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inmediares

inmediares 5-HTP for obsession?

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Altostrata

Seems pretty widely applicable. Why don't you take a look at it and see if it applies to you?

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inmediares

In my last post I said there was a lot to digest. I've been trying, mostly focusing on understanding borderline personality. For better or worse -- and I'm truly not sure which is the case -- I find a great deal that resonates when I read about the symptoms.

 

To an extent, DBT sounds like the sorts of things I'm already attempting -- but I should try and locate a proper practitioner rather than play at it. Not sure if that will be my current therapist -- I plan to discuss these issues tomorrow evening. We'll see how it goes.

 

Thanks for the suggestion.

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Altostrata

You're welcome. I didn't mean to imply you had BPD, just that this type of therapy approach might help.

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inmediares

No worries. You didn't. It's something I've thought about in the past, and the connection to DBT gave me reason to examine the question in greater detail. As it is, I'm not sure it's an accurate diagnosis. But, as I say, there seems to be a lot that fits. There are issues I've struggled with for a very long time. If that's really what's going on, I think the diagnosis would be distressing -- but I'd at least finally know why I so often feel the way I do.

 

Thanks for the feedback and suggestions. I appreciate it.

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alexjuice

Hi there,

 

When I spent a lot of time doing couch therapy, I was too keen on my diagnosis.

 

If I was in your shoes, I'd try to find a therapist I could talk to openly about the issues in my life.

 

Good luck,

Alex

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inmediares

Thanks Alex.

 

I'm not sure whether I can articulate this or not...to a certain extent, I'm not sure I care what the diagnosis is, but I feel (hope) as though it will be helpful to understand what's happening. If I know what's going on, that will give me some sort of foundation or basis for responding. That could well be wishful thinking, or some sort of control fallacy, or god knows what...it's the only way I know how to respond and move forward.

 

As it is, I feel confused and adrift. I'm filled with anger and frustration. I think about suicide nearly constantly. I was abandoned by my original therapist and -- despite his continued, direct reassurances to the contrary I'm convinced I'm driving away my current therapist. I worry my wife will give up. And I wouldn't blame them for doing so. I'm frustrated, fearful, and increasingly filled with rage. I've even begun to develop what feels like paranoia. These are all emotions and feelings I've dealt with for years -- decades -- but the termination (not four months ago) has brought them back with a severity and frequency that frightens me. I feel like I'm losing control, and it's hard to find the energy to try and maintain that control over myself and my life. I'm tired, and I'm not sure what the point is anymore.

 

I'm not sure why I'm sharing this...I have a session this evening, so maybe I'm just trying to organize my thoughts so I can share them with him. In any event, thanks for your concern and for listening.

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Altostrata

Anxiety about anxiety -- a sure way to stay anxious and depressed!

 

You were terribly hurt by that rejection by your prior therapist. Please talk directly about your fears of rejection by your current therapist WITH the therapist. That's what therapists are for!

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inmediares

Please talk directly about your fears of rejection by your current therapist WITH the therapist.

 

I've talked about it to a certain extent with him. I'm scheduled to meet tonight, and that's one of the items I plan to be very candid about -- he's been very supportive, but it seems difficult for me to get past the fear. I see it elsewhere in my life, and it's one (of several) reasons I'm looking at borderline.

 

Thanks for listening to me chatter on...it's helpful. Appreciate it.

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Skyler

You are more than a Dx, this said, I can't help but wonder why fear would be borderline? Anger is often found in people who are so 'labeled', but fear is generally not primary (shown here by your concern the doc will have a negative response to your feelings/thoughts). Have you discussed this with your therapist. I wonder if you write notes to take with you to help focus? Hope your apt. tonight is helpful. ~S

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inmediares

Anger is often found in people who are so 'labeled', but fear is generally not primary (shown here by your concern the doc will have a negative response to your feelings/thoughts).

 

It's specifically a fear of abandonment -- that he'll grow tired of trying to work with me and give up, as my former therapist apparently did. I have similar concerns with my spouse -- she'll grow tired of dealing with my long-standing issues and leave. Rationally, I think those fears are mostly groundless, but emotionally they loom large.

