All that I am, all that I ever was…

I am more than my mental health. I am more than my homelessness. I am more than any one aspect of me. I am Addy. And this is…


3 Comments

Borderline personality disorder is a hurtful label for real suffering – time we changed it

h53npjfz-1437369684

by Jayashri Kulkarni, Monash University

Standing in the cold, dark bathroom, she hacked into her wrist with a razor blade and quietly stared at the blood that flowed from the cut. She told herself she was a bad person and deserved the pain.

A part of her felt reassured by the sight of the blood – it showed she was alive – since she felt so dead and empty inside. As she stared at her image in the bathroom mirror, she thought, “I have no idea who that person is staring back at me.”

Such deliberate self-harm is very common in people diagnosed with borderline personality disorder. It takes many forms, including intentional overdoses of tablets with excessive alcohol, risky sexual behaviour, as well as physical self-punishment.

Other symptoms of the disorder include identity disturbances, feeling “dead” inside, rage responses or difficulty regulating emotional reactions to situations, mood swings, constant anxiety and panic, poor self-esteem, memory blanks, dissociation (“out of body” or feeling “unreal”) experiences, problems with concentration, feeling invalid, and fear of being abandoned.

A bad cycle

Between 2% to 10% of the population have some degree of borderline personality disorder, which puts them at high risk of suicide. While it’s poorly understood, we know that it predominantly impacts women.

There’s no medication that specifically treats borderline personality disorder, and it’s associated with a great deal of stigma among both health-care professionals and the general community. Research shows people seeking treatment for self-inflicted harm, including taking medication overdoses, are often seen as “difficult”, a “nuisance” or just indulging in “bad behaviour”.

Rage or diffuse anger is another symptom of borderline personality disorder that’s poorly tolerated by family and health professionals. If the person with the condition repeats self-harming behaviour, frustration among family, friends and health professionals increases and may lead to decreased care.

Since people with the disorder crave reassurance that they are worthy, valid and deserving of care, this rejection sets up a dangerous spiral of increasingly harmful behaviour that’s intended to attract care.

Origins in trauma

About 80% of people with borderline personality disorder have a history of trauma. They may block out recollections of early life trauma, but the impact of their emotional, physical or sexual abuse as a young person is profound and present for many years afterwards.

More specifically, people who were sexually abused as children often feel – wrongly – that they did something wrong, that they are to blame for being abused and that they’re bad people. At a deep level, they believe they deserve punishment; their self-harm acts out this belief.

The rage of people with borderline personality disorder, which often occurs in response to apparently small issues, may actually be a totally justified – a delayed expression of anger with the perpetrator of their abuse. And their memory blanks and out-of-body responses to stress may be attempts to repress recollections of abuse and to escape from trauma.

Not all traumas stem from physical or sexual abuse. Emotional neglect or deprivation can also be difficult for people to identify and define. They can, nonetheless, leave a mark for years to come. About 10% to 20% of people who have borderline personality disorder have no known history of childhood trauma.

Difficult diagnosis

The biology of this poorly understood condition includes the hypothesis that abused or neglected children produce high levels of stress hormones (cortisol) and remain on “high alert” – watching and waiting for the next abusive episode. These stress hormones impact brain circuits and centres that determine anger or emotional control and higher learning.

Deliberate self-harm is very common in people diagnosed with borderline personality disorder. | Rachel Collins/Flickr, CC BY

Women with this condition can also have cortisol-induced cyclical reproductive changes, leading to menstrual cycle-related depression, obesity, diabetes, high blood pressure, increased facial hair, infertility and ovarian cysts. All these long-lasting mental and physical symptoms appear to have their origins in a history of early life trauma with biological brain changes.

There are effective psychological treatments, such as dialectical behavioural therapy, for borderline personality disorder but health professionals have to recognise and explain the condition before appropriate care can be provided.

And many health professionals find it difficult to recognise the condition because different symptoms come and go over time. An overall view of the person’s life is needed to correctly make the diagnosis.

Ill-fitting name

As a diagnostic term, borderline personality disorder not only fails to capture any of the underlying issues and mechanisms involved in producing its symptoms, it also denigrates. In contrast, major depressive disorder describes a serious condition with the key feature of depressed mood explicit in the diagnostic term.

The word “borderline” was used in the 1930s by psychoanalysts to describe patients whose symptoms were on the border between psychosis and neurosis. But today the most common interpretation of the word is that the condition “borders” on being a real illness.

