurt.  I have acid reflux near to the point of anorexia again.  Sexual dysfunction is destroying my sex life, my self-esteem, and hurting my marriage.  And I’m back to full on social anxiety, because I’m too self-conscious to function.

But, at the same time, I’m aware that I need some kind of medication.  While, for now, I’m better off without it, the day will come where I am asked to step up, and perform at a higher function.  My family, including Finn, has been very great about my general lower function and picking up a lot of the slack for me.  However, this won’t last forever.

Treasure

Today, my son taught me an important lesson on value and how we place it.

My son is a really special little guy. He has Pervasive Development Disorder – Not Otherwise Specified on the Autism Spectrum.  So, a lot of little things that would be be considered typical in other children are really significant for him.  I can’t tell you how many times I’ve heard a parent tell their four year old to shut up because the chatter became overbearingly annoying.  I always feel that twinge of sadness, fearing that my son may never speak enough for me to become aggravated at all.  Those moments are significant for me, too.

But, then there are those moments that are significant in an enlightening way.

I was sitting at the dining room table this morning with my wallet and what we call “The petty cash box”.  I was mindlessly dumping change into it when my son approached me.  When he speaks, I listen with all of my might to make out what he is saying.  It might be the only thing I ever put my full attention into.  He said, “Mommy, money!”  I was thrilled that he took an interest in what I was doing, and I allowed him to put the money in the box while supervised.

He happily put the money in, and presented me with a quarter saying, “Mommy, want quarter?”  I was delighted that he could identify it.  Suddenly, he grabbed the box and started to walk away.  I was about to chase him down just when he put it on the end table. He turned to me excitedly and shouted, “Look, Mommy! Treasure!”

He started to prattle on about being a pirate when my heart just melted. It was a brilliant observation. The little box kind of resembled a treasure chest, brimming with different colored coins. And that’s when it hit me. It wasn’t just about the likeness. It was about the whole interaction. And the whole thing had taken on an entirely different value.

I started to think about the things that I value. What do I cherish?

The realization hit me. Lately, I’ve been dwelling on the things that I want, but don’t have. My focus had been shifted onto the seemingly hopeless pursuit of these things. And I realized that those things are intangible idealizations that may never even have the possibility of becoming a reality. Those things had gained all of the value over the things I truly cherished and clouded my mind.

What do I value then?

Little, daily victories for my son. A few engaged words here and snippets of hopeful conversation there. His new discoveries and interests. And each beautiful little smile and giggle. All of those shining moments that give me hope for his development through Autism Spectrum Disorder.

But even more for him, I value him. Him, as he is. My 4 foot tall, 55lb, brown haired, green eyed little Beast.

I value my husband’s caresses. This morning, he unexpectedly turned over and actually spooned me. It was more than welcome. It was soothing, comforting, and all spontaneous. It was one of those rare, intuitive moments he had. I cherish those.

But, I value even more than those fleeting moments. It is bigger than that. I see what I have missed all along. Every action is an intuitive, invested action. Whether I know it or not, he’s taking care of my needs that I don’t even think about anymore. I was overlooking what was right there in front of me because I was too involved with what I considered to be neglected needs.

Finally, my eyes started to open up.

When I really thought about it, I found value in myself today. I have been so fixated on what I am not, and the things I thought I had lost, I lost sight of who I am and all of the things I have gained. I am a mother. I am a wife. I have been those things for longer than I have been anything else. I am those things above all else. And I don’t know how I came to value anything else.

I lack certain qualities, but that does not make me devoid of myself. There is plenty of me. I am not stable, but I am spirited. I am not entirely well right now, but I cannot expect to be well all of the time. I have Bipolar Disorder. I am not Bipolar. I am more than my illness and more than my symptoms.

Today, I connected with my husband without trying or wanting. I connected with a son I thought I was losing to Autism Spectrum Disorder. But more so, he connected with me. He reached out and connected me with the world again. And that was what made all of the difference.

A new dawn, a new day.

Just Snap Out of It

Society has developed some seriously bad attitudes toward mental illness.  It’s no surprise.  We see it attached to the stigma of it.  We’re treated like lepers, as if this were a terribly contagious thing.

Depression is no exception.  Today, a lot of people have been discussing the topic of the “Just Snap Out of It” phenomenon that occurs out there.  Honestly, there is a saying out there about how if a person hasn’t experienced it, then they can never truly know.  A person who hasn’t experienced clinical depression, either in the form of MDD or BP depression can never truly know it’s depth and breadth.  It is an all encompassing monster that claims every last bit of life and any possible joy that can come from it.

