Paging LCSWs, LPCs, PsyDs, Psychiatrists, and other brain scramblers to the white courtesy phone

I had an exciting step in my growth.  (long story short, had a break up with Baltimore Girl in March and I can't get over it)  After a few months with my Therapist (a very bland and clinical example of an LCSW), he suspects Borderline Personality Disorder.  I know in my own studies toward LPC that psychological diagnoses are nebulous at best, and based on a complicated set of perceptions.  It's not like you can test my brain for how the synapses fire.  At any rate, many of the symptoms fit.

My therapist's basic notion is to listen and offer CBT-based advice, but he's not a very active or engaged man.  I think I will switch therapists but this is my third therapist in 5 months.  He suggested anti-depressants (which I might do, but the 6 or so different ones I've tried in the past had more side effects than effectiveness) and at least group therapy, maybe intensive outpatient.  Given the severity of my panic and pain over this, I'm thinking intensive outpatient might be the way to go but would like to hear your opinions.

Are there any of you with any specific knowledge on BPD and could maybe offer some advice?  How do I go about finding a good outpatient program?  What are they like?  What can I expect?  I feel like I need good one-one-one intensive help.

I looked at the list of potential things that are thought to cause BPD and not many apply, other than a vague association with genetic predisposition.  But "momma's boy" wasn't one of them.  Abandonment was absolutely never a concern in my house, at least not in any clinical way I could imagine.  Mom was a stay-at-home mom until my sister and I went to school, and then she was a substitute teacher in the same school.  Both mom and dad were very engaged in my childhood.  Dad and I are very close and we fish and hunt together.  We always did fun family trips and still do.  But I recall having these fears of abandonment as far back as age 8 or 9.  One  thing I will mention; mom was a "fixer."  I never had to really deal with any negative emotions because she always fixed them for me.  I grew up like Beaver Cleaver.  Sadness wasn't really processed in my house.

From NIMH, the indicators:

• Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned  This describes me, except the cutting off communication.  I hold on forever.  I haven't spoken with Baltimore girl in about three months... primarily at the urging of all of my therapists as they feel my need for connection is an addiction, but I want nothing more than to connect with her to find closure.
• A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)  This describes me some.  Intense and unstable relationships, and the idealization, but not the anger and devaluation.  I place such high value on connection that I fail to see their shortcomings.
• Distorted and unstable self-image or sense of self  YESSSS.  I'm a great guy but always felt like such a pile of E36 M3
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. Please note: If these behaviors occur primarily during a period of elevated mood or energy, they may be signs of a mood disorder—not borderline personality disorder  Not really applicable except I do tend to drink alcohol a bit more than is healthy.  It shuts my brain off so I can sleep without spiraling into stories of terrible fear.
• Self-harming behavior, such as cutting  Not me, unless you count smoking
• Recurring thoughts of suicidal behaviors or threats In the past, yes.  I had checked myself into an inpatient hospital for suicidal thoughts after my divorce in 2013.
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days  This describes me, but I mostly go from "not very good" to "holy E36 M3 the world is collapsing."
• Chronic feelings of emptiness  Very much me
• Inappropriate, intense anger or problems controlling anger  Very much NOT me.  I never express much anger.  That might cause a connection to become severed which I wouldn't like.
• Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions  Hmmm... possibly.  I don't have difficulty trusting necessarily, but irrational fear of others intentions, sometimes.
• Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality  Not applicable, at least not that I notice.

* important note:  I'm not looking for therapy or advice on healing, I'm looking for advice on what I should do to heal; what treatment should I seek and how do I find it? I included my responses to the indicators so that maybe one of you shrinks can advise me on treatment.  I realize that this is all stuff my therapist should be doing, but he just got me to the right street instead of dropping me off at the door.  If I can bridge this last gap and get to the treatment part I can start that and find another therapist.

Commenting on antidepressants: My wife has had different reactions with them when the brand changed, going from brand name to generic. That shouldn't be possible, but it is, and doing a search has proved it not to be just her (although it could be a placebo-ish result). YMMV, but she went through about 7 different antidepressents/combos of them before she found one that worked.

