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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Quintal on August 9, 2008, at 19:22:54
We spent most of yesterday's session covering this area. She doesn't think I have any sort of autistic spectrum disorder either, but I disagree on both counts. Most of this centers on why I feel so detached from people and disorientated in social situations. I feel there's an underlying problem besides the avoidance because whenever the avoidance is no longer a problem other factors have come into play. This seems to me to be mostly down to poor social skills (lack of reciprocity in particular) and unstable/stormy relationships with others and wildly fluctuating changes in self perception.
I have been diagnosed with BPD by my former psychiatrist, who I had a lot of conflict with. T agrees that this might have been a punishment and a warning to other doctors that I am a difficult patient, but nevertheless there is a great deal of truth in it which she refuses to see. If she really believes this was a misdiagnosis I hope she will write to my GP and ask for that to be removed from the list of current diagnoses. Anyway, we had a bit of a debate about this so she went next door and got a book on personality disorders so we could look at the diagnostic criteria together. I thought I met most of the them, and where I didn't I think it's because I've learnt skills to control certain behaviours, yet still had the urges (for example suicidal gestures and self injury).
The only thing I felt didn't apply to me was the fear and frantic efforts to avoid real or perceived abandonment. This is becuase I don't seem to be bothered about being left alone, indeed I prefer it, and this is something she's been trying to tackle. You can see from this post a few weeks ago that this isn't true - I do have problems with abandonment, but the difference betwen me and most borderlines (maybe the female borderlines who make up most of the population) is that I would rather be competely alone than face the constant risk of abandonment. http://www.dr-bob.org/babble/social/20080721/msgs/842788.html
I told her I'd ordered Marsha Lineham's DBT manual and it came today. I've read the introduction and the first few pages, and the thing that bothered me was that the therapy is primarily aimed at reducing suicidal and parasuicidal behaviour, and only in women. Lineham makes it clear that DBT has not been studied and proven effective for the needs of borderline men in the same way it has done for women. Despite the fact that women make up over 80% of the borderline population I felt this was a bit sexist and was left feeling rejected.
T didn't think DBT was what I needed, but said she would be interested in what I thought of the DBT manual. She thinks I need to work on my avoidance behaviours, whch I am, but we seem to be going round in circles because this borderline/autistic stuff keeps getting in the way. She thinks this is just a way for me to avoid tackling my avoidance behaviours, so I feel trapped, a bit like I did with my pdoc who didn't believe I had bipolar disorder or social anxiety. It took a psychotic episode to prove him wrong, and I don't want to end up having to prove my borderline traits by having a similar outburst. With the autistic/Asperger's thing I think I've developed such good coping skills that it's not obvious to anyone I meet in a professional, structured setting, but it is painfully obvious to myself and others in open-ended social settings.
Q
Posted by Sigismund on August 9, 2008, at 19:56:16
In reply to T doesn't think I have BPD or Asperger's, posted by Quintal on August 9, 2008, at 19:22:54
There must be something I don't understand.
>I feel so detached from people and disorientated in social situations.
If you feel detached from people, why would you feel disoriented in social situations?
I have been thinking that part of the reason for my social anxiety is that I am not nearly detached enough. I can never work out who is caring about whatever it is....is it me, is it someone else, is it both, is it me in them, is it them in me??
Open ended social settings suck (you might say) because the onus is on you to know what you want (other than to get away). But structured social settings can too.
Posted by Quintal on August 9, 2008, at 21:02:48
In reply to Re: T doesn't think I have BPD or Asperger's, posted by Sigismund on August 9, 2008, at 19:56:16
>There must be something I don't understand.
Maybe, but what do you really mean here?
>If you feel detached from people, why would you feel disoriented in social situations?
I don't see any conflict between the two.
>I can never work out who is caring about whatever it is....is it me, is it someone else, is it both, is it me in them, is it them in me??
I don't have any difficulty in figuring people out. The problem is I find I have nothing to say when it comes to that meaningless 'talking about nothing' chatter. I just can't work out what I'm supposed to say. It sounds to me like people making empty noise just for the sake of it - for distraction, and that's what I find very 'disorientating'. I actually get physically dizzy sometimes, like vertigo. I don't know where I'm at or where I'm going, and that's unusual for me.
I have no problem when it comes to conveying logical, factual information - it's this open ended 'just to be sociable' stuff that has me lost. Like "What are you having for tea?", "What did you do at the weekend?" or "How are you?" I used to reply with an honest literal response to these questions, but I can tell from their reactions this isn't what people want when they ask the question, so what do they want? I don't know. Just a bit of noise.
>Open ended social settings suck (you might say) because the onus is on you to know what you want (other than to get away). But structured social settings can too.
It's easy to predict what will happen in structured seetings, so I can plan responses in advance. Soical settings are a complete blank. It's like a multiple choice exam (where even if you don't know the answer you can make an educated guess by a process of elimination) versus an open ended question with a blank page staring back at you.