Having Bipolar Disorder, I am a person who naturally experiences some sometimes pretty obvious mood swings.  And the attitudes toward it are so completely off.  I have never had a person treat me poorly while I was in a manic episode.  Not one.  Not even when the plainly awful behaviors were showing.  Each person seemed to find it charming, amusing, or interesting.  Even when there were moments where I was so out of control that I was scared out of my wits, not a single person around me seemed to notice that there was something absolutely wrong with it.

No, my energy and spirits were high.  I would act impulsively, and people would take it as spontaneity.  I’d be overly, annoyingly chatty, and rudely interrupting others, but they took it as being outgoing.  Everyone seemed to think that was a sign that I wasn’t depressed anymore.  They seemed to think that it was some kind of miraculous recovery from “being like that”.

People only seem to take notice when I am depressed or mixed, like it’s some kind of disease that I choose to be afflicted with.  And the comments are absolutely endless, because everyone seems to have their own opinion about it.  It’s as if they consider themselves to be the authority on depression, anxiety and sadness in general. I will constantly hear phrases like, “Get over it” and “Get a grip” as if just snapping out of it were an option for me.

Meanwhile, people without mental health diagnoses start flinging clinical terms around, like they had some true application to their fleeting, shallow emotion.  For instance, “Oh, I’m so *bipolar* today”, instead of just saying that they are moody, or women arbitrarily making a comparison between PMS and Bipolar Disorder.   Or “I’ve just been so depressed lately”, to reference a little bit of discontent or sadness.

It’s not cute. It’s not funny. No one with those diagnoses thinks that it’s witty that someone is taking a serious clinical term with so much guilt and stigma that it could bring down a religion, and applying it to their BS, frivolous emotions!

It does everything it can to minimize those conditions.  It puts it in a light that we have some kind of real control over it.  As if it were something that a person can just “snap out of”.  It implies that a person chooses to be disordered.  It also puts a shameful connotation of attention seeking behavior.

Yeah, it’s the life, let me tell you. If I were doing anything for attention, it wouldn’t be this. It would probably be something more hilarious, like plastering myself with an obscenely worded banner and rollerblading through Downtown. Depression isn’t newsworthy, but that sure is.  Or maybe I’d be doing something a little more productive or noteworthy, like finding a cure for cancer.  But no, my depression is just that interesting that I would choose to gain that much needed attention from people I don’t even know or care about.

I have to wonder if the general public has to be so naive that they would actually be jealous over it.  So much emphasis is put on the “just get over it” ideals, as if that were possible. If I could will myself out of this state, don’t you think I would do it already? It would be more logical to think that I want to reclaim my life and be a productive person.  But no, according to others who are ignorant enough of mental illness, I am perfectly content to have disordered behaviors.   Sure, who doesn’t love ignoring their kid because the voices just got too loud? Personally, I love gripping my ears and screaming, “SHUT UP! SHUT UP! SHUT UP!!!!”

And as a result of this blatant ignorance, I am really starting to believe that some are just plain jealous.  Because, they seem to think that those with disorder aren’t being responsible for their emotions and behaviors that result.  I certainly have quarrels with wanting to thrust a sense of selfishness and entitlement out there, because it’s what I have to do to take care of myself and my own in this world.  It’s those same people that shove themselves and their ideals down other people’s throats, only to make them feel bad. Misery loves company, and we’re perfect targets, right?

The point is this.  If a person is out there reading this and getting offended, it’s time to take a step back and think hard.  Is it so fair to be so judgmental?  Isn’t it about time to take a look from another perspective?  Does a person with a congenital disorder choose to be symptomatic?  It would be an entirely different story if I were refusing treatment, but like anyone else, I am keeping my appointments and taking my medication according to doctors orders.  We don’t blame someone for their symptoms when they have a seizure.  Why should this be any different?

Let me assure everyone.  If could have snapped out of this disorder and been a “normal” person, I may have done it, instead of living this ongoing nightmare.

Anatomy of a Phobia

Lala at Seasons Change, and so have I reminded me this morning of some very sensitive subject matter that I often overlook.  See, I’ve programmed myself over the years to minimize my fears.  Fears are just another expression of weakness.  Or so I’ve been inadvertently taught throughout the course of my life.  Fears are irrational little demons that have no place in reality.  They are something to be ignored.  Fear is an overreaction and another possible way to be overdramatic about events that occur in life.

