I woke up at 5am this morning. It was one of those awakenings that just happens, suddenly and intrusively. I decided to read. I was reading a book about experiences with depression. Reading is stressful. I feel the need to read over most sentences more than once, and still I find they don't sink in. It's incredibly frustrating. But still, I read, for the distraction. After giving up on reading for the moment, I pondered my own experience with depression. I thought about times when I was doing well, and times when I was depressed but somehow managing it (i.e. for whatever reason, the depression was bearable). During these times I wasn't wandering around with nothing to do but feel the unbearable pain of being. I wasn't excruciatingly bored, wishing for a distraction to come along. I felt no deficit in my social life. I was quite content to watch tv. I was able to relax and be distracted.
Now, as my depression waxes and wanes, I experience persistent emptiness, boredom and loneliness. I am stuck in one hell of a rut, and it must be deep because I can't get out. I long for the time I had a vibrant social life. I have to ask: what happened there? Some friends moved away, some acquaintances I lost interest in. Plus, I no longer live in sharehouses, which involve near constant social interaction. What's left is four friends in Newcastle, none of whom initiate contact with me. One has a baby, two work full time, and the other has her own mental health problems and is a relatively new friend. Apart from the fact that I resent always having to be the one to organise get-togethers, it's hard to make the effort to do so when I'm depressed.
It's hard to admit to loneliness. It's even harder to tell someone about it. It seems so pathetic. I've asked myself if it's reasonable to feel lonely. After all, I have four friends, some new acquaintances, my boyfriend, and my boyfriend's family. My own family isn't that far away. But, maybe the problem is the lack of connection I feel with all these people. I just can't be that outgoing, talkative person I once was. For the first time in a long while, I feel shy and awkward. I'm at a loss for words most of the time. I feel blank, with nothing to say and unsure of how to actually have a conversation.
This strange inability to function socially reduces my motivation to even initiate social contact anymore. I just kind of gave up, gradually. And now I don't have much left in my life at all.
I've tried to think of what exactly has changed. I'm not trying to figure out why I'm depressed at this point, because according to my diagnosis it's biological. I'm trying to figure out why the quality of my depression has changed. Life was once bearable, and now it's a struggle to get through each day. I blame it on being in Newcastle, being unemployed, not knowing what I really want to do with my life, living in a crappy house, and having no social life. It's hard to see that a lot of the way I think and feel about these things is directly caused by the depression. It's my mind playing tricks on me. It makes everything seem uninteresting, meaningless and unenjoyable. It makes it feel impossible to change the things in my life which I attribute my depression to. Motivation is low, because I can't imagine getting any pleasure out of things.
I can blame depression on any of these things, but the fact is that I've been depressed in many different situations. Employed or unemployed, in Newcastle or Sydney, sure of what I want to study or not, nice house or crappy house, lots of social contact or none. Change might not make the depression go away, but it could make it more bearable.
Thursday, July 8, 2010
Tuesday, May 18, 2010
splitting
Yes, okay, I have to admit to it. Now that I think about it, how could I possible deny it? It's been a strange problem in every relationship I've had. It's not just normal uncertainty about the relationship, I do seem to go between two extremes. This person is amazing, this person is terrible. I may not end up hating people, but I do end up feeling like they are against me. Sometimes I know how irrational this is. I also think that people must also love me or hate me. There's no in between.
Chaotic relationships... my first long term relationship involved dealing with his neuroticism, but then there was mine. The abandonment thing was a big problem. I couldn't deal with him going away. I interpreted everything so irrationally. I don't even want to go into it.
Don't get me started on my high school boyfriend. I was simply a psycho bitch. I went from thinking he was the best to thinking he was crap and wanting to break it off. All I really wanted was to have someone, but I drove him away. I would always start arguments, and I don't really know why. I accused him of so much crap. So he dumped me, and I was absolutely devastated. He wasn't my type, and there really wasn't really any attraction, I just wanted a boyfriend.
Chaotic relationships... my first long term relationship involved dealing with his neuroticism, but then there was mine. The abandonment thing was a big problem. I couldn't deal with him going away. I interpreted everything so irrationally. I don't even want to go into it.
