I guess I should have read the second part of the last p-docs report a little more closely. She says it’s not bi-polar, but Persistent Depressive Disorder. I’ve never been manic and the hypomania symptoms I’ve experienced are common with Borderline Personality Disorder, especially as one comes out of a deep depression. So the official diagnoses are as follows: Borderline Personality Disorder, C-PTSD, Persistent Depressive Disorder, and Generalized Anxiety Disorder. What I’m really curious about is how, if I’m not bi-polar, the atypical anti-psychotic is working. I’ve done some research into it, and as best as I can figure, it acts as a mood stabilizer, even in the absence of bi-polar or schizophrenia, as an adjunct to the anti-depressant. Which may or may not work without it. I’ll find out soon enough. My GP has a referral in for me to talk to the p-doc about lowering my medication. I’m on 20 mg of escitalopram (Cipralex), 20 mg of aripiprazole (Abilify), 4 mg of prazosin, and 1mg of clonazepam (Klonopin) as needed. The prazosin and clonazepam I’m fine with. I enjoy my nightmare free sleep. And I only use the clonazepam once in a while. I’ve been using a lot of it for my dentist appointments, but now that I have my partials, I only need to go every four months for cleanings. It’s the aripiprazole that I’m mostly concerned with. It’s a strong dose to be on, especially if I’m not bi-polar. I’ll probably need to be on an anti-depressant for the rest of my life, I can understand that. But if possible, I’d like to minimize the doses. The longer I’m on the aripiprazole, the more likely I am to get Tardive Dyskinesia. I’m already starting to get very slight hand tremors. Not bad enough that my doctor is concerned, but they’re still there. We’ll see, I guess.
I don’t know if things are settling down, or if I’m just getting used to it. It’s like that Simon and Garfunkel song, “Hello Darkness my old friend”. Or Gordon Lightfoot, “Sometimes I think it’s a shame/ When I get feeling better when I’m feeling no pain.” Or maybe I’m just numb to the pain. Either way, I still am fighting the urge to self harm. I had a cigarillo Friday, and another one Monday. As my friend comforted me, “Whatever it takes to get through this.” Three more weeks, if past experience tells me anything. I don’t think I can survive three more weeks. I saw my therapist on Thursday. Got into a disagreement about self harm. Of course, I lost, and have a fresh copy of my safety contract in my bag. My work this week is to update it, since it still has my ex girlfriend as an emergency contact, and we broke up in April.
How to update my safety contract when four out of five of us don’t want to be on it anymore. I remember when she first mentioned it. I ignored her the first time. The second time I said I’d consider it. The third time, I said to her that since she’s mentioned it three times, she must feel it’s important, so we signed one. Did I mention this was all on my first or second visit? She knows it’s a valuable, strong tool. And I’ve proven to her again and again that it works. Many times it’s the only thing that has kept me from self harming. This week, if I had the means in my room to do it, the contract wouldn’t have mattered. But the only thing I have in my room is an art x-acto knife, and they aren’t really very good at deep, clean lines. I have disposable razors in the bathroom, but the act of pulling it apart gives me too many opportunities to really think through what I’m doing and stop it. Or deliberately chose to go through with it at each step of the way. It’s different when you’re desperately searching for something and you find something you missed in your last sweep. But no such luck. I purged very carefully last time.
So I sit in my bed, my safe zone, and try to keep my hands loose, so the nails don’t dig into my palms, which seems to be the thing I do these days. Ugh. My mind and body conspire against my brain.
It’s been a difficult couple of days. Completely lost it with my therapist yesterday. I had such an overwhelming somatic flashback that I couldn’t speak. For at least 30 minutes, if not longer. I know this is approximate, as my appointment was supposed to finish at 2:00 and I didn’t get out of there until 2:40. It was as though my young self hijacked my being and was so lost she couldn’t speak. Couldn’t articulate how lost and hurt and sad she was. I’m still struggling with my words over 24 hours later. And with connection. I feel completely detached from everything and everyone. I do feel some relief that the kids are at their dad’s this week, so I don’t have to fake feeling anything but numb.
This disconnect is disconcerting. Touch is nigh impossible to feel. And when I do feel it, it feels weird. As though there’s a barrier between my skin and the rest of the world. My homework this week is to stay present and connected: when I hug a friend, let myself feel the hug. To stop living from the neck up, as my therapist says. Easier said than done, my friend. Easier said than done.