 

You mentioned anger. It's a significant issue for me -- I'm generally able to control it such that I don't have an outburst, but it can be very difficult and takes a physical/emotional toll. There are other factors as well -- from my reading, there are nine criteria associated with the diagnosis. They all resonate to one degree or another, but there are five or six specifically I think are significant issues for me. I've made a list to help make sure I'm able to share my concerns and provide examples to my therapist.

 

I've mixed feelings about the diagnosis -- I actually think being labeled in such a way could introduce problems. But I'm also tired of struggling with all of these things -- for decades -- and not getting better. My problems have always been viewed as depression, and it's been treated that way. To no effect. If anything, it's grown worse. So I feel like I have to find a different way of looking at it, and working with it. As unpleasant or problematic as it seems, this appears to be a possible cause. So I need to pursue it. The other option is just to give up, either completely or just quit fighting and finish withdrawing.

 

Thanks again.

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Altostrata

Has someone labeled you as borderline?

 

I would talk directly with the therapist about how difficult it is for me to trust, and how I'm afraid someone I trust will turn on me.

 

Don't slip into intellectualizing e.g. "fear of abandonment," stay with your feelings.

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inmediares

Session is over.

 

I had sent a note asking to speak about borderline, which we did. He's reluctant to provide a diagnosis, for various reasons, but agrees that many of the things I'm experiencing and exhibiting are consistent with with such a diagnosis.

 

I did speak explicitly, candidly, and at length about my fears. He reassured me, in his words, "I'm not going anywhere." I explained that was helpful -- but that my fears have continued despite the reassurances, and that I'm likely to continue to seek those reassurances, even as doing so causes me to fear I'm pushing him away and setting limits. We spoke about it at some length, and I'm comfortable he understands my fears.

 

We discussed treatment options. He wants me to see a psychiatrist for an assessment, and provided recommendations. I've agreed to go -- I'm not sure how we move forward without that, but I'm extremely frightened by the likely outcome. I'm extremely averse to medications. I think I've talked about those concerns before. I'm going to try and not worry about it until I can actually speak to the doctor and see what her specific recommendations are for me.

 

My therapist also provided some suggested reading materials.

 

So, there I am.

 

As always, thanks for your time and concern.

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Altostrata

Why do you want a diagnosis of borderline?

 

Here's a doctor who often writes, intelligently, about BPD: http://davidmallenmd.blogspot.com/

 

If you find your therapist and psychiatrist are urging you to take medications when you don't want to, you need to fire them both. They must respect your wishes, or they're undermining your autonomy and mental health.

 

(BTW, BPD is not responsive to psychiatric medications.)

 

Okay, you're fearful even though he's reassured you. Your view of the world is fearful. You know the source of that is historical. How is your therapist going to help you deal with that?

 

You might want to write Marsha Linehan http://faculty.washington.edu/linehan/ , who developed DBT, to see if she can recommend a practitioner in your area.

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inmediares

Why do you want a diagnosis of borderline?

 

I'm not sure I want anything, other than to not feel the things I do.

 

I find it difficult to explain. Fundamentally, I think what I'm trying to do is to understand what's going on. As it stands, I have all this emotion and pain, some incomplete ideas about where it comes from, and no idea for strategies on what to do with it to get past it. The path I'm on isn't working, and seems like it's going to end badly, probably sooner rather than later. So I'm looking for information. The diagnosis seems to fit, at least to an extent, so that's the path I'm following for right now. Agreeing to meet with the psychiatrist is a part of that process. I'm also doing extensive research on my own. (I've come across Allen's blog as part of that research, have skimmed his posts but haven't been able to read them in enough detail to form any kind of opinion.) I've also taken your suggestion to contact Linehan in search of practitioners where I live.

 

So I don't know. At the moment I alternate between being horrified that this is really what's going on, and feeling relief for the possibility that I might actually know what I'm up against. I have no idea if that makes any sense. It's what I've got.

 

As always, thanks.

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Skyler

Google Dialectical behavior therapy (DBT)

 

 

A lot to digest. I'll work on it. Seems to be applicable primarily for BPD?

 

 

Seems pretty widely applicable. Why don't you take a look at it and see if it applies to you?