Fear is just another excuse not to do something.

There are a million reasons those phrases fail to sit well with me.  First, I am a person that has a complicated relationship with authority.  If fear were allowed to conquer my own free will, then it would become an authority figure.  I would become conflicted against my own self, and come to fear and loathe myself.  I can see the fallacy in the contradictory nature of all of those statements.  Because, I experience it regularly.  And the experience of fear complicates itself and entangles itself into my psyche.

I have phobias, whether I want to admit it or not.  At this point, I would rather come clean than try to diminish these symptoms any further.  It seeks to compound the confusing presentation of these intense fears.  Worse, I can’t readily dismiss fears like I used to.  As life progresses and my experience expands, I’ve come to situations that force a confrontation.  And the effects that the denial and repression produces are intense.

I fear planes and cars crashing into my house.
When I was a child, a plane crashed somewhere near my hometown.  The only reason this event was significant hinged on how it affected my area.  I lived near a fire department, a highway, and two interstates.  It seemed like there were people and sirens all night.  It was a hot summer night, and all of the windows and doors were open.  People had their eyes skyward.  And the thought of a plane falling out of the sky had never crossed my mind before.

In case I didn’t mention recently, I live in Pittsburgh, Pennsylvania.  At the time of 9/11, I lived about ten miles from our local international airport.  And we are the closest city to the crash site of Flight 93 that went down in Sommerset County, a few counties over from us.  That day was similar to the night of the crash from my childhood.  Only this time, it wasn’t an accident.  It was a terrorist attack.

I also lived by an Air force and an Army base.  When all of the planes were grounded, the skies were filled with military planes.  It was like living in a military state.  Other than those planes, the sky was empty.  The winds were unusually quiet.  And my best friend and I laid in our adjacent yards, staring skyward for the threat.

Somehow, throughout the years of being a pedestrian, the definition of “crash” came to include cars.  And Xan always joked with me about how silly it was.

In May 2010, a drunk driver crashed his jeep into the front of my house.  It was the day after Mother’s Day and only five minutes after my husband had left to put our one-and-a-half year old son into the car to come get me from work.  Had it been five minutes earlier, my son would be dead.  The impact to the front of the house sent the sofa into the middle of the room.  The impact would have been enough to serious maim Xan and kill, then 27 lb, Beast.

Since then, I would cringe every single time I would hear a car make an awful noise outside my home.  It is among the dozens of reasons I moved from 511 to 106.  Except, 106 is only a couple of miles from the airport now.  Instead, I cringe at low flying planes, and look skyward to their shiny metal bellies.

I fear enclosed spaces and crowds.
This comes to include any area that could become cramped or would be difficult to maneuver out of. I fear being crushed.  I have dreams about it sometimes.  I’ll go in after Beast in one of those kids tubes, and it will start to collapse on me.  Or, I’ll just get stuck.  And there will always be something threatening happening.

This definition expanded after the Columbine School Shooting.  It came to include areas where I would be “trapped”.  That means classrooms, buses, shopping malls, lecture halls, and unfamiliar cars.  Anywhere where I was not openly permitted to leave, or wasn’t easily escapable became suspect.

This was compounded when I was pregnant with my son.  I was afraid that I was going to be accidentally harmed in a public place by someone careless.  And, it was made even worse when Xan was involved in a serious car accident in June 2011.  People get hurt by the negligence of others all of the time.

I fear having an episode in public.
I know Bipolar Disorder isn’t as episodic as an anxiety disorder.  Maybe I have an anxiety disorder.  I just don’t know, and I’m not qualified to make that determination.  I’m afraid of being overtly symptomatic in public.  I just have this severe anxiety that I am going to have an unrelenting panic attack and do something, for lack of a better word, crazy.  Or that I’ll break down in hysterical tears over something practically benign, like losing my scarf or breaking a pencil.  Or worse, I’ll go out and binge eat to suppress some other urge.

I fear elevators.
Combine my fear of catastrophe, a mild fear of heights, and a severe fear of enclosed spaces, and a torrent of anxiety develops.  That’s what an elevator represents to me.

I have always been afraid of elevators, because the motion doesn’t agree with me.  I don’t like that moment of weightlessness when ascending and I don’t enjoy that feeling of plummeting to doom when descending.  I don’t like the jolts and starts.  And I especially don’t like being knocked off balance.

