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Sunday, November 02, 2003

DSM-IV kicks my ass 

I have a knack for recognizing the pathology of everyone around me. It is my firm belief that everyone has a spot in the DSM-IV -- if I haven't assigned you one, that just means I haven't spent enough time around you.

Of course, it could just be that I attract the mentally ill.

Either way, it's been apparent to just about everyone around *me* that I've got certain psychological problems. I've been described as unstable, emotionally volatile, controlling, excessively clingy and needy too many times to count.

I've seen a few shrinks while in the throes of a psychotic break. Schizophrenia is easy -- take two antipsychotics and call me in the morning. Further, it's recognized as one of those few psychological problems that doesn't require time with a therapist -- just a diagnosis, medication, and perhaps occasional hospitalization.

So what's happened, inevitably, is I've been given a prescription and sent upon my merry way, without even considering my everyday behavior. After all, I have little trouble holding a job, and in public situations I certainly appear quite normal -- so why bother to investigate further?

The why is a lot more obvious if you're someone who has lived with me, been in a relationship with me, or God forbid, both at once.

I've never figured my behavior to be abnormal -- atypical, sure, but not abnormal. I mean, yeah, I'm very emotional, I have a lot of intense mood swings, I HATE HATE HATE being alone... but that's just part of who I am.

Still, it recently came to my attention that my "normal" (ie, non-psychotic) behavior was not helping my relationship with Steve. Combined with his autism and lack of experience, it's certainly no wonder we struggle so much.

I was browsing around the web with this on my mind, when I ran into a website that had the full DSM-IV text available, and decided to read through it. This, for me, is "light reading material" anyway -- it's kind of fun to plug people I know into neat little categories.

I came across the following, however, and was greatly disturbed:

Beginning by early adult life, the patient has unstable impulse control, interpersonal relationships, moods and self-image. These persistent or recurrent qualities are present in a variety of situations and shown by at least 5 of:
-Frantic attempts to prevent abandonment, whether real or imagined (don't include self-injurious or suicidal behaviors, covered below)
-Unstable relationships that alternate between idealization and devaluation
-Identity disturbance (severely distorted or unstable self-image or sense of self)
-Potentially self-damaging impulsiveness in at least 2 areas such as binge eating, reckless driving, sex, spending, substance abuse (don't include suicidal or self-mutilating behaviors)
-Self-mutilation or suicide thoughts, threats or other behavior
-Severe reactivity of mood creates marked instability (mood swings of intense anxiety, depression, irritability last a few hours to a few days)
-Chronic feelings of boredom or emptiness
-Anger that is out of control or inappropriate and intense (demonstrated by frequent temper displays, repeated physical fights or feeling constantly angry)
-Brief paranoid ideas or severe dissociative symptoms related to stress


Except for the last, every single criteria fits me like a glove. That's seven -- five are required to make a diagnosis.

I would have said, "Yes! That's a perfect description of me!" except that I saw the actual disorder this is, and I balked. It's none other than Borderline Personality Disorder, which has some pretty negative connotations. Certainly, the one person I knew who had it (Chris, an ex) was uh.. not a pleasant person.

I spent a lot of time reading about BPD since I happened upon the diagnostic criteria, and there's no question about it. And then I told Steve, which may well have been a mistake.

I'm not sure. I felt it was the right thing to do -- I hate the idea of keeping things from him, and I thought he'd be happy to hear anything that might give him a better idea of how my mind works.

It didn't go over well, though. The stigma of mental illness, and BPD in particular, is very strong. And trying to explain splitting (seeing everything in black or white terms) to him was a nightmare in and of itself...

I guess we'll see what happens. I think the biggest problem was the fact that BPD is associated with unstable, intense, **short-term** relationships. We talked about that, since it's there are quite a lot of people out there who have been married to someone with BPD for decades. Hopefully he's feeling a bit better on that count...

I'll write more later.. right now I'm mentally and emotionally exhausted.


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