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.

 

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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.

The Costly Mistake

“A mistake was made.  Dr. G. needs a half an hour with you, so you have to come in at 4:15PM.”

The third attempt in three days on my doctor’s part to reschedule me.

I panicked.  The plan was for Xan to come home and cart me off to my 5:30PM appointment.  That in itself was stressful enough.  Xan rarely gets off of work on time anyhow.  I would be playing this pacing game where I wear a rut into the corkwood floor of my eroding living room.

“But, I can’t.  I don’t have transportation.”

She was uncompromising.  “Dr. G. leaves the office at 5PM.  It’s 4:15PM or she will not see you today.”

I anxiously stammered, “I’ll see what I can do.  I’ll call you back.”

In her cheery, patronizing voice she said, “Okay, we’ll pencil you in for 4:15PM.  Hope to see you then!  Bye!”

And the phone went dead.  I was cast off that easily.  Complete disregard for my needs.  She’s one of those people who is just doing their job and nothing more.  Patient care doesn’t matter.  My threads started coming loose as I desperately grasped at the fabric that remained.  Hope was dimming.  Trapped in my head, trapped in this perpetual hell called my life, completely alone with this demon so inadequately named Bipolar Disorder.

For a moment, I let the wholeness of the situation set deeply into myself.  I read my prescription bottles closely and they said in big, haunting letters NO REFILLSWaves of panic nipped at me at the shoreline.   The tide suddenly grabbed me, and ripped into murky, black waters with the undertow.  There was no sense of what was up and what was down.  The air escaped me, as if being viciously sucked from my lungs, and they shriveled into nothing.

My fingers flew fast as I texted Xan.  The idealization took control as my head filled with these surrounding waters.  My mind swam around my skull, looking for solutions.  Grasping at the fabric, the tearing fabric holding my sanity, my hope, any kind of connection to reality and sanity.

“Hold for a moment on this.”

I am a business call.  Twenty minutes elapsed.  It was like standing in a queue for my husband’s attention at a clear crisis.  Those glimmers faded as I clung to anger.  Anger, my failing life preserver as it began to deflate into complete hopelessness and despair.  I trashed with distress, but to no matter.  Anything.  Anything . . .

“I’m calling the scheduler.”  I warned him that wasn’t wise.  The ultimatum was set forth.  4:15PM or not at all today.  4:15PM I could see this new doctor, and maybe in coming days, I could exit the tunnel of misery and dimness.  I could reclaim myself, my life, and everything that awaited me on the other side.

I wanted to beg him.  I wanted to get down on my knees and plead with him to leave work early.  He would have put his eight hours in that day, and it would have been alright.  Be my knight in shining armor.  Save me.  Save me from myself.

I started crying, huge, loud sobs belting through my house.  My son, my little four year old son with autism spectrum disorder approached me.  And he said, “Mommy, are we okay?”  I cried even harder, despite any efforts to control myself.  My son’s first four word sentence, his first appropriately placed words relevant to the situation, occurred because his mother was hysterical.

I said to him, wiping the tears from my face and pushing everything down, “Yes, Beast.  We’re okay.”  I wish I could have meant what I said to him.  His first question, and I had to lie to him.

The phone rang, playing a melody that I hope meant promise.  Promise that someone had conceded or made an exception for my desperate pleas.  I answered despondently, even with my head overflowing with idealistic notions of the outcome.

“Here’s the good news,” he started.  My heart seized up, anxiously hopeful.  “The nurse agreed to put a fill in for your prescriptions.”

“And my appointment?”

He continued, “It’s a bit of bad news.  Dr. G. is booked up until December 11th.  I scheduled you in for that day.”

I choked on my own voice, the bile rising from my stomach and the wires of my brain sparking as they frayed.  “December 11th?!  I can’t wait until then!”

“It was the soonest she had.  It was the best I could possibly do for you.  But, at least you have your medication until then.”

The tears finally came, screaming down my faced as I sunk against the sink.  “I need a doctor.  I need to get this fixed.  I live every single day in this perpetual hell.  This was my last hope, my only hope.  It has been stolen away from me.  Is there nothing we can do?”

He started to become cross, “What do you want me to do?  What more could I possibly do?”

“You can’t leave work?” I pleaded desperately.

“It wouldn’t matter anyway,” he informed me, “The scheduler already complained to me about your poor attendance record, and gave your appointment to someone else, anyway.”