In effect, there’s an invalidation of the illness in its name. This mirrors – as well as possibly enhancing – the feeling of invalidation the person with the condition already suffers.

And all this is not helped by the next word either. To suggest there’s something about someone’s personality that’s disordered – especially as personality is, collectively, the intimate and unique qualities that describe a person – is a devastating blow. And it cuts further into the already diminished self-esteem that people with this condition have.

Why it matters

Diagnostic labels carry a great deal of weight. They describe symptoms, attempt to answer the question of “what is wrong” and lead to a treatment plan. A diagnostic label such as borderline personality disorder with its stigma and propensity to invalidate the person’s suffering clearly has many negative impacts.

A name that captures the origins of the condition, such as complex trauma disorder, could shift the focus from seeing the person as “behaving badly” or not having a “real” illness, to recognising them as a survivor of trauma or abuse. Such a change could improve outcomes for them and their families.

Of course, what’s also urgently needed is clinical research that creates better understanding of the condition, and the development of tailored, effective treatments. But ultimately, prevention of early life trauma would make the biggest difference to the development and expression of this disorder.

In the meantime, changing the label borderline personality disorder to something more sympathetic, even if just informally, may start shifting negative attitudes to people with the condition.


Jayashri Kulkarni is Professor of Psychiatry at Monash University.

conversation-full-logo-1070aea8b0feb9a5f470ed093ecef06e

This article was originally published on The Conversation.
Read the original article.


10 Comments

Tomorrow I quit smoking – for good!

cigarette-ash-art_130434526842

When I first started smoking, way back in 1999, I was a naive twenty year old who wanted to stop self harming. I was tired of the cutting, tired of the burning, beating and bashing, so, in one of my finest ever decisions, I decided to swap self harm for cigarettes. It kinda suited me at the time. I was living in a backpacker hostel, surrounded by people who smoked, people who socialized whilst they were smoking. Having a cigarette in the smoking lounge meant having someone to talk to. And at a juncture in my life when I was also trying to stave off the social anxiety, it suited me to have an ‘excuse’ to be social. And by the time you can say ‘big stinking idiot’, I was addicted.

I no longer smoke to be social. I smoke because I am hugely (and annoyingly) addicted to cigarettes. Nicotine has me in its grasp. Cigarettes fill me with joy, with happiness, with frustration. I hate bowing down to the commands of such a cruel mistress, but with boredom and depression eased by my filthy, disgusting habit, who am I to argue? Smoking gives me something to do. Smoking fills the time and stops me from going insane. Smoking is something that 32% of people with a mental illness do, so there must be something in it. It must soothe the demons somehow.

But smoking is doing its own unique brand of damage. It’s infecting my lungs with cancerous chemicals and slowly eating me from within. It’s draining my bank account and forcing me to choose between food and clothing. It’s making me smell like an overflowing ashtray and staining my skin a grotesque shade of yellow. All things that, until recently, I have just accepted as side effects of my chosen vice. But not any more.

Tomorrow – the 15th July 2015, coincidentally my brother’s birthday – I have decided to quit cigarettes. From the moment I awake in the morning I will not be reaching for the cancer sticks to kick-start my morning. I will not be turning to them throughout the morning to stave off boredom and I will not be smoking my way through them during the long, bleak afternoon of nothingness. I’m tired of being a slave to addiction. I’m tired of the damage that I’m doing to myself. I’m tired of having no money because it all gets spent on tobacco.

It’s going to be hard – I’ve given up in the past – but in time it will get better. After a few days, once the toxins have left my system, it will get easier. Or at least, that’s what I’m choosing to tell myself. I know that for the next couple of weeks I’m going to be the crankiest bastard on the face of the planet. I’ll be snippy, short-tempered and a pain in the arse to be around. But it is for the greater good. It is for my health, my wealth and my sanity.