Don't get me started on my high school boyfriend. I was simply a psycho bitch. I went from thinking he was the best to thinking he was crap and wanting to break it off. All I really wanted was to have someone, but I drove him away. I would always start arguments, and I don't really know why. I accused him of so much crap. So he dumped me, and I was absolutely devastated. He wasn't my type, and there really wasn't really any attraction, I just wanted a boyfriend.
down
My mood dropped after seeing the psychiatrist today. Probably because there was nothing to feel apprehensive about.
I'm at home alone and it's night, but I'm doing okay. I don't know why I can't usually handle this situation. When I was younger if I was feeling alone I would have to have the tv or radio on to feel connected to the outside world. I used to fall asleep with the radio on.
These days, sometimes I'll find myself at home alone at night with no plans, so I'll get into a frenzy of trying to find someone to hang out with. It just comes from a fear of being alone. Sometimes I can handle it, though.
I'm at home alone and it's night, but I'm doing okay. I don't know why I can't usually handle this situation. When I was younger if I was feeling alone I would have to have the tv or radio on to feel connected to the outside world. I used to fall asleep with the radio on.
These days, sometimes I'll find myself at home alone at night with no plans, so I'll get into a frenzy of trying to find someone to hang out with. It just comes from a fear of being alone. Sometimes I can handle it, though.
cigarettes
I've been smoking a lot. I feel elevated, and agitated. I've started tracking my moods on moodtracker.com and posting on the forum there. It's good to just talk to people I don't know. It's liberating. I finally feel like I have some support!
There is just a hint of anxiety as well. It's hard to separate it from the agitation. I feel like I can crap on and sometimes can't stop myself from saying something. I have the urge to just write, or do something. I'm waiting for my psychiatrist appointment. I'm sitting outside in the cold at uni, just waiting until I can catch that bus. I don't feel like I could focus on my assignment, but I do feel motivated to work on it.
This sort of writing is so disjointed, but it helps. Any writing helps. I usually can't write this much. I'm getting psychomotor agitation. It's different from the inner agitation, but it can go along with it. I'm feeling both. I don't know what to do with myself. I thought all this would end when I was off the medication. It hasn't. I guess I gelt this way before abilify, too. And I wasn't on much else then. I was almost weaned off effexor. I don't know what started all this. I thought it was the effexor making me agitated, and it stopped for a while when I managed to lower the dose. But then it started again, and it got worse on abilify. Maybe it was a bit better on risperidone, but I didn't take it for long enough to know. Now I'm just back to how I was before abilify. I can't read for extended periods. I used to be able to. I can read, but it's multiple things at a time. It's hard to focus on reading articles for my assignments.
I hope I don't get depressed again any time soon. I might like to be free from agitation, but depression is just so dull. Not normal dull, depressingly dull. It's like a heaviness in the air. It's like having sensory deprivation, or hearing the same tone constantly.
There is just a hint of anxiety as well. It's hard to separate it from the agitation. I feel like I can crap on and sometimes can't stop myself from saying something. I have the urge to just write, or do something. I'm waiting for my psychiatrist appointment. I'm sitting outside in the cold at uni, just waiting until I can catch that bus. I don't feel like I could focus on my assignment, but I do feel motivated to work on it.
This sort of writing is so disjointed, but it helps. Any writing helps. I usually can't write this much. I'm getting psychomotor agitation. It's different from the inner agitation, but it can go along with it. I'm feeling both. I don't know what to do with myself. I thought all this would end when I was off the medication. It hasn't. I guess I gelt this way before abilify, too. And I wasn't on much else then. I was almost weaned off effexor. I don't know what started all this. I thought it was the effexor making me agitated, and it stopped for a while when I managed to lower the dose. But then it started again, and it got worse on abilify. Maybe it was a bit better on risperidone, but I didn't take it for long enough to know. Now I'm just back to how I was before abilify. I can't read for extended periods. I used to be able to. I can read, but it's multiple things at a time. It's hard to focus on reading articles for my assignments.
I hope I don't get depressed again any time soon. I might like to be free from agitation, but depression is just so dull. Not normal dull, depressingly dull. It's like a heaviness in the air. It's like having sensory deprivation, or hearing the same tone constantly.