My poor attendance record?! I screamed.  “I have no way to get to appointments!  And people keep blowing me off, like I don’t matter!  Like I’m not in a bad way! Like this can wait and as if I’m doing so well.  The only time I get to go to an appointment is to get this stupid medication that doesn’t even work filled.”

I paused, only for the brief moment it took for catch my already shallow breath, “I don’t know if anyone noticed, but I haven’t been well.  I have spent almost my entire year in one episode or another.  It’s beyond discouraging.  It’s thrown me into the jaws of despair and hopelessness that I will never get any better!

We sat in silence for a few minutes.  I sobbed violently, just waiting for some kind of word.  Some kind of solace.  Any rescue from the deep, dark recesses of my own caged mind.  Finally, I asked, “Are you still there?”

“Read your text messages,” was all he could respond.

I have people three feet from me.  I can’t talk about it.

My being shattered so deeply that I had felt fractures of each bone in my entire body.  I became enraged at his choice.  Work.  Work over his ailing wife.  No exceptions could be made.  And in his mind, I’m sure the thought had occurred, This too shall pass.

“Goodbye,” I choked out without another word.

The anger, the scraps that remained, boiled in the water.  The blackness around me turned scarlet and thick like the blood coursing through my veins.  I grasped my phone with a crushing forced and launching it against a wall.  It exploded into three pieces, the unit, the battery, and the backing.

Screams erupted out of shrieking sobs, “I can’t go through this hell anymore!!!  Why do I have to go through this?!  Why?!  Endlessly, I raved and ranted like a mad woman.  A mantra repeated, “I can’t do this!!!   I can’t!!!”

“That job!  I hate that f***ing job!  His work, his work!  Nobody cares!  Nobody!” I grabbed my “Teacher”coffee mug from the cabinet and smashed it against the linoleum floor.  I’m not a teacher anymore.  It is a lie every single time I drink from that mug.  I am a nothing now.  I am a nobody.

I stood there staring at the pile of the remaining shards of ceramic, heaving panting sobs.  I slid down against the stove, next to the pile and pulled me knees to my chest.  A ball.  Nobody can hurt me.  I can’t hurt me.  No one can come near me.

Alone.  I am slated to be alone.  Alone in my own mess.

I WANT TO DIE.

It’s all I could think.  There is no life ahead of me that I want to live.  It’s only a life full of pain and misery, where I am tragically locked in my head.  No one wants to hear of these complaints.  I have no perspective to gain.  No more words left to give the world.  No hope for myself or anyone else.  I have nothing.  I am nothing.  I will always be nothing.  To anyone, anywhere.

And if I were to say goodbye, I would be wished well.  I would be let go without another word, another prayer or any thoughts left for me.

There is no treatment that will make better.  I will always be like this, with this crushing weight upon me.  My eyes are constantly fixed on the rear view when I’m not navigating the endless series of trials within this tomb of a labyrinth.  Even in the fleeting happy, peaceful moments, I will always be cautiously watching over my shoulder for the monster who will eventually gain on me, and overtake me.  I will never find happiness.  I can never find a place of peace and solace within this madness.

A plan started hatching.  There will come a day where I will take my life.  I can’t truly know when, but the day is inevitable.  I must make preparations.  I took a handful of Xanax and considered washing it down with a swig of rum.  No, it would be bad enough that I am doped up around my child.  My child.  My beautiful baby has to witness this in his already confused life.  It fueled the fire to hate myself even more.

I will get my house in order.  I will not leave a mess to clean up, because there will be enough of a mess when I am gone.  I will get my son into a program and have him taken care of.  My belongings will end up in boxes, so that they may easily shipped off.  I will leave nothing but mournful whispers behind.

I wish I had something inspiring to say.  I wish I could tell you that I went on about my life, went to class last night, and came back in better shape.  I wish I could tell you that the rays of hope descended upon me, and I am determined to hold out until December 11th.  I wish I could tell you that I look forward to better days, where this awful, gnawing feeling dissolves into some kind of happiness.

But I can’t.  I can only give up and start to let go.  I can only start to say my goodbyes and write my heartfelt letters to those that I love.  Because in the end, whether I want it or not, this is my fate.  To eventually succumb to my illness.  To eventually self-destruct.

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.

Vitamin L : Medication Adventures

Lamictal.  The one drug that I can say that we’ve all been on at one point or another in our adventures with medication.