My Feldenkrais practitioner, Fariya, taught me to gently rub my fingers in a corkscrew motion. This helps in grounding. Fingers are very ennervated, so they are very sensitive. But it feels… odd… to me. Touching myself in any way is foreign. I am an alien nation unto myself. Vera, my therapist, aims to change that. So much to work on, she says. Even after the trauma stuff is sorted out, there’s my borderline eating disorder, my gender/body issues, my self-hatred. As we work on the trauma, the other pieces will slowly fall into place, but I believe they are going to need to be addressed individually, once stability has been achieved. If. No, when. Positive thinking is a must. It’s so hard to, today. Today, I even went out and bought a pack of smokes. Something I haven’t done since Christmas.
Today feels like a day to stay in bed and wish for death to come upon me. Instead, I am out at my friend’s cafe, eating poutine. Reaching out. Keeping safe where I am loved. Not isolating. Which is all I want to do. Vera would be proud.
The past couple of days have been really really tough. Stuck between hyper and hypo arousal constantly shifting back and forth. Moments where I’m overwhelmed by fear and can’t breathe, and then moments where the slightest sound makes me jump. Even though my mind finds no connection between the here and now and this feeling of doom, I have a full blown fear reody response. My therapist did get back to me today, (YAY!) and she said it sounds like I’m having somatic flashbacks. I should have recognized this right away. What is a somatic flashback? It’s your body remembering, not your brain. “Memory is reminding you about the state of your being all those years in childhood and adolescence when you were in danger” is how my therapist worded it in her email to me today. I lived in fear growing up. Beatings from my father were a daily, consistent thing with him. The only thing that was. And I had a real rough session this week. Last week brought up a lot of history, how no one noticed the sad little me acting out and begging for attention. And this week brought more of that to the fore. And just like I did in adolescence, I’m living a double life of sorts here at home again. My parents don’t know about my cousin molesting me. They don’t know about the abusive relationship I was in at 15. They don’t know about my sexual assault three years ago. They don’t know I’m living with PTSD and Borderline Personality Disorder. They think my therapy is for my anxiety. I have to keep so much hidden, while living in the house where I grew up abused. They say you can’t heal in the environment that broke you, but I am. Granted, things are different now. I’m a grown woman with a voice. My body and being are different. It’s now 2019 and I am no longer in danger from anyone.
So I orient to the here and now. I’m in my room, the room I grew up in, focusing on what’s different. My bookcases, the books in those cases. My bed. The decorations on the wall. The flooring. The sheets on my bed. All things that are from the present. Nothing in my room remains from the past except my bear, Bettina, who has been with me since I was six months old. She has been the one constant in my life. I have been struggling with the desire to self harm this weekend. That, too, was a constant in my life for many years. It had its purpose then. But things are different now. I need to remember this with the very core of my being. All my emotional parts need to recognize that we are no longer trapped in trauma time. I have so many new coping tools and a great support network. Parts of me may be trapped in the past, but I have the strength, courage and determination to show them a better future.
I’ve been thinking about diagnoses and what they mean to the one receiving them. Usually they come with a sense of relief: I’m not crazy. These symptoms do mean something. But what happens when the diagnosis means you are crazy? What does that mean? I’ve been fighting the BPD diagnosis for years. Never had a therapist agree with it, though I’ve received the diagnosis from more than one psychiatrist. Recently there has been a movement in the trauma treatment community to change it to Complex Post Traumatic Stress Disorder. My current therapist, who is a gift sent from wherever such things come from, explained it to me in a way that made me feel a lot better. It’s not that I’m not fixable, which is the prevailing feeling among most old school practitioners; it’s just that my brain needs a different way of fixing it. I’ll never be neuro-typical. But I can learn to adapt and rearrange the way I process information.
Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape. (wikipedia) The resulting symptoms closely mirror that of BPD. The key difference between BPD and C-PTSD is that symptoms of BPD stem from an inconsistent self-concept and C-PTSD symptoms are provoked by external triggers. The inconsistent self-concept happens as a direct result of the early childhood trauma or ongoing trauma with no escape. Combine the two, you end up with a very fractured sense of self. Typical therapies for BPD used are DBT (Dialectic Behaviour Therapy) and CBT (Cognitive Behavioural Therapy), neither of which address the underlying trauma.