Q
Posted by Phillipa on August 10, 2008, at 13:56:16
In reply to Re: T doesn't think I have BPD or Asperger's, posted by Quintal on August 9, 2008, at 21:02:48
Since I'm terrified of being alone and can't be what do I have BPD? Confused and lost. I can make idle chatter but not engage in stuctured interractions any longer so what is that? Phillipa
Posted by raisinb on August 10, 2008, at 14:47:53
In reply to Re: T doesn't think I have BPD or Asperger's, posted by Quintal on August 9, 2008, at 21:02:48
Hi Quintal--
I'm not an expert, but I have taught several kids with Asperger's, and it certainly sounds as if you have something very similar. Kids with Asperger's don't pick up on social cues, and they cannot dissemble. But your therapist must have some reason for thinking as she does.
Posted by Quintal on August 10, 2008, at 15:52:07
In reply to Re: T doesn't think I have BPD or Asperger's » Quintal, posted by Phillipa on August 10, 2008, at 13:56:16
Most people have some of these personality traits, and I think it only becomes a disorder if it's causing a lot of distress or disability.
Q
Posted by Quintal on August 10, 2008, at 16:41:34
In reply to Re: T doesn't think I have BPD or Asperger's » Quintal, posted by raisinb on August 10, 2008, at 14:47:53
I think the problem my therapist has with confirming these diagnoses is that (at least as my outward behaviour in the clinical setting is concerned) I don't meet the full diagnostic criteria for either of them any more. I think this is because I've developed pretty good skills to compensate for them rather than the underlying problem having gone away. I suppose what I'm looking to get from these diagnoses is validation of the struggle I've had to get to where I am now, and praise for the coping skills I've developed on my own. She also said last session that she could see no sign of the social anxiety or rigid posture that I was reporting, but I most definatelty do have these problems (which she doesn't deny), but it does make me wonder what else she isn't seeing in me, and whether she's being entirely honest in her asessments (I stayed in the same position for the entire session). I think she's just trying to look on the positive side and bolster my self esteem, and also not get too bogged down with labels.
I had a similar struggle with my psychiatrist over bipolar disorder. I've been treated for that since 2001, but my last pdoc discharged me in 2006 because he claimed not to have seen any sign of 'bipolar symptomology' in me in over two years of assessment. This is so frustrating. For years I questioned whether you actually have to act out your mood swings to have bipolar disorder or whether it's just internal. In October of last year I got my answer to that. I became psychotic and was sectioned in December, and ended up under the care of the same pdoc that had discharged me. He diagnosed a manic psychosis, proving really that I do have a fairly severe bipolar disorder afterall.
I'm just so tired of the third person objective perspective being given precedence over the first person subjective. Science has taught us that objectivity is always the best method of investigation, but I don't think that's true when it comes to the mind. Mental suffering is a personal experience. I've been reading the Dalai Lama's thoughts on this subject in "The Universe In a Single Atom" and it has been a great comfort.
Did any of the kids you've taught ever learn to regulate things like eye contact and body language? Oh, I almost forgot (and forgot to tell T too), when I was small my parents took me to the optician because they thought I might have some sort of sight problem - apparently I would look at people as if I could 'see straight through them, as if they weren't there', whatever that means. I suppose some sort of eye conact problem. When the tests showed my eyesight was normal they took me to the doctor because they thought I might be slightly autistic. I don't know exactly what was said in that appointment, but I gather it was a 'wait and see' thing. I managed to limp on by at school (but certainly had a lot of problems), so they never followed it up. My mother was always feircely defensive that there was nothing wrong with me.
Also, when I was in hospital last December two of the nurses told me it had been suggested that I was autistic. If they could see what I'd been doing in private (mostly rocking, walking on the sides of my feet, and my usual obsessive compulsive rituals) I think they'd lean even more towards the view that I'm on the autistic spectrum. Unfortunately I was punished for displaying these behaviours when I was a child, so I learned to do them only in private. They're the only real comforting/self soothing behaviours I have. I wish I had one of Temple Grandin's squeeze machines!
Q
Posted by raisinb on August 10, 2008, at 18:18:41
In reply to Re: T doesn't think I have BPD or Asperger's » raisinb, posted by Quintal on August 10, 2008, at 16:41:34
I'm not sure if they did; I teach high school, so typically I only see them for a year or a semester. But the Asperger's kids I've had couldn't do those things at age 15+.
Posted by Quintal on August 10, 2008, at 19:07:07
In reply to Re: T doesn't think I have BPD or Asperger's » Quintal, posted by raisinb on August 10, 2008, at 18:18:41
This is one of the key doubts. I don't have problems with eye contact or body language, but I seem to have done in the past. T says Aperger's kids don't change in this respect.
Q
Posted by rjlockhart '05 on August 10, 2008, at 23:07:20
In reply to Re: T doesn't think I have BPD or Asperger's » raisinb, posted by Quintal on August 10, 2008, at 19:07:07
I know psychiatricly i am doctumented with Asperger's. But when i read about Borderline Personality Disorder, it has many symtoms that may link from a result of rejection.
I hate the danm disorder. It takes me longer to do things, and simple tasks are diffifcult, complex tasks (some) are easy. Such as freeminded thinking, and conclusions.
rj
Posted by Quintal on August 11, 2008, at 16:57:54
In reply to Re: T doesn't think I have BPD or Asperger's, posted by rjlockhart '05 on August 10, 2008, at 23:07:20
How did your pdoc arrive at the dignosis of Asperger's Syndrome?
Q
This is the end of the thread.
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