Saturday, May 15, 2010
euphoria
I know the feeling of euphoria well. It can be a tingling and a buzzing that spreads throughout the body. It can be a feeling rising in my chest, like anxiety, only good. It's a dizzying high. I have felt euphoria without the aid of drugs. Falling in love, listening to music, exercising, socialising, dancing, drinking, seeing a band, seeing something pretty, or just catching the bus on a good day. All of these things have given me euphoria. I'm always chasing this high. None of these things really do it for me when I'm not in this happy state. But when they do, they do it good. Just fantasising about it is amazing, when I'm happy enough to be able to imagine it. It makes me want to run everywhere. It makes me want more of it. It makes me want to be around people, and it makes me feel charismatic.
I think this is how my obsessions with people came about. I would be attracted to someone, and just get such a high from being around or thinking about the person. It was the highest of highs, and so addictive.
I think this is how my obsessions with people came about. I would be attracted to someone, and just get such a high from being around or thinking about the person. It was the highest of highs, and so addictive.
ICD borderline criteria
If I were to go by the ICD, there's no way I could be borderline! For starters, I would need 3 of:
1. marked tendency to act unexpectedly and without consideration of the consequences;
2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
4. difficulty in maintaining any course of action that offers no immediate reward;
5. unstable and capricious mood.
AND 2 of:
1. disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);
2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
3. excessive efforts to avoid abandonment;
4. recurrent threats or acts of self-harm;
5. chronic feelings of emptiness.
AND these would have to be chronic, pervasive and present across all situations.
The only of the first section that I could possibly have are unstable mood and tendency to act without consideration of the consequences. Definitely not the others. And I do consider consequences, I just decide that I don't care at the time. I'm obviously capable of maintaining a course of action that has no immediate reward. I just also tend to really enjoy things that give an immediate reward.
1. marked tendency to act unexpectedly and without consideration of the consequences;
2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
4. difficulty in maintaining any course of action that offers no immediate reward;
5. unstable and capricious mood.
AND 2 of:
1. disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);
2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
3. excessive efforts to avoid abandonment;
4. recurrent threats or acts of self-harm;
5. chronic feelings of emptiness.
AND these would have to be chronic, pervasive and present across all situations.
The only of the first section that I could possibly have are unstable mood and tendency to act without consideration of the consequences. Definitely not the others. And I do consider consequences, I just decide that I don't care at the time. I'm obviously capable of maintaining a course of action that has no immediate reward. I just also tend to really enjoy things that give an immediate reward.
DSM stuff
So according to the DSM, having a personality disorder means that you do not feel or behave the way you're supposed to ("as expected") in your culture. I guess it's just another way of saying that you deviate from "normal" in some ways, which is necessary for any psychiatric diagnosis. I don't know why it's emphasised for personality disorders. It's as if they're still thinking of these disorders as being a manifestation of moral weakness. But, they're only called "personality" disorders, I assume, because they are "pervasive and inflexible", have an "onset in adolescence or early adulthood", and are "stable over time". This means that the symptoms are always there, and they have been since a young age, and they are there in many different situations. Personality is supposedly like this, although you would call them traits, not symptoms. Also, a personality disorder must involve "distress or impairment", which is what makes it a disorder.
I went to borders to check out some books, and I found one called borderline personality disorder: a therapist's guide to taking control, by freeman and fusco. For every DSM criterion there were vignettes to demonstrate it and a series of questions to ask to see how much the patient has problems with that criterion. I found that the only ones I scored high on were impulsivity, suicidal thoughts and emptiness (the first mainly applies when I feel stimulated, the last two only apply when I'm depressed). I didn't even score that high on self harm or emotional instability. I have a little bit of all of the criteria, but not enough, I don't think. I have at times frantically tried to avoid abandonment, but this doesn't happen in every relationship and I think that I exhibit a pretty mild form of "frantic" compared to the vignettes. In my first ever relationship in high school I probably acted exactly like someone with BPD. I may still be a little bit like this. It doesn't mean I have BPD.
I don't idealise people as much as just become obsessed/fall in love easily. I certainly don't devalue anyone afterwards.
I don't have the identity disturbance that was described in the book. I definitely have a normal amount of identity disturbance for a young person.
I could relate to some of the questions about anger, but they only applied to when I'm feeling agitated.
I'm not that emotionally unstable since I can go through long periods of stability, and I usually have a general mood which lasts more than a few days.