 

 

In my last post I said there was a lot to digest. I've been trying, mostly focusing on understanding borderline personality. For better or worse -- and I'm truly not sure which is the case -- I find a great deal that resonates when I read about the symptoms.

 

To an extent, DBT sounds like the sorts of things I'm already attempting -- but I should try and locate a proper practitioner rather than play at it. Not sure if that will be my current therapist -- I plan to discuss these issues tomorrow evening. We'll see how it goes.

 

Thanks for the suggestion.

 

 

 

Why do you want a diagnosis of borderline?

 

I'm not sure I want anything, other than to not feel the things I do.

 

I find it difficult to explain. Fundamentally, I think what I'm trying to do is to understand what's going on. As it stands, I have all this emotion and pain, some incomplete ideas about where it comes from, and no idea for strategies on what to do with it to get past it. The path I'm on isn't working, and seems like it's going to end badly, probably sooner rather than later. So I'm looking for information. The diagnosis seems to fit, at least to an extent, so that's the path I'm following for right now. Agreeing to meet with the psychiatrist is a part of that process. I'm also doing extensive research on my own. (I've come across Allen's blog as part of that research, have skimmed his posts but haven't been able to read them in enough detail to form any kind of opinion.) I've also taken your suggestion to contact Linehan in search of practitioners where I live.

 

So I don't know. At the moment I alternate between being horrified that this is really what's going on, and feeling relief for the possibility that I might actually know what I'm up against. I have no idea if that makes any sense. It's what I've got.

 

As always, thanks.

 

Inmediares... did you start to think borderline in response to the suggestion Alto made above? DBT is used for more than borderline diagnoses and it sounds like you would be a candidate because your emotional reactivity is significant.

 

It's dangerous to start diagnosing yourself, and you could bias the pdoc by inadvertently focusing on symptoms listed in the DSM. The DSM is no more than a 'cook book' listing of symptoms upon which most of the scripts for psychotropics rest.

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inmediares

Short answer, no, it wasn't what Alto said. I don't remember when I first heard about it -- it's been a couple of years. I brought it up at one point with my former therapist who rejected it out of hand. Given that she recently complained to my new therapist that I was "harrassing" her ((I'd left 4 phone messages over two weeks asking to meet) she might now have a different view.

 

I'm sitting in a parking lot trying to regain my composure so I can drive an hour to work. Had to be near my former therapist's office, and the proximity combined with all the other stress set me off.

 

I've left a message for the psychiatrist who I was referred to. If I can't get a handle on my emotions, will call my therapist.

 

When I see the new psychiatrist, I'll mention what I think is going on, but will try to provide a complete view of my history. Will probably have to write it down, and may have my therapist review.

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Skyler

I've left a message for the psychiatrist who I was referred to. If I can't get a handle on my emotions, will call my therapist.

 

When I see the new psychiatrist, I'll mention what I think is going on, but will try to provide a complete view of my history. Will probably have to write it down, and may have my therapist review.

 

Sound like good ideas.. I'm sorry this is all so difficult for you. Being left without understanding why is very painful. But I have not seen anything in your posts that signals borderline and having a DSM diagnosis will not help the way you feel.

 

I hope you are bonding with your current therapist.. sessions will revolve around your fears and his/her reassurances as you work thru the trauma for some time. This will mitigate the hurt, and help you feel better than now.

 

I hope work helps you refocus and find some good in your day. ~S

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inmediares

But I have not seen anything in your posts that signals borderline and having a DSM diagnosis will not help the way you feel.

 

Dear Schuyler:

 

Thanks for the note -- thanks to everyone for the support and concern. I appreciate it very much.

 

Part of what drives me towards a diagnosis (whatever it might be) is the belief that if I understand what's happening -- what's wrong -- that it will help me, and my therapist, find the right path forward. As it is, I've looked at what's happening with me as depression and that's how practitioners have treated it. I've struggled with this since I was a child, and have been on various courses of antidepressants for about 20 years. No help. The therapy I worked through for 2.5 years helped with a number of issues, but I was left with some of the same fears and feelings. I'm sure it's simplistic, and quite possible wrong, but I feel like I need some sort of framework I can operate within to try and work through all of this. The one I've been using just isn't working, and I'm well overdue for a re-assessment.