Pardon me, my aphasia is showing with a little dash of emotional flattening.

I’m having difficultly remembering how to spell things.  You wouldn’t know it, because there is a such thing as spell check just for this purpose (but not solely).  My emotions are at such a level that I don’t actually feel.  It’s closer to a favorite pair of jeans where the dye has just completely washed out.  The jeans still look good, but they are faded and muted.  That’s me.  Faded and muted.

I can’t write intelligently like I did before.  Everything just comes pouring out like word vomit, because I can’t hang on to a thought for longer than a moment.  It’s a miracle that I can put anything coherent together.

The landscape of my technicolor world washed away into an old movie reel.  It’s so surreal.  Once, I was the flowing turquoise waters of the seas, ever changing, always in motion.  Now, I am the cracked earth, immobile and silent.  And ever so slowly, I am drying up and eroding, existing without life rooted in me.  Only the empty air whistles in my mind, catching a faint tune here and there, only to carry it away.

Moments come in flashes.  I am engrossed and deeply engaged for just a few seconds before I am distracted by something nonsensical.

Stop.  Sip of coffee.  What was I doing again?  I reread my last passage, and I am stumped, because it seems futile to even continue.  What is the point I am trying to convey with such vague and poorly worded imagery?

That was my world for the last month, prior to the last couple of weeks.  That is my life today, a translucent figure shrouded by shadows, discontent with such a shackled self.

That was not my life over the past couple of days.  That is how I narrowed down what medicine was doing this to me.  I was starting to run out of Lamictal, my Vitamin L as it’s commonly called in the mental health community (not to be confused with the Vitamin L of Lithium).  I lowered my dose from 300 mg to 200 mg in order to make it through successfully.

Except, there was no success to be had.  I went straight back into the same mixed episode I’ve been a slave to for more than nine months.  It was almost as bad as before, sans the psychosis.  I referred to it as Energetically Sad.  The story of my life.  I went into several crying fits a day, panicked and shouting the same phrase again and again,

“I can’t do this!!!  I can’t do this!!!”

Not again.  Not again.  Not again.

I can’t do this again.

Ultimately, I grabbed my precious medicine and dosed. The distress was immeasurable. I needed relief from that hell, the one I had endured for far too long.

But, I realized I’m not experiencing relief. I’m experiencing escape. My mind goes into a state of partial shutdown, leaving me no real clarity in any aspect. My consciousness is jagged, disjointed, and blurry, at best.

I experience slow motion waves of hollow, but shallow depression. Futility is found at every turn. The shadows seem deeper and more defined, like menacing sillouttes in the distance. I can’t shake them, but they can’t seem to touch me. They nip at my heels, and send ripples of darkness through me, infecting every molecule. And in a few moments, it passes, the poison having been purged.

At first, I thought it was just me. It felt like a new state altogether, like anxiety masked by a tight cloth, rustling, deperately seeking an outlet. It had the face of depression, leaving me dispondent and uninspired. But no true symptoms existed. Not in the desperate, deep dark places I’ve been. I stood in a parellel existence unlike anything I’ve ever known.

And then I thought, “Is this what it’s like to be better?” Dullness and mild discontent.

It’s not.

It’s the medication.

So, that leaves me with two very undesirable states. Perpetual distress or muted depression and anxiety. One zaps my everything, making me too medicated to function. The other disrupts my life with meltdowns, only making me partially functional.

One little pill is what makes the world of difference. My vitamin L.

Liquid Courage and Tablet Saviors : 30 Days of Truth

Day 20 : Your views on drugs and alcohol.

“Drugs are bad, m’kay?”

Or are they?

There is this long, Nancy Reagan-induced diatribe about the dangers and evil of illegal drugsSay no to drugs.  This is your brain on drugs.  The war on drugs.  Above the influence.  Don’t drink and drive.  Prom promise.  Those of us that are Reagan babies and older, through the boomers, are well aware of the presence and negative consequences of drugs and alcohol.   And despite the heavy dialogue, many people have personally experienced their own battle with substance abuse and dependence.

Alcohol had torn my life apart at the seams.  As with any addiction, it starts off as a recreational activity.  It’s a part of popular culture, especially in the younger age groups.  In my youth, drinking was cool.  Truthfully, it was a fun escape from the drudgery of daily life.  That was at seventeen.  Within a year, I started to find solace at the bottom of a bottle.  Coincidentally, that was the same year Smile Empty Soul sang:

I do it for the drugs.