Compound that fear with actually getting stuck in an elevator.  It was my freshman year in high school, and I was assigned a dorm room on the sixth floor at camp.  We were children, and we were stupid.  The elevator clearly stated that the maximum capacity was 14 people.  Instead, we had closer to twenty, all jammed in that elevator.  When it opened, I could clearly see the floor between the fifth and sixth floors.  We were stuck in midair in a rickety old elevator, where no one could immediately get to us.

From then on, I took the stairs.  I dragged my footlocker and luggage up flights and flights of stairs to avoid any similar occurrence.  Of course, it never happened under their watch again.  But the singular experience was enough to have me fit for stairs and hiking stairwells for the rest of my life.

My doctor’s office is on the third floor of an office.  I can’t tell you how many times I’ve been running late, and I arrive at that check in desk breathless and sweaty.

Then, there are the sillier fears.
The aforementioned are just huge fears that have come true for me.  There are fears that have absolutely no grounds in reality.  For instance, I fear toilet snakes.  I know there is no such thing.  I don’t know if there has ever been an incident of someone getting bitten by a poisonous snake while using the bathroom.  And if there has, don’t tell me.  I don’t want to know.

I fear lightning strikes.

I fear bugs in the bed.  Or just bugs crawling on me in general.

I fear the apocalypse.  Irony of ironies.

I fear being touched by a stranger.  There are a million different reasons why that’s a serious fear that has no grounds.  All my brain knows is that sometimes touch is bad.

Then, there are the more common ones.
I fear judgement.  I fear failure.  I fear unfamiliar social situations.  I fear being alone.  I fear dying alone.  I fear getting hurt and having no one there to help me.  I fear strangers.  I fear germs.

I know that some of these are rational, and these are things that should be reasonably feared.  But most of the time, they strike me, and I’m left with the deer in the headlights feeling.  That is unreasonable.

What are the most common fears out there?  What are the most uncommon?  Which are ones that my mind made up?

 

BPD and Me

A post by Angel, concerning Avoidant Personality Disorder, had me thinking again about the possibility of me having Borderline Personality Disorder.  This is a suspicion that has plagued me throughout the course of my treatment within the last year or so.  Instead of going straight to the Borderline Screenings, I went to a personality disorder screening to see the possibilities of what I may be dealing with.

Disorder Rating
Paranoid Personality Disorder: High
Schizoid Personality Disorder: Low
Schizotypal Personality Disorder: Moderate
Antisocial Personality Disorder: Low
Borderline Personality Disorder: Very High
Histrionic Personality Disorder: High
Narcissistic Personality Disorder: High
Avoidant Personality Disorder: High
Dependent Personality Disorder: High
Obsessive-Compulsive Disorder: High
Take the Personality Disorder Test
Personality Disorder Info

I really never imagined that I would be symptomatic of multiple disorders in Axis II.  Since BPD still remained the highest, I decided to take a specific screening.

Results of Your
Borderline Personality Test

You scored a total of 43.
Severe Borderline Personality Disorder Likely
You answered this self-report test in a way that’s consistent with people who have been diagnosed with severe Borderline Personality Disorder. This suggests that these concerns may be an issue for you as well, and something that you should seek out further assistance with this issue from a trained mental health professional immediately. Borderline Personality Disorder is characterized by a pattern of unstable and intense relationships, as well as frantic efforts to avoid abandonment — even if it’s not real.

I thought about the entire year and the instability of my own marriage – the most solid thing I can think of.  I had all of these paranoid delusions that my husband was cheating on me, although in the back of my mind, I knew it was not a possibility.  I sabotaged myself at work with the line of thinking that everyone was against me.  I started severing ties with coworkers and hiding in my classroom.  I had always thought that was characteristic of bipolar psychosis, but now, I’m not so sure.

Using the same site that Angel used, I discovered something kind of shocking:

You may be at risk for developing BPD if:

  • you have a family member who has BPD
  • you felt emotionally unstable or emotionally vulnerable as a child
  • people in your household were impulsive when you were a child
  • you were emotionally abused as a child

And all of those were true.  My mother does not have a confirmed case of Borderline Personality Disorder, but it seems she is symptomatic.  When she was a very young child, she was put into foster care.  She has absolutely no memory of this, and none of her family members will detail what happened.  My mother married her first husband on a whim, because his draft number came up to go to Vietnam.  She had an extremely turbulent relationships with him, and he mostly left her alone all of the time.  That’s how she met and fell in love with my father.