I've experienced dissociation and I'm sometimes paranoid. I'm not paranoid about being abandoned as much as being judged, though. And mostly I've experienced dissociation randomly, not during stress. I think it's pretty normal to have experienced some sort of dissociation. It's not a problem for me, I don't lose time or space out. I think the paranoia is related to social anxiety, or maybe the agitation.
So the criteria I actually fulfill are impulsivity and irritability when agitated or stimulated, and emptiness and suicidal thoughts when depressed. I may experience some dissociation and some paranoia when I'm agitated. I do fear abandonment, but this only comes out when I'm depressed. My relationships improve as I get older. None of the criteria that I fulfill are constant for me. They are not stable over time. They're not pervasive and inflexible. The identity disturbance and abandonment fears have improved over time, like you would expect. I don't see any way that a personality disorder could explain my symptoms.
On the other hand, I looked at a book about understanding the DSM. The section on bipolar was interesting. Mania was described more clearly: elevated mood interrupted by irritable outbursts, increase in goal-directed activity which can appear like unrelievable restlessness (exactly what I experience), thoughts & mental activity speed up (for me, reading and writing fast), high level of verbal output (in speech OR writing), loosening of inhibitions, foolish ventures e.g. business decisions, spending, sex.
Instructions were given to confirm presence of mania or hypomania by looking for changes in: sleeping and eating patterns, energy levels, restlessness, increased activities especially risky or destructive ones, problems concentrating, easily distracted, instances of extreme feelings of happiness, laughing inappropriately (usually accompanied by agitation), increased talking, pressured talking, racing thoughts - unable to keep up with the influx, impaired judgment, grandiose ideas, inflated self esteem, increased irritability or impatience, easily excitable, lack of interest in personal relationships, hallucinations, incoherent speech, violence, disorientation. Also important is a history of alcohol and drug use, medical conditions and medications.
Hypomania was described as increase in energy or irritability, decreased need for sleep, increase in activities (including spending), increase in pressured verbalisation, and the tendency to become quite creative.
Cyclothymia was described as having milder mood episodes but being chronic, lasting at least 2 years with no symptom-free periods lasting more than 2 months.
BP-II patients have a strong family history of bipolar OR depression.
The book also had an interesting case study of a bipolar woman. She had a complicated history of social and behavioural problems. Her mania manifested as delusions, compulsions, being argumentative, paranoia, dissociation, anxiety and obsessions. Her symptoms started at age 16 but she wasn't diagnosed properly until she was 34 (she was diagnosed with depression at age 30). She has tried over 15 meds, none of which stabilised her. She apparently had depression, low self esteem and attachment issues since childhood. She has a history of childhood abuse and parental abandonment. She has been married 3 times and had multiple abortions. She has violent mood swings and deep depressions, which she always thought was caused by PMS. She self medicated with marijuana every day from age 16 tp 36. She has always felt inferior and continues to. She has casual sex and has had numerous troublesome relationships. She idealises men and feels rejected when relationships end. She has no social or recreational interests. She excelled in school when she applied herself but always had trouble with concentration, attentiveness and social skills. She is generally suspiscious of people. She dropped out of school, and later attempted further study, but couldn't complete the degree. She has had many types of jobs, and self doubt and social fears stop her from following through on career decisions. Compulsive shopping binges lead to financial trouble. She has had chronic insomnia problems, increased appetite and weight gain. At the time of the assessment she reported depressed mood but she seemed talkative and her speech was pressured and non-goal-directed. She has had inappropriate judgement in the past and reports poor concentration, although she was alert during the interview.
It's interesting that no one ever tried to give her a borderline diagnosis! According to this book for a proper diagnosis of bipolar you need to identify mood episodes and then see if they meet the criteria AND see if they affect many areas of functioning. Current and past behaviours must be considered.
I went to borders to check out some books, and I found one called borderline personality disorder: a therapist's guide to taking control, by freeman and fusco. For every DSM criterion there were vignettes to demonstrate it and a series of questions to ask to see how much the patient has problems with that criterion. I found that the only ones I scored high on were impulsivity, suicidal thoughts and emptiness (the first mainly applies when I feel stimulated, the last two only apply when I'm depressed). I didn't even score that high on self harm or emotional instability. I have a little bit of all of the criteria, but not enough, I don't think. I have at times frantically tried to avoid abandonment, but this doesn't happen in every relationship and I think that I exhibit a pretty mild form of "frantic" compared to the vignettes. In my first ever relationship in high school I probably acted exactly like someone with BPD. I may still be a little bit like this. It doesn't mean I have BPD.
