Diseases & Personality Disorders Answers

Why is it so hard to communicate my feelings to my significant other?

Dear Minnie,   Before I go on to talk about emotions – identifying, understanding, and expressing them – I would like to ask you to reflect a bit on your current relationship with your significant other. Since you are focusing specifically on the challenge you have expressing your feelings to them, I wonder if could be because, 1. This is the most significant relationship in your life right now and so resolving this issue is essential, and therefore a top priority; 2. Sometimes a partner in a romantic relationship will ask for/demand emotional transparency in a way that other people in your life do not; or 3. If you identify this as a pervasive problem in your life in other relationships besides this one.   The reason I am asking that is to get an idea of the context of your struggle. A brief review of how human beings develop emotionally:  We are all born essentially screaming. Newborns have one language, and that is crying. They have basic needs – to be fed, held, and comfortable. At that point, communication is super simple – the baby cries, the caregiver tries to figure out what the need is and fulfill it, and then the baby relaxes until the cycle starts all over again. As the months (and then the years) go by, communication becomes more complex. Small children learn the feelings that come with certain facial expressions. They learn that their own expressions elicit different reactions in other people. Then they learn words and are often told to “use their words” when they regress and express their needs like a baby or younger child.   How does emotion factor into this? Well, children start to learn about emotions by mirroring the emotions of their caregivers. Take the typical tantruming toddler, for example. That child is all emotion – maybe they are overtired, hungry, physically uncomfortable in some other way, or anxious; maybe they want something they can’t have. For a young toddler all of these emotions can blend together into a general feeling of “bad,” or “not right,” or “upset.” Starting off with only that vague idea, that child can learn a lot from how their caregiver responds. Of course, the concrete response should be to meet the need, if it is clear and reasonable – feed, comfort, soothe. If the child is asking for something that they desire but that is not good for them, then it is the emotion itself that the caregiver is responding to. The healthiest response communicates to the child that it is okay to have “big” feelings, to cry, to protest (but not to hit or kick, etc.)   If a caregiver does not understand that this is typical toddler behavior, they might get mad, and think, “This child is a brat; how dare they cause so much trouble!” Then they might scold the child. This response tells the child that feeling and expressing sadness and anger is not acceptable. What if the caregiver yells and “tantrums” back? That heightens the overall level of emotion. The adult has risen to the child’s level of agitation and intensity.   The most ideal response is to stay calm and be comforting. The child might still scream, but they see that it is possible to react to the intensity with calm. Eventually, the level of emotion will soften and fall to the level of a calmer person. The child learns something every time this happens. They feel wild, messy, unpredictable emotions, and are met with calm and compassion and eventually calm down themselves. The caregiver is teaching the child, by example, how to manage or regulate their emotions. The way that child handles strong emotions when they grow up will likely correlate closely with the most common way they have seen their caregivers respond in such situations.   As the child continues to grow, the adults in their life help them to develop an emotional vocabulary. For example, when a playmate abruptly grabs a toy away from them, they will likely feel some combination of sad, angry, startled, and afraid. They will likely experience this mixture of feelings as simply “bad,” or “upset.” It is their parent or caregiver’s job to observe the emotion and reflect, “I can tell you were sad when your friend took the toy away…” Or, “Are you feeling angry about that?” As interactions like this happen over and over again, children learn to interpret their own emotions more clearly.   Returning to your question, I’m curious if you have identified this as a problem for you before, and also about how emotions were handled in your family of origin. Every family has its own way of communicating, and that can range from extremely healthy to moderately healthy, to “we just don’t talk about things,” to indifferent, all the way to angry and toxic. I have worked with people who never saw themselves as having a problem with understanding or voicing their emotions. For the family, they grew up in and the friends they spent time with, their level of emotional insight and expressiveness always seemed just fine. Then they might partner with someone who highly values sharing feelings and talking everything out. The person can be kind of blindsided, feeling like a huge amount of detail is being demanded of them. Detail about a topic that had previously seemed simple to them.   We see this scenario often when couples come to therapy: One partner (often the woman in a heterosexual relationship, but not always) complains: “He (or she) never talks about feelings!” or “They don’t open up to me,” or “How are we supposed to have any emotional intimacy when they won’t talk?” The first partner might respond with confusion. They might say, “But we do talk. We talk all the time!” or ask, “What if I’m not feeling anything in particular, just okay? I don’t always have a good answer for that question.”   If this is the case with you and your significant other, if you feel bombarded by questions that demand more emotional detail than you find yourself actually feeling, it’s possible that a gentler approach from your partner could work better. You could agree to explore and discover more about your emotions through journaling, therapy, or reading. And they could agree to be patient. When the pressure is off, and small gains are respected, that extra space might allow you to you gradually get in touch with the subtle variations of what you are feeling.   Whether this condition is longstanding or more recent, I highly recommend that you pursue individual therapy, as the symptoms you describe could also be indicative of depression. Assessment and treatment are vital for your well-being if this is the case.   If however, you identify this as an issue that you have struggled with for most of your life, in other relationships and friendships, and if it really is a mystery to you how you are feeling and how other people are able to talk about it so easily, there is a condition called alexithymia. It is characterized by difficulty identifying and expressing emotions. If you think this might apply to you, therapy could help you explore this possibility. It can help you better understand and cope with your way of processing things. Including your significant other in some sessions could help increase their capacity to see the world through your eyes. If they can recognize that you are not hiding your feelings from them, not unwilling to share your deepest self in your relationship, that in itself can build mutual understanding and closeness.   Alexithymia is not an official mental health diagnosis, and there is no specific treatment recommended for it. However, therapy can help you increase your ability to tune into your emotions, even though they may be hard to access. One step toward this could be developing a greater awareness of your physical states, such as your heart rate and breathing. Every emotion has a physical feeling associated with it, but sometimes they are very subtle.   Thank you for reaching out to ask about this. I hope it has been helpful. Knowledge is power, and the more you know about your individual makeup, the better equipped you will be to face life with positivity and intention.   I wish you the best,   Julie  
(LCSW)
Answered on 10/27/2021