I do it just to feel alive.

I do it for the love that I get from the bottom of a bottle.

Bottom of a Bottle – Smile Empty Soul

By the time I was in college, I was seeking out opportunities and excuses to drink.  A set of rules existed which meant to separate alcoholics, the loathsome bunch that we perceived people like our own parents to be, and recreational drinkers.

  1. Never drink before 5PM.
  2. Never drink alone.
  3. Never drink without occasion.
  4. Don’t drink before or during work or school.

As I gained my own freedom with my own apartment, the rules started to change.  In private, I could do what I liked.  I could deny everything and anything when I failed to be under the limelight of public scrutiny.  I began to use alcohol as more than a crutch; I started to abuse it completely as a coping mechanism.  That’s when alcohol and I started our sordid love affair.

The environment in my private life began to change.  I have spoken about it many times in various posts like Decent into Hell where I described my addiction as:

The last days of that relationship are blurry; my memories are obscured by the drugs and alcohol intoxicating my mind.  The days blended together in a ritualistic, self-medicated loop, work.drink.sleep.work.drink.sleep.sleep.drink.sleep… suspended in agonizing slow motion.  The silence was deafening in the deep, dark hours of night, still, cold, indifferent.

I had become a functional alcoholic.  I never drank before 5PM.  There was always an occasion, even if it was a day ending in “Y”.  And I certainly was not without company to share in my intoxicated merriment.  But there is a solid difference.  Every waking moment I did not spend at work was with a glass or a bottle in my fist.  I had gone far beyond the point of mixers, and mostly beyond the need for glasses.  It was me, a bottle of Bacardi 151 sans the filter, and a bottle of Gatorade to chase.

I wrote in Love the Way You Lie:

At that point, the seeds of alcoholism were taking root.  I violated my own rules of drinking.  It’s 5 o’clock somewhere!  I’m not drinking alone if I’m drinking with my boyfriend.  Hair of the dog, best way to cure a hangover.  If I’m still managing to get to school and hold an honor’s average, I’m not drinking too much.

Liquid courage and comfortingly numb.

It has always been my vice, and holds the looming, unending threat to assume control and ruin my life. In another 30 Days of Truth piece entitled, Control, or Lack Thereof, I went into a full exploration of recent recreational alcohol use and the negative impact it created in my life.

Flip that coin.

Drugs have revolutionized my life.

People neglect to realize that they are consuming legal drugs daily.  It becomes painfully obvious when you sigh over exorbitant copays at the pharmacy counter, like many people with mental health disorders often do.  But, instead of calling them “drugs”, we call them “medications”.  Did you know that Wellbutrin technically has the same chemical composition of a methamphetamine?  And that benzodiazepines work on the same receptors in the brain as alcohol?

So here I am, with my uppers to wake me in the morning, and my downers to put me to bed at night.  It would be illegal and detestable if I were using meth and boozing away.  Instead, it’s under the supervision of a doctor, as a controlled substance, in a convenient little pill.  Don’t get the wrong idea.  I am only likening the effects.  The supervision of the doctor is safer, and the medications are regulated by the FDA.  And as a result, I have most of my functioning back.

And I wouldn’t have it any other way.

Exercises to Build Self Esteem: #1. Pleasure and Happiness

Writing your Pleasure List

1. Take a clean sheet of paper and head somewhere you feel safe and relaxed.

2. Divide the paper into four sections:

– Section 01: People and Pets (who bring me pleasure when I think of them)
– Section 02: Places (that bring me pleasure when I think of them)
– Section 03: Things (that bring me pleasure when I think of them)
– Section 04: Things I like to do (that bring me pleasure)

3. Then write as many examples as you can under each section.
4. Remember to allow yourself to feel happy!

Section 01: People and Pets

  • Xan, my husband.
  • Beast, my son
  • Dill, my friend
  • Zen, my cat that passed on last year
  • Rees, my friend.
  • Ruby, my friend
  • Carla, my friend
  • Monday, my friend
  • My MIL
  • My FIL