Years ago (2008 according to my receipts) I settled on Lexapro and it actually did OK for my mood, but the side effects were insane.  When the doctor finally took me off of it, it was a month of weird altered states during withdrawal.  Not too keen on getting back on that.

following to see if this eventually leads to DBT.  Cognitive is the better-known path, but as Molly Hatched said in Flirtin' With Disaster, "it aint for everybody."

ITT, many acronyms of which I do not know the meaning.

dudebro. You're a good dude who is largely a happy guy. You're relatively successful, and think through problems. I don't see you as being very irrational or impulsive. I don't think you're a danger to yourself or others. 

You're recently out of a long marriage, on relatively good terms. 

How many relationships and/or dates have you been in/on since the divorce? There is definitely going to be self-loathing and images issues after a divorce, especially as a 40-something (I'm guessing here) in the dating game. I'm going to go out on a limb and say that you're at least 10 years older than me and I'd hate being in the market at my age. 

I'd be very hesitant to do anything too drastic, antidepressants being one of them.  

I recently met with a new nurse practitioner as an alternative to a normal doctor for a yearly checkup. She had some good advice, but one thing that bugged me a bit is that I've long been a casual "as needed" user of stimulants to help with ADD. Like, I can make a low-dose  30 count prescription of Concerta last a year. Although I was frustrated that she wouldn't just prescribe me what I asked (because that had always worked in the past), she did have good reason: I've got a good marriage, a good job, a nice house, no drinking problems, no spending problems (at least compared to compulsive gamblers and what not) and in her words "why do you need to take one of the most overprescribed medications on the market, considering how good your life is?" 

Taking my experience into consideration, I think you should meet with a few meet with a professionals before messing with meds. 

I found that moderate drinking and sport berkeleying the available talent in my area helped me get over my break ups.

Bury Baltimore girl under a few casual experiences and see if you don’t feel better.

pheller said:

dudebro. You're a good dude who is largely a happy guy. You're relatively successful, and think through problems. I don't see you as being very irrational or impulsive. I don't think you're a danger to yourself or others. 

You're recently out of a long marriage, on relatively good terms. 

How many relationships and/or dates have you been in/on since the divorce? There is definitely going to be self-loathing and images issues after a divorce, especially as a 40-something (I'm guessing here) in the dating game. I'm going to go out on a limb and say that you're at least 10 years older than me and I'd hate being in the market at my age. 

I'd be very hesitant to do anything too drastic, antidepressants being one of them.  

I recently met with a new nurse practitioner as an alternative to a normal doctor for a yearly checkup. She had some good advice, but one thing that bugged me a bit is that I've long been a casual "as needed" user of stimulants to help with ADD. Like, I can make a low-dose  30 count prescription of Concerta last a year. Although I was frustrated that she wouldn't just prescribe me what I asked (because that had always worked in the past), she did have good reason: I've got a good marriage, a good job, a nice house, no drinking problems, no spending problems (at least compared to compulsive gamblers and what not) and in her words "why do you need to take one of the most overprescribed medications on the market, considering how good your life is?" 

Taking my experience into consideration, I think you should meet with a few meet with a professionals before messing with meds. 

 

 

 

Since divorce in 2013, I went on two first dates, both of which were comically not good matches for me, then Dec '16 - Mar '18 I had a very deep, meaningful, exclusive relationship with Baltimore Girl (she's not from baltimore, I just call her that because it was where we went on our first date).  It has now been 4 months since the split and I am in 24/7 panic mode worried who she's sleeping with and why it isn't me, having visions of terrible things happening to her and her son, reaching out to her friends to try and get information, and generally a non-functional human.  I find myself much of the time pacing and crying. I had to deactivate my FB account because of a fear of seeing her face.  Everywhere I go I look for her car so we don't cross paths.  I will get back on FB long enough to check to see if she clicked "interested" or "going" to an event that I'm interested in so I can avoid it.  I'm obsessed with her not having a bad opinion of me. I had a falling out with her best friend who gave the impression that she was trying to help, but then she began mocking me and lashing out at me, eventually talking behind my back to my therapist about me.  This set me on a three-day panic attack at seeing another abandonment.  Apologies for the directness, but I'm fresh out of pride.