What are good factors to identify if i have borderline personality disorder ?

Dear Sol,   I can tell from the details in your question that you are already well informed about the characteristics that make up borderline personality disorder (BPD). It is healthy and appropriate to make an educated guess about your own symptoms as you try to better understand what is going on with you. However, I need to start by stressing the importance of not making assumptions or forming any conclusions based on what you’ve read, or on anything I say here. If you are currently under the care of a mental health professional, I strongly encourage you to have this discussion with them.   That being said, here is a brief overview of BPD. Your experience is consistent with it, as you are already aware. Its characteristics include rapidly shifting moods, insecurity, fear of abandonment, feelings of worthlessness and guilt, impulsive behavior driven by emotions, irritability, and frequent emotional outbursts. BPD is often associated with severe childhood trauma. Working with a trauma specialist to heal the wounds of the past is often the most effective way to ease BPD symptoms and gain a greater sense of security and stability.   Fear of abandonment plays out in several ways. It can mean being excessively dependent on a partner and terrified of losing them. This can lead to clinging and a need for constant reassurance. But there is a flip side to this fear, and you illustrate it perfectly when you say, “I would rather leave before I’m left.” Sometimes it is just too scary to feel like your life, happiness, and security depend on this one person. So people with BPD may want to trust and commit to a relationship, but may find themselves inadvertently sabotaging it and pushing the person away.   People with BPD tend to view things in extremes – black or white, all or nothing, good or bad – with a limited ability to see the gray areas that are such a big part of life. Please note, however, that this kind of thinking is by no means limited to those with BPD traits. It seems to be human nature for everyone to get stuck at times in an “either/or” mentality, despite the fact that we live in a complex world where “both/and” is applicable to a far greater range of situations. From my experience, this is one of the most common issues addressed in therapy in general. Being more extreme (and therefore more distressing) is what distinguishes BPD. Because of this commonality, the methods of treatment I describe below are likely to be effective for anyone who struggles with extreme emotions, whether or not they meet the full criteria for a diagnosis of BPD.   Before I discuss treatment options, I would like to specifically address a couple of things you say in your message. First, the sudden and vivid memories you describe. That experience is incredibly normal and expected for trauma survivors. The example you give of the cookie is perfect – you might think it sounds weird, but sensory experiences – of taste, smell, and texture – are deeply encoded in memory. This is true for everyone. It’s not uncommon to hear someone remark, for example, that upon smelling a certain perfume, they were instantly transported back to their third-grade classroom. The same thing goes of the smells of cooking in a home, etc.   These sensory memories are especially intense when it comes to traumatic experiences. Traumatic memories are encoded in the brain in a different way than average, neutral memories are. When one of them is triggered by a taste or smell, it can literally put your nervous system in the state it was when you were traumatized. This can be terrifying – bringing not only feelings of sadness, but of truly being in danger. The automatic “fight, flight, or freeze” response can lead to anger and aggression, running away, or shutting down.   