Their marriage isn’t much better.  In private, she has gone on and on about my father’s faults.  They have had a rocky relationships, where I recall them throwing around the word “divorce” probably far more often than they should have.  She binge drinks and sometimes takes too much medication.  Medication that isn’t even hers to begin with.  She is as impulsive as she can be in her restrictive environment and goes through so much emotional turbulence.  But, she will never leave my father, no matter what.

I was an emotionally unstable child, and I wasn’t the one to immediately notice.  My preschool teacher had mentioned to my mother that I needed to “toughen up”.  That one little phrase was enough to spark years of tough love and general emotional abuse and neglect.  It gave them a free pass to call it “good parenting”.  As a result, I developed this need for achievement as a means of recognition.  I was designed to people please.  Regardless, another comment came from a teacher stating, “Doesn’t take constructive criticism”.  And the idea that criticism was encouraged compounded what I was already going through.

Impulsiveness!  My father used to just go drive off in his car without telling my mother where he was going.  He’d be gone for hours, and she’d be a wreck.  One time, he went through the house waving a gun, terrorizing us with suicidal gestures.  Honestly, I can never get that scene out of my head as hard as I could ever try.  My parents have both run their credit into the dirt over impulsive shopping sprees.

Now, here’s where things get tricky.  Friends and family in the past have suggested that I may be suffering from Borderline Personality Disorder.  An ex used those weaknesses against me.  So the presentation is convoluted because my actions are purposefully deceiving.

frantic efforts to avoid real or perceived abandonment

I self-sabotage in this area.  When I perceive abandonment, I start to shut that person out of my life.  I have this funny idealization that person will perceive my own emotional abandonment and come running back.  It’s what my parents and my ex did to me, and I seemed to have picked it up.

I’ll also become more sexual and start having defensive sex or performing certain sexual acts to peak someone’s interest and entice them into staying with me.

I also have this habit of changing everything about myself to appease my partner.  This is an effort to avoid abandonment.  And it’s one that’s been preyed on before.

pattern of unstable and intense interpersonal relationships, characterized by alternating between idealization and devaluation (“love-hate” relationships)

People that are close to me are also subjected to this regularly.  Honestly, this is a major reason why I don’t let people get too close to me.  At first, I idealize someone and pick out the best of their characteristics.  Then, I start to idealize how the relationship with them will go.  Soon, I will become disillusioned at the first sign of trouble.  And it is at that point that I begin to demonize someone.  Everything about them is bad, and I have ever right to be suspicious at their deceptive behavior.  Except, it wasn’t deceptive.  I perceived them to be something that they weren’t and assigned them to the task of living up to my unrealistic expectations.

extreme, persistently unstable self-image and sense of self

I’d like to paraphrase the way I perceive myself.  I have lived a dozen lives, and each time, with every death, I’ve risen like the phoenix out of the ashes.  In my life, I have been a dozen different people and will be dozens more, each with their own birth, life, and death, only to start once more.

I take one aspect of my life and characterize myself through it.  I’ve been a baker, a mother, a wild child, a caretaker, a housewife, a teacher, a crazy woman, a bipolar woman, etc.  And for some reason, I can’t seem to integrate all of those periods of my life into the same entity.  They are just all separate from one another, as if I were living so many different characters in the same skin.

impulsive behavior in at least two areas (such as spending, sex, substance abuse, reckless driving, binge eating)

It is well known that I have a substance abuse problem with alcohol. But, here are a few facts that are the most difficult things for me to admit. I am guilty of day drinking every now and again. It is never when I’m alone with my child, for the record.  I am also guilty of taking too many benzodiazepines to escape reality from time to time.  Yes, I abuse my medication every now and again.  But, it’s not a dependence kind of thing.  I don’t find that it’s necessary, until I get into a frenzy of hysteria that produces so much distress that it’s unbearable.  The drugs quiet my mind.

And the other one is very difficult to admit as well, and I’m not sure if I can spell it out in detail.  I have a difficult relationship with food, dieting, and exercise.  I am guilty of binge eating.  I am also guilty of purging if I am distressed.  Especially if it’s about my weight.