 

My reasons for considering borderline include:

 

1) Intense fears of abandonment -- no doubt exacerbated by the manner in which my former therapist chose to terminate the relationship. These fears encompass my new therapist, my wife, and to a certain extent my children. I'm convinced they'll all become tired of dealing with me and my issues and will give up. Just like my first therapist did.

 

2) Re-current thoughts of suicide -- multiple times daily. It's something that's never far from my mind -- I feel as though my family would be better off without me, and that however painful it might be for them in the short term they'd suffer less in the long term. Since the termination, those thoughts have shifted much more towards anger and revenge. At one point, I threatened to commit suicide on my former therapists front lawn, wherever she puts out her trash. I have the means, although I've never actually attempted it. I do sometimes act carelessly with medication -- I quit drinking over two years ago, but I'd combine heavy drinking with sleeping pills. Lately, I've begun combining small doses of Ativan late in the day with Ambien at bed time. That may count more toward questions of impulsivity rather than self-harm.

 

3) Anger and explosive outburst -- I'm generally able to maintain control, at some physical and emotional cost, with others. But my family takes the brunt when these happen. Frequency and intensity vary. My commute is long -- about an hour each way. I take a longer route, which adds another 30 minutes, because traffic is so much lighter and I'm less likely to become enraged with other drivers.

 

4) Emptiness -- frequent.

 

5) Emotional swings -- dependent on stress. The last few weeks in particular have been difficult. Today, I was in an ok mood, but had a doctors appointment near the office of my old therapist. I broke down driving by and had to find a place to park while I cried. After five-ten minutes I regained my composure, then lost it again 15 minutes later. My time at the office was ok -- took a couple of Ativan during the day -- but my trip home was filled with a number of reminders of frustrations, and I spent part of the drive in tears. Once at home, I argued with my wife over trivial matters and blew up at my oldest son.

 

6) Disassociation/Paranoia -- Don't really recall this being an issue much in the past, but I've have multiple experiences over the last couple of weeks that concern me.

 

I think the remaining categories include things like impulsive behavior, unstable self-concept, and unstable relationships. Mixed ground here. I've been married for 20 years. But my average job tenure is 1-2 years. Self-esteem is generally poor, although I can generally muster up some confidence and bravado when the situation requires.

 

I've shared most of this with my therapist, and will share it with the psychiatrist.

 

Thanks.

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Skyler

Hi Inmediares.. a lot of thinking went into the above. I understand your concern and sincerely hope you get some relief soon. ~S

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Altostrata

My take on effective therapy is it doesn't depend on a diagnosis, it depends on the skill and compatibility of the therapist.

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inmediares

My take on effective therapy is it doesn't depend on a diagnosis, it depends on the skill and compatibility of the therapist.

 

I agree, particularly after my experiences with my first therapist, especially with respect to the questions of skill and compatibility of the therapist.

 

I'm not a therapist, so I can't speak to the importance of a diagnosis in effective therapy. My current therapist hasn't given me one - at least, he hasn't shared it with me.

 

The search for a diagnosis stems from a desire on my part to understand what's happening. I believe if I understand what's happening, I'll be better able to understand how it happened and how I can overcome the challenges I face. I'm driven by a need for data, I'm generally adept at finding patterns and identifying structure. In many parts of my life, that's a winning strategy. Maybe not in this part of my life, but that's kind of what I've got to work with.

 

I also tend to be pretty self-directed. I'm happy enough to do things by myself. That's most likely a function of my analytical bent -- and a fair amount of emotional pathology from past failures and disappointments from failures in working with others. Maybe that's telling in many ways.

 

I understand what you're saying, I think. I believe my current therapist is skilled -- he has a Ph.D, is licensed as an LCSW, and has spent 20 years as a therapist after a career in government and business. He came recommended by an individual I trust. As for compatibility, so far it seems ok. Im not completely sure how to tell, other than in the moment. After all, I thought i was quite compatible with my ex-therapist. I was clearly wrong about that, and my trust was misplaced. Given my experiences, I have tremendous issues with trust and fears of abandonment. I've shared those fears with him repeatedly, and he's repeatedly reassured me he is committed to the process. My fear does remain--but again, given what's happened to me I think it's going to take a very long time before I can trust anyone in this role.

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