Also, you described “always feeling I have two sides of myself – the one that cares for me and is perceived as mean to the world, and the one that is kind to everyone but is always scared of being hurt or abandoned”. This is also consistent with trauma. Everyone’s personality is made if up different parts in a sense, and this can be especially true for trauma survivors. It sounds like your experiences have taught you that you can either be self-protective and harsh with others, or kind to others and sacrifice yourself. This might have been true at one time when you were in a dangerous situation. Therapy for trauma involves identifying and questioning such beliefs. They might have been useful and helped you survive at one time, but now remain even though they are outdated, only to be harmful in your present life.   In addition to therapy that addresses trauma directly, there are other therapeutic models designed to help individuals with BPD increase their ability to manage their emotions and get some relief from the suffering that comes from such extreme fluctuations in mood, self-image, and sense of security in relationships. One is called Dialectical Behavior Therapy (DBT). It shows evidence of decreasing the symptoms of BPD by challenging the extreme, all-or-nothing thinking that characterizes it. The word “dialectical” refers to the concept that two opposing ideas can be true at the same time. Developing the capacity to recognize this and integrate it into one’s thinking and belief system is a huge step toward being able to see all the shades of gray that get lost in black and white thinking.   DBT is made up of four main components: distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness.   People with BPD traits feel emotions more strongly. It can be compared to a radio turned up to maximum volume. When an emotion is triggered, it is like turning the radio on. For the “average” person, the volume is set to something mid-range and comfortable, so “on” just means you can year it now; the sound is present. For those with BPD traits, it is more like someone cranked the radio up to maximum volume before you even turned it on. That is jarring. Emotions feel like huge waves rather than being consistent with how triggering they are – some small, some medium, some large.   Because this is a factor, a primary goal of DBT is to build distress tolerance skills. This means that you acknowledge that yes – emotions are going to be outsized and upsetting. Before even trying to bring them down to size (emotion regulation) you want to develop your ability to weather the storm, no matter how big it is. Yes, the wave might be huge, but you can learn to not allow it to knock you down. This sometimes involves simple distraction or re-directing of your attention. This is not about suppressing or denying your feelings, it is about acknowledging that they are there and deliberately choosing to focus your attention elsewhere so you can regain your bearings.   Mindfulness – People with BPD often describe a sense that their thoughts are spiraling, their minds working so fast that what they are experiencing moment to moment has more to do with the scenarios playing out in their minds that what is actually happening. Mindfulness is the ability to maintain nonjudgmental awareness of the present moment, just as it is. I like to use the word grounding – the sense that I am here, I feel my feet on the ground, what is really going on in this moment?   Emotion regulation – While distress tolerance can be compared to increasing one’s ability to tolerate the blare of the radio being turned up to max volume, emotion regulation is more like the ability to turn the volume down, even slightly.   Interpersonal effectiveness – Everyone can benefit from improving their communication skills – the ability to listen deeply and express oneself in a way that is both clear and kind. In DBT, these skills augment the other three components, increasing mutual understanding with others.   I hope this answer has given you a clearer picture of what BPD looks like and given you some hope that relief from its emotional intensity is possible. If you are not already receiving therapy, I highly recommend that you pursue it. I wish you healing and happiness.   Julie        
(LCSW)
Answered on 10/27/2021

I think I'm autistic. My sister thinks I'm a narcissist and a sociopath.