Just go easy on me. Please. :)

 


2 Comments

The DOs and DON’Ts of Self Harm

I found this years ago in a Facebook group and have always thought it quite brilliant, hence my reason for sharing it today:

The DOs and DON’Ts of Self Harm

SI Awareness

01. Don’t ask them why. If they want you to know why, they will tell you. Most of the time they don’t even know why.
02. Sometimes they just need to tell someone, because they fucking need to.
03. Never talk about him/her behind their back. They will find out and they will be pissed. They prefer you to speak directly to them.
04. If you ask them to never self-harm again, and they say “okay”, they’re lying.
05. Never ask them to never self-harm again.
06. Don’t try and understand why they do it. You’re wasting your time.
07. If you don’t know what to do, just ask them “Are you [insert appropriate form of harm here]? Do you need to talk about it?”
08. Get over your own insecurities about worrying if they’ll hate you for asking.
09. Asking shows concern. Not asking shows negligence and an “I really couldn’t care less” attitude.
10. Telling a teacher/parent/counsellor/other friend before talking to the person in question shows “I can’t be fucked working up the courage to ask them myself”. But it’s better than #09.
11. Offering suggestions of other means of coping is pointless.
12. Tell them that you’re there for them. No matter what. And you never judge. And you will always listen. And you will always just be there. And sometimes you never have to say a word at all. Sometimes they don’t want you to say anything.
13. It does not mean they love or enjoy pain.
14. It gives them the right to make fun of themselves/other self harmers.
15. Depending on the situation, it does not give you the right to.
16. Classifying them as “emo” only reduces yourself to an ill-informed bitch who believes you’re God’s gift.
17. It is not always a case of attention-seeking. A lot of the time it isn’t.
18. Self harm is a way of coping with emotions. While most people might cry and scream and rant and rage, self-harmers generally don’t express those sorts of emotions openly, and bottle them inside. The only way they know that works of releasing them is by inflicting pain on themselves. Hence the NOT ATTENTION SEEKING.
19. If they wanted attention they would go slit their wrists in the toilets at school and walk out with their clothes soaking in blood, collapse in the middle of the school grounds, and wail.
20. Other people self harm because they’re so emotionally numb on the inside, they need the pain to remind themselves that they’re alive.
21. Others hurt themselves because they believe they deserve it.
22. There are 39846324956234986487562387456238475123518746459865 other reasons for self harm.
23. There is not one direct cause. There is usually a trigger. A trigger may be a picture of a cut. That will get them thinking of cuts. That will get them into the mindset of cutting. And inevitably, they will want to cut.
24. Other triggers include any form of high negative emotion.
25. There is a difference between cutting for release and cutting for addiction.
26. Addiction-cutting is when you used to cut because you needed it, and now you cut because you can’t stop. You have no way of controlling the emotions without cutting. So you cut when you’re angry, sad, depressed, etc. It works. Temporarily. So when the same emotion comes up, they do it again. Only this time it doesn’t work as well. So they do it harder. And etc.
27. They know they shouldn’t do it, it’s no use telling them that.
28. Some of them like their scars, some of them hate them. Some are proud of them, some are ashamed. Just because one likes them and the other doesn’t, does not mean that the one who likes them is “okay” with what they do.
29. The need and want to self-harm rarely goes away.
30. Ask them questions about what they do. If they don’t want to talk about it – don’t push it. But if they do want to talk about it – keep asking questions. Don’t let them do all the talking. Ask questions. Questions are caring. Questions show them that you love them enough to want to know what they do, so you can understand and be there for them as best as you can.


5 Comments

How to cope with PTSD flashbacks?

I feel it pertinent to point out that this isn’t a ‘how to’ post. You may feel slightly jipped to discover this, especially since the first two words of the post title are “how” and “to”, but I did place a wee question mark at the end of the title, meaning I need your help. And with your help, perhaps we can write the ‘how to’ post that you were probably expecting.

My PTSD is a complicated beast. It doesn’t just come from one traumatic incident, but several, the memories of which have combined to form an almost impenetrable wall of trauma that I have no idea how to deal with. Firstly (and foremost) there is the emotional abuse that I was the victim of. Without question this causes the most damaging of my PTSD symptoms. Secondly, there is the assault and rape I experienced when I was in Adelaide in 2007. Thirdly, there is the recurrent memories of being homeless; of being ostracised by society and forced to exist in a sub-human state on the streets of Melbourne and beyond. Fourthly, comes the various physical assaults that I received during this homeless existence. On a daily basis I am hounded by flashbacks of these four incidents; flashbacks that occur without warning, leaving me a quivering, delusional wreck.

