Doctors Lounge - Psychiatry Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Psychiatric Topics
|ModestGoddess - Thu Nov 15, 2007 2:31 pm||
I've posted on here quite a bit, so I hope it's not getting old, but I find this forum rather helpful. I've had a lot of difficulty coping with my past issues lately, especially as my life has become "good". And I could use some advice about what else I could try, either changes I could make, a therapeutic approach i could try, etc.
A little about my Hx: My mom, I think, has some kind of undiagnosed mental disorder (bipolar or borderline, perhaps) and had a lot of abuse in her childhood. Sometimes she was very fun, affectionate, caring, outgoing...and other times cold, distant, angry, blaming, demanding of perfection. There was no consistency with her. She was very focused on her appearance (always on a fad diet, frequently changing hair color), had a lot of changes in her religion when I was a kid (became very zealous for awhile), and often threatened to leave me and my dad for seemingly no reason-- a couple times did leave for a few days. My dad was very quiet, emotionally detached, usually gave in to her demands to keep the peace. I was molested by my cousin (on my mom's side) 12 yrs older than me when I was 3-6. I didn't give much memory or thought to this until I was about 15, when I finally did tell. While my parents "believed" me, I experienced rejection from my extended family (whom I was very close with.) I don't remember ever NOT being depressed as a child. I had two suicide attempts by pills-- one at 12 (which was ignored and denied by my mom), one at 16 which led me to being hospitalized for a week. I never had a whole lot of friends as a kid/teen, due to depression, low self-esteem, and intense shyness. But then when I was 15 (very shortly after I told my family about the abuse), I got involved with an older guy (19). The relationship slowly become very controlling and emotionally abusive-- He had a need to always be right and no one was allowed to disagree with him, ever (even if it took hours and hours of him screaming and breaking thigns to "change your mind.") Well, I guess you can say that he somewhat brainwashed me-- I learned not to have opinions of my own, never knew what I was feeling because he would argue with my feelings until I "felt' whatever he wanted me to, kept me from hagning out with anyone except for his friends. It also became physically abusive on a few occasions toward the end (we lived together for 2.5 yrs), but the biggest damage was the emotional stuff. Since getting out of that relationship 3.5 yrs ago, I have been involved in some briefer unhealthy relationships: one with a guy that had a girlfriend, one that was really degrading and forced me sexually, one even with a female (despite the fact that I'm not attracted to women) who refused to acknowledge me in public and denied we were even in a relationship (except for alone). And most of my "friendships" since then have been really unequal/unhealthy. Basically, I have always just "taken what I could get" in relationships-- I didn't seek out relationships/friendships with people that I was drawn to but rather with people that seemed to want me. In the past, I've felt a sense of "guilt" if I didn't want to pursue a relationship with someone-- if they liked me, I almost felt it was "wrong" of me to say no, like I didn't have a right to reject them.
Well, I do feel different in a lot of ways now. Despite all of that, I managed to finish college/grad school 2 years early with a 4.0 (I've always been a good student). I moved to a different state to get a "clean start" after graduating. I have a good "career" job. Without even looking to be involved, I met a great guy and have been in my first healthy relationship ever, for over a year. However, in many ways, I feel "worse" than I did before. One of my biggest issues now is that I constantly fear that my relationship is going to end. If he is tired and unable to do something or wants to do something with friends without me, I feel such an intense abandonment that I know is irrational. I'll often start to cry if, for example, he's over at my house and says he needs to leave to run some errands or whatever. Then I'll feel embarassed about my response, and start to cry further. Then, I'll think that, even if he wasn't initially going to leave me, he definitely will now after a response like that. I often fear that each time I see him will be the last time, that he will suddenly just cut off contact with me. I had some of these feelings earlier in the relationship, and I thought they would get better as I got more secure in it, but it only gets worse. I interpret everything as a sign that he "doesn't really love me." He does know about my past and is supportive of me. It's gotten to the point that I've almost contemplated breaking up with him because it hurts so much to not know when it's going to end. I hate being like this, but I don't know how to stop it. I talk to my therapist about it, but she only says things like, "You need a lot of support." Um, yeah, I agree. She's great for talking about past issues only but what about dealing with the present and how the past affects me in the present?