And lastly, I recently made a confession of my sexual exploits in my youth in Promiscuously Yours, in the series The Friday Confessional.  I had multiple reasons for cheating on my ex, which is something I wouldn’t normally do.  I have a better moral compass than that.  Sometimes, I was so distressed that I just wanted to feel some kind of love.  Sometimes, I was trying to prove to myself that I was something special.  And other times, I did it out of spite.  Any which way you look at it, I did it in highly emotional moments.  And I always regretted it later.

recurrent suicidal behavior, gestures, or threats, or recurring acts of self-mutilation (such as cutting or burning oneself)

My cutting has been well documented in the past.  Unless I make a mindful effort not to self-harm, I will engage in the behavior.  I’ve written posts about the whys and wherefores in Why Self-Injurious Behavior?.  It’s complicated.

unstable mood caused by brief but intense episodes of depression, irritability, or anxiety

The mood episodes aren’t brief, so it leads me to believe that I may have a co-morbid diagnosis instead of a misdiagnosis.  However, I’ve always said this, and people have disagreed with me.  The only two constants for me and my disorder are reactivity and irritability.  I was under the impression that everyone with bipolar disorder is reactive and generally irritable most of the time.  Apparently, I was wrong.

I always have this underlying anxiety.  It’s made worse by social interaction, certain phobias I’ve developed, and worst of all, having to make decisions on my own.  It’s difficult for me to take care of my personal affairs, because I am always waiting on another person’s approval.  I get anxious when I make a decision by myself, because I often second guess myself.  I am constantly seeking reassurance about my decisions and guidance from others.

chronic feelings of emptiness

This one is complicated.  I don’t often feel empty.  I often feel lonely or distant.  Sometimes, I feel invisible, rejected, or ignored.  Most of the time, I actually feel too full.  I’m too full of emotion, noise, and stimuli.  I often have several voices and personas that follow me and make commentary on my life.  It’s too much.  But when medicine gets rid of them, though I am relieved by the lack of conflict, I am lonelier.  It feels like a piece of me is absent.

inappropriate and intense anger, or difficulty controlling anger displayed through temper outbursts, physical fights, and/or sarcasm

I recently wrote a post called, “I Want My Yellow Dress” using the analogy of a little girl in a movie in the most epic temper tantrum ever known to describe my own inner child.  My anger is often out of proportion for a given situation.  I have a bad temper, and I know it.  It’s something I’ve tried to deny for a long time.

In Love the Way You Lie, I described a mutually abusive relationship.  It was the only time in my life I have ever lashed out physically, but the point is that I did.  Whether a person could classify that as self-defense is questionable.  There were times I did it because I wanted to inflict pain on him.  I felt like he needed to know my own pain.

stress-related paranoia that passes fairly quickly and/or severe dissociative symptoms— feeling disconnected from one’s self, as if one is an observer of one’s own actions

I’ve written scores of blog posts and theories about this.  I am prone to paranoia, and I experience it rather frequently.  With my recent medication change, I can say that I usually only go through it once weekly.  Prior to the medication change, it was much more frequent than that.

The dissociative symptoms have been documented in Conscious, Subconscious, and Extraconscious, where I described a theory of multiple personas rather than full blown personalities residing in a place between the conscious and subconscious mind.  It’s complicated to get into, but it’s worth a read honestly.  It would give you a better idea of what I’m talking about in terms of dissociative symptoms.

When I’m doing something out of character, I often feel like I’m not the one who is doing it.  I feel like I’m trapped inside myself, or even completely outside of my own body, as a helpless observer.  When everything is said and done, sometimes I don’t quite remember the details of what happened.

It’s something I’m going to have to talk to my doctor about, because as I get older, it seems to get worse, rather than better.  Sure, I am not self-injuring in the sense that I’m not cutting.  But, I am still engaging in impulsive behaviors, and I can’t tolerate distress or disappointment.  My anger is out of control most of the time.  And that’s not when I feel too doped up to do anything.  Sometimes, I have symptoms regardless of the medication.  When I relapse, it’s usually very bad, and feels like it’s worse than the one prior.  I don’t just have a blip of an episode, but a full blown, complicated one.

Conditional Conditions

I was having a fantastic time at Tang Soo Do class last night.  I excelled in techniques that were far above my level.  I was really doing well with jump kicks and then, POP!  I landed on my knee wrong, and here I am.

Mental health disorders with limitations are difficult enough on their own.  I find that I am unable to just go to the mall.  I have to plan, and take a Xanax or two well in advance.  The same is true for many other crowded public places.  Forget concerts, bars, clubs, and occasionally anywhere within Pittsburgh City Limits.  Even the idea of attending an event is overwhelming, fiercely bashing my panic button.  It’s enough of a deterrent on its own.