Over the last few months, ever since becoming unwell, the memories of the emotional abuse I received have been impossible to contend with. I have been regularly conversing with a hallucination of my abuser to the point I devolve into a fuming, shouty monster. Lord knows what my neighbours think of me, for the walls between us are thin, and my voice is raging. I will scream, yell, holler, bellow, bawl and shriek as I replay specific abusive events and attempt to discover why she saw fit to abuse me. I am desperate for answers, desperate for closure, but I know I can never receive it so my voice rages ever louder. I want to know why she decided to destroy my sense of self, why she was so cruel and callous in her criticism and insults, why she worked so hard to drive a wedge between my friends and I, why she decided I didn’t deserve to be in tertiary education and why she decided I should die because “my voice is so boring and monotonous it inflicts pain on everyone I talk to“. I need to know why I deserved the abuse she gave me. But like I said, I know I will never discover these answers, I will never have the closure I need, so how do I cope with it? How do I live with the trauma rather than let it control me?

At least fourteen hours a day are lost to these fuming, shouting sessions. They occur when I’m home, they occur when I’m walking down the street and they occur when I’m surrounded by people in the high street. And I have no idea how to stop it. I have no idea how to cope with these intolerable flashbacks.

My GP believes a new anti-psychotic will help – a week into taking it, it hasn’t. I’ve tried mindfulness techniques. I’ve tried my usual coping mechanisms. I’ve tried CBT and DBT techniques. I’ve tried flooding myself with distraction. But nothing has worked. I always devolve into the shouting, always devolve into the trauma and always allow it to control my thinking, my actions and everything in between.

Hence the question – how to cope with PTSD flashbacks? How do you cope with your PTSD flashbacks? How do you stop it controlling your life?


3 Comments

The mystery is solved

As I mentioned in my last post, my physical health has been somewhat of a problem since the beginning of this year. Abdominal pain led to pancreatitis which led to hospitalization and, since I was discharged from hospital, a mysterious abdominal pain that has zapped me of my strength, energy and motivation. In fact, it left me a doubled-over-in-pain, nauseous, vomiting wreck of a human being – and all I wanted to know was what was wrong with me. So last week, after numerous consultations with my GP, I was sent for a scan.

The scan took two hours. Two – tediously boring – hours! First of all I had to force myself to drink nearly a litre and a half of water. I don’t know why I had to consume so much liquid, this was never explained to me, it was just brought out to me and I was asked to drink it as quickly as possible. After making myself feel quite nauseous I was summoned into the scanning room where, after changing into a nifty hospital gown, I was laid on the CT scanner and was told I would need a canulla inserted in order to pump me full of the radioactive contrast medication that enables the scan to be viewed more clearly. This isn’t a problem if you have strong veins…but I don’t. After a gloriously failed (incredibly painful) attempt, the man summoned in his superior who would hopefully have better luck. They didn’t. So they decided (thankfully) to run the scan without the medication. Alas, this didn’t work, so they tried again to install a canulla into my quivering body. This time they wheeled in the ultrasound lady to try to locate my veins through technology. Two further (extremely painful) attempts later they finally managed to get the wee medical equipment into my vein and we were good to go. As the scanner man said “it took forty-five minutes to do something that should have been done in five”. At least the scan itself took only a couple of minutes.

The wait for the scan result, however, was seven days of anxiety inducing madness. As each day clicked over my mind flooded with all sorts of possibilities that could be causing this (at times) excruciating abdominal pain; could it be pancreatic cancer? Maybe it’s stomach cancer? Or an ulcer? Maybe it’s several ulcers all conjoining to create the world’s most grotesque stomach growth?

Yes.

I have hypochondriac tendencies.

It’s not fun!

But after seven days of waiting I finally got the results of the scan yesterday. Apparently what is causing the pain is a 4x7cm cyst that has nestled itself into my pancreas and is happily doing whatever cysts do, much to the chagrin of its host. The GP said this might require surgery (which I’m not too keen on) but because the pain has subsided slightly over the last few days, he hasn’t referred me to the surgeon’s knife just yet. He’s going to monitor me over the coming weeks and, in a couple of months time will send me for another scan (which I’m not too keen on given the canulla nightmare of my recent scan) to see what the cyst is getting up to.

Strangely enough I’m not too fussed about having a cyst. It’s a little disconcerting (especially given its size) but it’s wonderful to know that there is an actual cause of the pain and that it’s not just some depression/anxiety induced psychosomatic symptom. It’s also wonderful to have a doctor that seems to genuinely care about what I’m going through. He really has been fantastic over the last several weeks, putting up with all sorts of paranoia, hypochondria and anxiety from this most stressed out of individuals.