Also, I tend to get consumed by thoughts about the past, and then I get obsessively busy to distract myself. It's not necessarily "flashbacks"-- I just think about all of these things over and over and dwell on them. And then sometimes I'm so afraid to have these thoughts that I cannot relax. I can't just sit there and watch a movie-- I have to also be folding laundry, and checking my email, and cooking something. I can't just have a relaxing day off-- I have to schedule lots of activities so I won't have time to think and have memories-- and then if people aren't available to do what I had planned (or if I do have down time), I tend to cry. I mean, it's good because I get a lot done, but it's bad for my anxiety level-- I get a lot of headaches, muscle tension, sleep problems, etc. Also, it's to the point that other people notice and comment. Also, I tend to be a perfectionist (especially with regard to cleaning, to hobbies like writing or crafts, to work) to the point that it's hard to get things done sometimes-- it's almost like I feel like if only I can be "perfect" enough that it would make up for all of the bad stuff, and if I can't do something perfectly, then I might as well not do it at all (I was a lot more like this when I was younger and have been working on it, but it does still affect me).
Anyway, I've had a lot of different diagnoses: PTSD, depression, general anxiety, social anxiety, OCD. (I'm sure they can't all be correct.) I'm starting to think I might have borderline personality disorder...according to the above, does that sound at all accurate? I am in therapy and group therapy weekly and I take 60mg Cymbalta. What else could I try, not necessarily medication but things I could do, to alleviate some of this, especially the obsession with him leaving me and crying when he can't spend time with me. I don't want to sabotage this relationship. Any help woudl be appreciated!
|Dr. K. Eisele - Mon Nov 19, 2007 12:58 pm||
Superficially anyway, the intense fear of abandonment does sound characteristic of borderline personality disorder. This disorder is very common among those who suffered abuse during childhood--sexual, physical, and emotional--especially sexual abuse.
However, there is so much more to a diagnosis than simply matching up DSM criteria to characteristics/ symptoms. Making an accurate diagnosis truly comes only from interacting with the patient and getting to know that individual. You have posted multiple times and I do some correlation between your symptoms and borderline personality disorder.
You could also very definitely have PTSD--with the abuse you suffered, it would be odd for there not to be some sort of backlash of that nature. OCD is a very specific diagnosis, never one of exclusion. It requires specific obsessions and/or compulsions that the individual knows are irrational. Compulsions serve as a relief of anxiety that the individual feels will somehow "fix" the obsessive thought. Social phobia or social anxiety has to do with doing things in public and the fear of [pubilc humiliation. Generallized anxiety disorder is a disorder of nearly constant or constant anxiety about multiple things over which one has no control and is accompanied by physical symptoms such as yours.
It seems to me, just on the surface, that PTSD, generalized anxiety, and depression on Axis I fit you the best. Borderline personality disorder is an Axis II diagnosis that has to do with the cause of the Axis I diagnoses (the PTSD, generalized anxiety, and depression). Having said all that, I will add that what can look like symptoms of anxiety, when accompanied by depression, may only be depression because depression and anxiety are close cousins.
Why do you have such a fear of rejection/ abandonment? Your fear likely comes from your history of sexual abuse. Sexual abuse is almost always about establishing control rather than about sexual gratification. That the latter is achieved by the perpetrator is a secondary effect. The victim is often left to feel dirty, because in their perception, they are being punished for some sin even though they have no idea what that was. When another's will is imposed upon anyone, but especially a child who cannot possibly understand that type of physical contact, the child's subconscious takes over, because of the incomprehensible horror they feel. This is meant to protect the child's conscious awareness from harm (e.g., mental breakdown). In cases of particularly brutal abuse, the subconscious' takes over so frequently and so intensely, that multiple personalities can develop.
Another effect of the subconscious' protection is that in order to make the situation tolerable, the child loses sense of personal boundaries. The term "boundaries" means that perceived line that separates you from others. Since that line is so blurred, and in some cases, erased, when a romantic interest leaves, even temporarily or to run errands, the patient feels as though a part of them is also leaving, which is a frightening proposition at best, or, as in your case you fear that he may not return because deep down, you suspect that you are "bad." Why else would you have been punished so brutally?--remember, as a child, you had no idea what you were being punished for. This is potentially the reason that you feel so abandoned at those times. People with borderline personality disorder, in a desperate, misguided effort to prevent that abandonment, often do the very things that push the other person away.
Whew! That's really a lot to absorb all at one time. Please feel free to ask questions.
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.