I didn't eat for 10 days straight, I lost 40 lbs in just over a month. To say things are bad is an understatement.  I'm beyond panicked about coming home from the lake back to the town where we live.  I think if I saw her, I would honestly pass out.  If I saw her with another man I have no idea what I would do.  I'm completely obsessed.  I just want closure, which could have happened internally if I wasn't the type of person who draws his entire self-worth from how others view him.  A romantic relationship is the ultimate high for me, and I can't handle the abandonment and separation.

As far as the happy guy part, I put up a good front.  I don't think I'm impulsive either, but irrational, yes.  I'm finding out that I am very irrational in relationships.

On a side note:  When Baltimore girl left, she said three things:  1- I love you and always will, but not in love with you anymore, 2- things got heavy, and 3- that she started feeling responsible for my happiness.

Alone, those could be chocked up to a relationship dynamic, but I had to look back to an email from my ex wife.  Not only did she say those exact three things, she wrote them in that order, and nearly verbatim.  That caused me to look inward and also take a look at my first "real" relationship in high school/first two years of college, and the same dynamic happened there, although it wasn't ever verbalized.  I have also had a nearly impossible time in my life having long-term best friends.  I had one in HS and we still talk sometimes, but every other friend has been in their own group and I was accepted in.  With the exception of that one in HS, I have never had a best friend.

and thank you for the kind words.  I do know I'm a good man, but my self-image is garbage.  I have never had to love myself and never developed the skills to even know what it feels like.  I  have always derived my self-worth from others.  Even in my own hobbies where I was proud of my accomplishments, they all had an ulterior motive; having the flashy car, the fastest boat.  In my work, I didn't build the sets for the shows so well because it was my passion, I built them so that the patrons, actors, directors, designers, and my bosses would approve of me.

In my world, I have basically emotionally raped the women I have been with.  That sounds harsh and it's an exaggeration, but I have always lacked something (self-image) and I found a way to distill it from romantic relationships - more or less taking the power I lacked from others.  My currency is love, so I overgive to the point where the person becomes exhausted so that I can keep extracting the currency I need in return; love, acceptance, intimacy, companionship.

For all of my hatred of modern misogyny, it turns out I am an active participant.  I extract what I lack from a feminine source.  The only reason I felt comfortable reaching out about this is because since I got a [nebulous] diagnosis, for the first time in my life I had a concept that it may not be my fault.  Responsibility, yes, but regardless of the accuracy of the diagnosis, I had never even considered the fact that it might not be that I'm a horrible person.  It might be a funky chemical, or the way my brain developed with a funny fold in a lobe, or that a clown punched me when I was 2.  I always thought; "why can't I find love or dates, why can't I heal from pain, why do I get so stressed if someone is angry with me, why do I roll over and say it's my fault just to stay in good graces with people, why do I overgive in work, why can't I see when a relationship isn't healthy?"

With both Baltimore girl and my ex wife, in hindsight there were some messed up things.  My ex and I dated for 6 years and married for 14.  Starting at year 2, the intimacy pretty much disappeared.  Toward the end of our marriage, things were so bad that she asked me to clean the house so her date (that I tried to forbid) could come over.  Not only did I do it while sobbing, I left the house so they could have time together.  And I fought to keep it.  Baltimore girl separated from me for about a month and held it over my head that there was this guy she always wanted to sleep with and she might, and refused to see me until they had their date.  She didn't, but what kind of berkeleyed up E36 M3 is that?  I should have had self worth and excused myself from the relationship, but I didn't.  I wanted the connection, and in light of the fact that I've only ever experienced remarkably few "connections" and was never successful at dating or finding intimacy, I knew that leaving her would mean a long time of being alone... something I am no good at being.