In fact, it’s safe to say that I have never in my life felt this ill (even when I had glandular fever, which is the closest comparison to my current woes). And when I feel ill, I don’t function well mentally. My mood turns sour, depression creeps in and life becomes bleak and unenjoyable. So hopefully, as time ticks on, and my physical health improves, I will find my mental health improving alongside it.

For I really am completely over hospitals, canullas and abdominal pain. Although I do quite like the gowns, as they show off my cute wee behind! :p


6 Comments

Pancreatitis, pneumonia and abdominal pain, oh my!

It’s been nearly seven months since my last post and sometimes I don’t know where the time goes, for I certainly didn’t plan on being absent for so long. Last year (2014) was a nightmare for me from beginning to end; one elongated depressive episode that sapped my strength and rendered me incapable of performing even the most basic of tasks. I was lost from the first minute after New Year to the last tick of the clock twelve months later, and the only solace had been the hope that 2015 would prove to be “better”, for want of a better word.

Alas, this year has got off to just as bad a start, albeit for totally different reasons.

In early January I began to feel sick; abdominal pains, aching limbs, nausea, vomiting, the list of symptoms were as uncomfortable as they were endless. Then, a few weeks later, the abdominal pain became so severe I was forced to do something I have never in my life done before – I called an ambulance. At 3am, I crawled in agony from my bed and dialled 000 in order to find someone who was willing to help me with my physical torment. Fortunately, the ambulance was quick to arrive and even quicker to inject morphine. A short trip to the hospital later I found myself being connected with all manner of tubes, catheters and heart monitoring equipment. Another short trip to a different hospital later (my local hospital is on the small side) and I found myself in the critical care unit being diagnosed with acute pancreatitis; an illness I was told “could prove fatal”.

All in all I was in hospital for a little over two and a half weeks and every second of it tested every coping mechanism I have. The pancreatitis, I was told, had been caused by the mood stabilisers I was taking, so they were immediately stopped, causing for a little over a week all manner of paranoia and delusional thinking. At one point I believed the operators of the CT scanning equipment planned to murder me. At another point, I believed the hospital was under attack by a cursed Egyptian Princess and only I could save it. Fun times.

Because of my experiences in boarding houses when I was homeless I can’t deal with sharing my space, so being in a ward with three other gentlemen and only a thin curtain between me and them proved highly anxiety inducing; cue anxiety attacks, panic attacks and long sleepless nights listening to what can only be described as a symphony of snoring.

Eventually – after a brief bout of pneumonia which I picked up in hospital – I was fortunately discharged with a bag of pain meds and sent on my merry way. You would have thought this would have been the end of it. That my weeks in hospital would have fixed any physical ailments plaguing my body, but alas, over four weeks later I continue to suffer through an assortment of symptoms that no-one can explain.

The abdominal pain has continued but, rather than being related to the pancreatitis (which I’m assured has healed), is focussed on my stomach. Thus, I have spent much of the last month doubled over in pain whilst simultaneously vomiting and being unable to stomach virtually all foodstuffs. To say I am “over it” would be an understatement. I miss having energy. I miss being motivated. I miss my appetite. I miss feeling ‘healthy’.

Tomorrow, I am going in for another scan (which I’m told will take an hour and a half) in the hope that it will shed some light on whatever is causing my body to rebel in such a painful, uncomfortable and yucky way. For, nearly three months into the year that I hoped would be “better” than 2014, I’m still unable to enjoy a single minute of it.


1 Comment

I really hate change

One thing I don’t deal with very well is change. I think this is something that many people with mental health problems can probably relate to. I, like many, need some semblance of routine and order in my life. When something comes along that unsettles the carefully balanced apple cart of my life, my brain is sent scattering like the aforementioned apples bouncing away from the safety of their cart.

Yesterday, I discovered that change is afoot, and I am not coping with it at all. In fact – given how depressed, lost, confused and alone I’ve been feeling over the last several weeks – I’m a bit of an emotional wreck, truth be told.

Basically, the mental health organisation I’ve been utilising over the last eighteen months has had its funding pulled by the government; which means I will be losing my support worker in mid-late June. This may not sound like much, but it took me a long time to build a trusting relationship with this person and the thought of losing their support has totally freaked me out.

I have no idea how this is going to impact on my life. I’ve been told they will try to help find me a new support worker via a different organisation, but this is fraught with difficulties (given my lack of psychiatric support and anxiety issues) and may ultimately amount to nothing.

In fact, all I do know at the moment is that I’m not happy about the change and wish it wasn’t happening.

But it is… :(