I don't idealise people as much as just become obsessed/fall in love easily. I certainly don't devalue anyone afterwards.
I don't have the identity disturbance that was described in the book. I definitely have a normal amount of identity disturbance for a young person.
I could relate to some of the questions about anger, but they only applied to when I'm feeling agitated.
I'm not that emotionally unstable since I can go through long periods of stability, and I usually have a general mood which lasts more than a few days.
I've experienced dissociation and I'm sometimes paranoid. I'm not paranoid about being abandoned as much as being judged, though. And mostly I've experienced dissociation randomly, not during stress. I think it's pretty normal to have experienced some sort of dissociation. It's not a problem for me, I don't lose time or space out. I think the paranoia is related to social anxiety, or maybe the agitation.
So the criteria I actually fulfill are impulsivity and irritability when agitated or stimulated, and emptiness and suicidal thoughts when depressed. I may experience some dissociation and some paranoia when I'm agitated. I do fear abandonment, but this only comes out when I'm depressed. My relationships improve as I get older. None of the criteria that I fulfill are constant for me. They are not stable over time. They're not pervasive and inflexible. The identity disturbance and abandonment fears have improved over time, like you would expect. I don't see any way that a personality disorder could explain my symptoms.
On the other hand, I looked at a book about understanding the DSM. The section on bipolar was interesting. Mania was described more clearly: elevated mood interrupted by irritable outbursts, increase in goal-directed activity which can appear like unrelievable restlessness (exactly what I experience), thoughts & mental activity speed up (for me, reading and writing fast), high level of verbal output (in speech OR writing), loosening of inhibitions, foolish ventures e.g. business decisions, spending, sex.
Instructions were given to confirm presence of mania or hypomania by looking for changes in: sleeping and eating patterns, energy levels, restlessness, increased activities especially risky or destructive ones, problems concentrating, easily distracted, instances of extreme feelings of happiness, laughing inappropriately (usually accompanied by agitation), increased talking, pressured talking, racing thoughts - unable to keep up with the influx, impaired judgment, grandiose ideas, inflated self esteem, increased irritability or impatience, easily excitable, lack of interest in personal relationships, hallucinations, incoherent speech, violence, disorientation. Also important is a history of alcohol and drug use, medical conditions and medications.
Hypomania was described as increase in energy or irritability, decreased need for sleep, increase in activities (including spending), increase in pressured verbalisation, and the tendency to become quite creative.
Cyclothymia was described as having milder mood episodes but being chronic, lasting at least 2 years with no symptom-free periods lasting more than 2 months.
BP-II patients have a strong family history of bipolar OR depression.
The book also had an interesting case study of a bipolar woman. She had a complicated history of social and behavioural problems. Her mania manifested as delusions, compulsions, being argumentative, paranoia, dissociation, anxiety and obsessions. Her symptoms started at age 16 but she wasn't diagnosed properly until she was 34 (she was diagnosed with depression at age 30). She has tried over 15 meds, none of which stabilised her. She apparently had depression, low self esteem and attachment issues since childhood. She has a history of childhood abuse and parental abandonment. She has been married 3 times and had multiple abortions. She has violent mood swings and deep depressions, which she always thought was caused by PMS. She self medicated with marijuana every day from age 16 tp 36. She has always felt inferior and continues to. She has casual sex and has had numerous troublesome relationships. She idealises men and feels rejected when relationships end. She has no social or recreational interests. She excelled in school when she applied herself but always had trouble with concentration, attentiveness and social skills. She is generally suspiscious of people. She dropped out of school, and later attempted further study, but couldn't complete the degree. She has had many types of jobs, and self doubt and social fears stop her from following through on career decisions. Compulsive shopping binges lead to financial trouble. She has had chronic insomnia problems, increased appetite and weight gain. At the time of the assessment she reported depressed mood but she seemed talkative and her speech was pressured and non-goal-directed. She has had inappropriate judgement in the past and reports poor concentration, although she was alert during the interview.
It's interesting that no one ever tried to give her a borderline diagnosis! According to this book for a proper diagnosis of bipolar you need to identify mood episodes and then see if they meet the criteria AND see if they affect many areas of functioning. Current and past behaviours must be considered.
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