KyAllroad (Jeremy) said:

I found that moderate drinking and sport berkeleying the available talent in my area helped me get over my break ups.

Bury Baltimore girl under a few casual experiences and see if you don’t feel better.

I would, but in my 44 years, that has never happened.  I am too worried about rejection to ever approach the topic.  The few times in my life that I did feel confident in trying were unsuccessful and remarkably painful.

Plus, its just more of the drug that I'm addicted to... connection and feeding my own self with the energy I get from intimacy and companionship.  I can't learn to love myself if I'm just sapping it out of someone else.

In reply to Curtis :

Thanks for posting that Curtis. While I can’t offer you any advice, I found it to be very eye-opening. I’ve come to realize over the years that almost everyone has some type of psychological or emotional issues, whether diagnosed or not. 

Some of the points you highlighted apply to me to, while others do not. It also sounds like we had quite similar childhoods. I’d never considered the term “abandonment”, but in that context it fairly accurately describes my transition into adolescence - and given that I’ve told people “I’m still trying to become the 14-year old boy I’d always wanted to be”, I guess it still affects me today?

Wow, deep E36 M3...

Anyway sorry for derailing your post Curtis, but thanks once again for the introspective guidance!

I see. 

You derive your self-worth from your partner. Like, "I'm an awesome guy because I've got an awesome girl!" 

You need to be more like "I'm awesome guy, girl or no girl!" 

It also sounds like you put 100% of your social "weight" on a female partner, rather than bonding with other dudes. I love my wife dearly, but if she died tomorrow I would retreat to old close friendships that I've maintained for ages. 

If I still lived in PA I'd totally hang, but it sounds like you need to make (or establish) some dude friends before you pursue more ladies. 

I'd still be super hesitant with medication (because it can take a non-suicidal person and make them so) , but there is some destructive stuff surfacing here. I still think getting some second/third opinions would be beneficial. 

So far the three therapists I've seen all keep trying CBT and it fails miserably.  In my brain, CBT only works if you believe what you are saying.  Like my current therapist said, I'm supposed to try and calm myself by saying things like "this is just where I am now, but I won't be here forever."

But I don't believe it.  My emotions have complete rule over my brain.  CBT has been completely ineffective, and actually triggering and damaging right now.

In reply to Curtis :

Dude, I totally get it.  I wasn't trying to make light of your situation.  I see a lot of parallels to my own, I never had a "best friend" to speak of, I wasn't great at dating in my teens and twenties which led me to marry the first girl who said yes.  She cheated on me within the first year of our marriage and used it against me later as I tried endlessly to keep her happy (not wanting her to cheat again).  So monumentally berkeleyed up.  I totally identified as "married dad guy" and when the wheels came off that particular train I was a wreck for a couple of years. 

And while I went on a BUNCH of worthless dates, I learned something from that experience.  I am a good guy, regardless of my relationship status.

I'm totally with you on the age thing (47 now) and it's not the easiest thing to do but with dating apps there are ways to get back out there.  It'll take some time and effort but you have to learn that there are so many fish in the sea, any particular one can be replaced (and quickly).

Good luck!!

And yes about the awesome guy/awesome girl, but its a little deeper than that.  Its more like, "I have value because someone values me."

Its not necessarily that the intimacy is the value, but intimacy and deep connection is the ultimate form of acceptance.  If someone values me deeply enough to enter into an intimate relationship with me, then I must REALLY have value.  Then when it ends, I have no value... both because I no longer have the validation, and because I just gave all of myself to the relationship and didn't keep any "me" for myself.

I want to get to a state like your second quote; I want to have intrinsic value regardless of whether or not anyone else gives a crap about me.

Stuff like this is very hard to to really figure out because its not an arena of black and white, its just a whole lotta gray.

So instead ill tell you what my gut reaction to your post was: you are wallowing in your misery. This could be totally wrong but i feel like having a total outsiders gut honest reaction would be helpful.