Section 02: Places

  • Myrtle Beach, South Carolina:   It is absolutely, hands down, my favorite vacation spot.  The beaches are huge and sandy.  The local, southern food is amazing, and the local people are very friendly.  I have some of my most fond memories there.  When I was sixteen, it was my first taste of freedom.  It was the only town I was ever allowed to wander around in unsupervised.  I was free to go wherever I wanted within a certain 15 block radius in either direction.  For Myrtle Beach, that’s a lot of territory.  I spent my honeymoon there with Xan.  It was the first time I had ever gone on vacation as an adult.  We just had the most lovely time, I recall.  Good food, peaceful setting, and a lovely beach.  I got to wake up every single morning to go out on the patio and watch the sunrise.  It was magical.
  • Virginia Beach, Virginia:  I recall Virginia Beach having one of the most impressive boardwalks I had ever been on.  Anything you could ever want was on that board walk.  I was thirteen years old, and I’d sneak out to my very own balcony in the middle of the night just to watch the moon rise on the ocean.  It was one of the most beautiful sights I had ever seen.  It was fairly close by car, so I wasn’t stuck in the car forever with my parents.  And, since I had my own room in our suite, I had a huge amount of privacy.  It was the best vacation I can remember from my childhood.
  • The Fountains in Pittsburgh:   There’s something about those fountains.  Pittsburgh has plenty of them, because we are so close to the river.  There was one in particular that I loved, and I took a photo of it right before my surgical consultation the August before last.  Something about it was calming, and settled me down to think about the beautiful things in life.  I even wrote a post called, “All the Pretty Things”.
  • The Trestle:   By my old house, in the same neighborhood I grew up in, there was this old, abandoned railroad trestle.  My best friend showed it to me when we were in our early teens.  We used to hang out there to drink and smoke pot.  Then, we’d have these deep conversations about our thoughts and feelings.  Those were very intimate moments.When Beck, my ex, and I became secret lovers behind her back, we used to frequent the trestle.  It was the place that I had my first kiss with a boy.  And he and I would sit there for hours, holding each other, talking about our dreams, and making plans for our future together.  And after Beck and I broke up, I didn’t go back again.

    Until there was Xan, three years later.  At the time, we were living with my ex, Avi.  I felt a bond with Xan that I couldn’t quite explain.  So, I took him there, so that we could be alone.  We hung out and we drank.  It was a beautiful alone place, even if it was a rusted trestle.  You could see the creek below, and it was surrounded by trees, a rarity in that neighborhood.

    It was the place where Xan and I spent our first night together as a couple.  We sat up all night and talked.  I don’t recall what about.  The past.  The present.  Maybe even the future.  I know we went through the story of our developing relationship, and how we got to this point.  And I remember we held each other in the rain until the morning light.

Section 03: Things:

  • My computer
  • My Samsung Captivate Glide
  • Pandora
  • My stuffed animal from when I was a kid
  • Coffee
  • Pizza
  • New clothes
  • Cigarettes
  • Overhead Lighting
  • WordPress
  • Facebook
  • Bejeweled Blitz
  • Bed
  • My blue coffee cup
  • My brown skirt
  • The Internet
  • Wikipedia
  • WebMD
  • Medscape
  • Google
  • Craigslist
  • My blue blanket
  • My journals
  • Inkjoy pens
  • G2 Gel Pens
  • All no bleed Sharpies
  • Office supplies
  • Caffeine
  • My medication
  • My contacts

Section 04: Things I like to do:

  • Go for long car rides
  • Eat at this little mom and pop diner a few towns over
  • Shop
  • Get dressed up (sometimes)
  • Take hot showers
  • Visit my in-laws
  • Craft
  • Take on a new project
  • Crochet
  • Write
  • Read
  • Write on WordPress
  • Read on WordPress
  • Do selfless acts
  • Practice Tang Soo Do
  • Play computer games
  • Watch my favorite TV shows
  • Create things
  • Play with my son
  • Spend time with my husband

All that I am, all that I ever was...

“Pleasure is the only thing one should live for, nothing ages like happiness.”
~ Oscar Wilde ~

Accentuate the positives

The first exercise toward building better self-esteem is to focus on the positives. Now, I’m not a convert into the positive thinking movement, in fact I find books that proclaim all we need to do is think positively and everything we want will magically appear out of thin air complete crap. I don’t believe someone can ‘pretend away depression’ nor do I believe thinking positively will cure you of cancer or the myriad of other illnesses that people suffer from.

However, thinking positive thoughts about ourselves can bring about an attitude change toward better self-perception.

Once upon a time I was in a counselling session. I had seen this counsellor for several sessions and in each one he noted how stressed and tense I was; how I sat in a…

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