I grew up always afraid of my father. I don’t remember a time when I wasn’t. That’s how early the abuse started. He was never physically violent to my mother, but he was very much emotionally and verbally abusive. In typical abuser fashion, he never started until after they were married and she was “trapped” with a baby. My therapist explained to me that babies can pick up what’s going on around them, so if my mother was anxious, sad, or afraid, I would’ve understood something was wrong. When asked why she stayed, she recently told me she couldn’t admit to her mother that her mother was right. So her pride ruined my life. Well, my life up to this point. I’m taking charge of it now, and learning to say no to the shit I don’t have to put up with.
Add to the mix a cousin who taught me things no six year old should ever be aware of, a very abusive relationship at a young age with a much older man, and a more recent sexual assault, is it any wonder that my sense of self is fractured? I’m now learning that I matter, that what I want and feel are valid. Novel concepts to be learning at 45. I wish I had the confidence of my young sons. They know they’re important, they understand body autonomy, and while they may not yet know what it is, they live their lives with a purpose.
I long for the day when I can live beyond the day to day, minute to minute, second to second it takes to survive sometimes. But everyday I’m getting stronger. A solid therapist with strong boundaries is key. I’m very fortunate to have found one. She holds the space while I try to feel whatever emotions are coming up. She holds it without judgement and without forcing it. Which is what someone who has suffered much trauma needs. I am doing EMDR, (Eye Movement Desensitization and Reprocessing) along with a combination of other modalities. I take a mood stabilizer to boost the effect of my anti-depressant, and I take an alpha blocker, which helps prevent the nightmares. Being taught coping mechanisms (Babette Rothschilde is an amazing source for this), I can even manage my panic attacks and flashbacks. I’m in a stable relationship, I’m a pretty decent parent, and a damn good friend. None of which should be possible if I was truly only suffering from BPD.
So what does the diagnosis mean to the one receiving it? In my case, nothing at all. It bothered me at first, and if I had received it years ago, before I started working with my current therapist, it might have destroyed me; taking away any hope of ever getting better. Now, it’s a label that might help my disability claim, but that’s all it is. It doesn’t define who I am as a person. It changes nothing. My trauma work is the most important thing I can do for myself, and in doing it, I will free myself from the bindings of a difficult diagnosis with a less than helpful prognosis.
Last year my doctor sent me to see a psychiatrist for an assessment and med adjustment. He’s generally a decent general practitioner, but we’ve been struggling for years to get me stable. I have a history of needed to take three months or so off of whatever job I’m doing because of stress. My previous therapist thought I might have a type of bipolar. No one was sure, so off for an assessment I go. PTSD, depression, anxiety, borderline personality disorder, and cyclothymia. Which I didn’t understand. I get depressed enough that I’m suicidal, and I’ve made an attempt in the past. That being said, a mood stabilizer in conjunction with my anti-depressant has made all the difference. That, and I’m now working with a trauma specialist. Doing EMDR. This year, I went for another assessment. A different psychiatrist this time, who read the notes of the previous one. Saw me three times, instead of just forty minutes. No bipolar diagnosis this time. PTSD, persistent depressive disorder, borderline personality disorder, and general anxiety. Says my symptoms of BPD overlap a lot with the BP, and that the meds often work in tandem together when the antidepressant isn’t enough even without the presence of bipolar. We talked about the BPD diagnosis, and the main reason for the diagnosis is history: self injury, suicide attempts, and, most telling, the feelings of self-loathing and feeling empty and numb. She said with the amount of trauma I’ve experienced, it was inevitable that I would wind up with BPD. So now I’m struggling with yet another identity, one that I have avoided for years. I remember my ex yelling at me, at one point, “I’m not the only borderline here”, yet I was the only one actively seeking help. My therapist told me not to worry about the diagnosis. It basically means I have C-PTSD, (Complex Post Traumatic Syndrome Disorder) and I’m doing the hard work to get better. So that’s something at least. It explains these long, empty nights where I feel so numb and the siren call of self-injury is so strong, even though I’m not feeling depressed. Just numb.