I do have a date this weekend up here near the lake, but I'm coming home on Monday.  I kept the date anyway thinking it would be a good way to have a date that has no expectations.  She knows I'm coming back to the states on Monday and she wanted to meet anyway as well, so here we go.

Antihero said:

Stuff like this is very hard to to really figure out because its not an arena of black and white, its just a whole lotta gray.

 

So instead ill tell you what my gut reaction to your post was: you are wallowing in your misery. This could be totally wrong but i feel like having a total outsiders gut honest reaction would be helpful.

That is very accurate, but since I wallowed in misery after every woman I've dated, and then entered into the same patterns of abnormally ascribing huge importance to keeping non-functional relationships alive simply because they fed me, tells me that its more than just sad guy.  I'm really berkeleyed up and having difficulty coping.

My buddy makes some tasty “baked medicinal goods” that help him stay off antidepressants and anti anxiety drugs.  Maybe an herbal remedy is a good place to start because psychotropic drugs hardcore screw people up.

In reply to Curtis :

You also seem quite content with your misery, or at least very engaged by it.

Before drugs or outside help you might consider looking into why that is but really imo the best thing to do is to stop even thinking about it for even a small amount of time

Meh... herbal medicine of that type just makes me feel blah and sleepy, and sometimes paranoid depending on the strain.  Paranoia is not something I want to risk right now.  I did have some a few days ago and it neither helped nor hurt.  My experience with those sorts of things lean toward the stimulants being more helpful, but I haven't partaken of any for a few years.  Spirit Molecule is supposed to be good, as is Lucy, but I'm avoiding any chemically-altered mental states right now.  A bad trip in my condition would be a really crappy notion.

Except beer.  That just shuts up my brain (and likely further contributes to my depression).

Antihero said:

In reply to Curtis :

You also seem quite content with your misery, or at least very engaged by it.

Before drugs or outside help you might consider looking into why that is but really imo the best thing to do is to stop even thinking about it for even a small amount of time

I detest the misery.  I have been seeing three therapists to try and figure out how to end the misery.

Stopping thinking about it is as likely as a faerie-dusted unicorn playing the bagpipes.  If I stop typing, playing a card game, cooking, sleeping, swimming, running, lifting weights, or watching mindless TV, I'm completely consumed by my emotions and thoughts about things that aren't even likely true.  I have zero control over them.  I never learned that skill.  My brain makes up truths and no amount of telling myself they aren't true isn't helping.  It's not that I'm engaged by it, it is engaging me.  It has the control.  I watch everyone else around me have the ability to not think, or heal themselves, or choose to feel differently, and it is completely foreign to me.

This isn't about using a healthy brain to move forward with life and coping, this is about a brain that is possibly damaged in the areas that would normally be able to do those things.

I always find weight training to be pretty therapeutic. It gives me a chance to work out any aggression that I feel and allows me to just focus on lifting the weight. Counting reps. Proper breathing. It's almost meditative. It involves setting goals and achieving them, which could help with the self worth stuff. And it helps you to be better physically for yourself and for the next one. I know you didn't start this thread to hear about me, or to get everybody suggesting their preferred coping mechanisms to you but I think that finding a repetitive way to increase physical activity, burn off some steam, and improve yourself while you're working on the psychological side of the equation can only help. That's my very unprofessional advice.

Edit: AAANND you just addressed this while I was posting.

Yes. Beer definitely helps momentarily. Have you looked into mindfulness? I promise this isn't a canoe. It has helped me greatly in being aware of my internal dialog and has contributed to finding an "emotional center" that I was missing. It is no panacea, but it is definitely worth exploring. 

And you don't have to get too deep into the meditation part of it if you're not the type. I'm not either, but the awareness part has proven to be extremely helpful for many, many people. 

It really sounds like you need to gain some control of your internal dialog. It's the conversations you have with yourself all the time that most people aren't aware is happening. Making a conscious effort to know what you are saying to yourself helps to get some distance, and will calm you down. You have to cut down the noise, not drown it out with distractions.