Phobias often limit places I go and events I attend.  Social anxiety often limits my capacity for meeting new people and maintaining friendships.  And bipolar disorder comes with it’s own special set of challenges.

Bipolar disorder has proven to globally stunt me, from the disorder itself preventing me from having stable relationships and jobs to the medication causing aphasia, making it difficult to express my own thoughts.  “My memory ain’t what it used to be,” although it was never stellar in the first place.  I find it challenging to create new short term memories and even sometimes long term memory is kind of foggy.

Depression and mania, in their own respects, both cripple my ability to function.  In depression, I have a tendency to isolate myself, causing my relationships to go sour quickly.  I find that the state of depression and the behaviors associated with it are generally a mystery to others.  Since it is so misunderstood, people may start attributing it to life events incorrectly.  And when the depression doesn’t subside, others become short with me, occasionally to the point of ignoring me.  No one likes a wet blanket, so to speak.

Depression also causes me to lose interest in activities I used to find enjoyable.  Worse, I become disinterested in work and start to have issues with the processing speed of my cognition.  I cannot focus on a particular task, and most situations become completely overwhelming.  In short, I feel like I am unable to handle my life any longer.

Mania is a horse of a different color.  In certain types of mania, I become overly social to the point of being overbearing, blunt, attention-seeking, and needy.  It puts an extreme burden on friends and family.  In euphoric mania, I will demand my impulses be satisfied without a thought to how it will affect anyone else.  Contrastingly, in dysphoric mania, I will become enraged at the slightest thing, real or imagined.  I have been known to become aggressive.

I have a tendency to become overly ambitious.  That would entail me taking on too many tasks at once, with the intent to finish them all, but with zero follow through.  This is especially detrimental to my work, seeing as how I find it next to impossible to sit still, or remain on one task for any significant duration of time.  I will demand immediate satisfaction, and have an inclination to become aggressive with co-workers.

With psychosis involved, there is a whole new ball game.  In psychosis, my grasp on reality starts to loosen.  I will insist that conversations took place that never actually did.  I will invent ulterior motives from suspicion generated by delusion.  Or, contrastingly, I will assert myself incorrectly by insisting I am infallible and all-knowing.  In the worst instances, I have had delusions of being a time traveler, not living in this reality but in an overlapping parallel reality.  Psychosis makes typical functioning next to impossible.

Mixed states provide a variety of issues drawing from both mania and depression, respectively, but also brings other unique symptoms and behaviors to the surface.  In mixed states, I often suffer from dissociation and splitting.  It’s as if my mind cannot handle the overload of external stimuli that provokes and emotional response, therefore I dissociate.  Occasionally, I have been prone to partial dissociative amnesia, where events that took place become only vague in my memory.  I have been known to have multiple personas, and in the most distressful of moments, my dominant persona becomes pushed into a partially conscious state as a disgruntled, passive observer to the actions and behaviors of the alternate persona.

As if these conditions are not serious enough on their own, they can be aggravated by a physical illness or injury.  I am experiencing a lot of emotional turbulence over this knee injury.  First, I am panicked that I did not receive professional medical attention.  I am wearing a brace from my last visit to the ER for a similar condition, but I obsessively worry that I may be using it incorrectly.  I am putting a small amount of weight on it, and it occasionally hurts pretty badly.  I worry that I am doing more harm than good.

Secondly, I am embarrassed over the injury that happened in the middle of class.  In short, I landed wrong during the jump kick and felt my knee give out.  I feel like a complete rookie, although I am only a white belt at this time.  As I am very sure that many people have gotten injured before, I still feel like it is maybe too big of a deal.

Next, I feel guilty that my husband had to spend his entire night driving back to 511, our old home, to retrieve my knee brace.  Why didn’t I have the presence of mind to bring that knee brace when I am well aware that I have life long knee problems?  It seemed like an entire night wasted, all over a silly injury I probably could have prevented, had I been more careful.

And lastly, I feel helpless.  I am responsible for supervising my child while my husband is off at work for nine or ten hours a day.  I am terrified that I am not going to be adequate to care for him properly.  I am unable to move around, therefore my function is limited.  Mostly, I will likely be confined to a sitting position for most of the day.  I am at the mercy of others.

All it takes it one spark.