Hello Skunkette. I want to begin by saying how proud of you I am for reaching out and asking for some clarification on what you have been experiencing.    Before I begin I do want to put the disclaimer I am basing my answer on only the information you provided in your question.  Let’s begin with what I feel is the simpler of the questions you have asked me.  “Does the person writing this even sound like a sociopath, in your honest opinion?”.  I do not feel what you disclosed describes a sociopath.  A sociopath is not an actual diagnosis but a person who demonstrates more severe traits of a person who has Antisocial Personality Disorder.  A person who is truly a Socio Path is the opposite of how you described yourself.  Meaning they are not the “weird kid”, they are the popular ones, the ones that everyone loves.  They will go above and beyond to make people love them, but when they are not performing in front of others and have alone time with one or two people this is when they can show their true colors.  A genuine sociopathic person is highly aggressive, arrogant, impulsive, unempathetic, narcissistic, immoral, enjoys causing severe harm to others (such as cutting, burning, and even murder), and will not stop until they feel they have caused enough suffering to their pleasing. So, leaving a poor review on Google or sending them mail is nowhere near a Sociopath.   To further support you not sounding like a Sociopath,  per the Diagnostical Statistical Manual Five (DS-5) to receive a diagnosis of Antisocial Personality one must fit the below criteria.   A pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three (or more) of the following: 1.    Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest. 2.   Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit. 3.   Impulsivity or failure to plan. 4.   Irritability and aggressiveness, often with physical fights or assaults. 5.   Reckless disregard for the safety of self or others. 6.   Consistent irresponsibility, failure to sustain consistent work behavior or honor monetary obligations. 7.   Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person. 2.   The individual is at least age 18 years. 3.   Evidence of conduct disorder typically with onset before age 15 years. 4.   The occurrence of antisocial behavior is not exclusively during schizophrenia or bipolar disorder."   Moving on to your concern with possibly having ODD is more complex to answer.  Typically ODD is diagnosed in childhood, others in the family have been diagnosed, and more times than less you outgrow it by adulthood.  If a person has not outgrown it this adult will struggle immensely with having healthy long-term relationships, they will be angry the majority of the time, will go out of their way to make others angry, and will purposefully do things just to get on other people's nerves. These people get a euphoric feeling out of making others mad.  You reported the examples of “not like being told what to do, especially if a person has no authority over me, and often flaunt I'm doing the opposite of what they said.”  A person with ODD will focus on authority, meaning those are who they want to fight/argue with most.  To properly diagnose you with ODD I would need to know more about your history and meet with you regularly to observe behaviors.  To further clarify what is needed to be diagnosed with ODD here is the criteria per the DSM-5 A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior. Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture. B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder. Specify current severity: Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings. Severe: Some symptoms are present in three or more settings. Now, for the most complex question, are you on the spectrum?  I can clinically say don’t know.  Please try not to be too frustrated and keep reading.  I say this because I do not feel any clinician will be able to diagnose you from what you shared with us with your entry.  You shared some symptoms that could be related to the spectrum but also other diagnoses.  The first two diagnoses I addressed are more specific with their criteria that need to be met, whereas being on the spectrum has more of a broader base.  For example, you shared you wet the bed until the age of 11.  This could be related to the spectrum, this could be trauma, this could be anxiety, or a medical issue.  With you biting your nails could also be trauma, anxiety, or you are being on the spectrum.  I know you may be thinking at this point “but my son is on the spectrum”, that does not necessarily mean you or his father must be.  That also does not rule out you are not.  If you desire full psychological insight into yourself I recommend for you meet with a licensed therapist and even a psychologist.  This will be the only genuine way for you to get answers.
(LCSW, CSAYC)
Answered on 10/27/2021

I’m looking for a therapist in Ga that specializes in narcissistic personality disorder.

I see that you are looking for a therapist in GA - is there a specific reason that you are requesting someone in GA? Are you involved in any situations that have court involvement pending?  I am located in GA and I am a Licensed Clinical Social Worker. I have worked with several cases involving narcissistic personality disorder as well as with individuals who may not have met the criteria for the diagnosis but had symptoms of the disorder.  Could you provide a little more detail about the situation - are you diagnosed with a narcissistic personality disorder or if you are someone living with, interacting with, or caring for someone with this disorder? I have experience working with families who are dealing with a loved one. I have worked with several cases where custody of children has been involved and narcissism was impacting the emotional health of the children. I have found these cases to be incredibly challenging while at the same time I believe each and every person can learn new ways of communicating and engaging with others. I will say that I have not had good outcomes with the individual diagnosed with a narcissistic personality disorder. I cannot say for sure if this was relative to my capacity and knowledge about the disorder or if it was on the part of the client who just may not have been in the readiness state for change. I know from experience that until someone acknowledges there is a problem and is ready to accept the help that we as therapists can try every approach in our toolbox but nothing is going to change.  I would be open to more dialogue about the specifics related to your situation to determine if I am a good fit as a therapist to take this case. There are several more questions that I would want to explore with you before I would provide a definite answer one way or the other. If you are interested in having some conversation with me about your situation, please feel free to connect with me so that we can do that. 
Answered on 10/27/2021

I know I have bpd. I know some of my triggers. Whats the next step?

Hi Jada, Thank you for sharing your history, you have been through so much at such a young age. Borderline Personality Disorder and trauma go hand and hand. Moreover, now that you know you have this diagnosis, it is about researching the best strategies to help you with working with the symptoms of having Borderline Personality Disorder. I am going to break some things down to help you understand, and help you think about the next steps. Please allow me to help distinguish what is part of you and what is Borderline Personality Disorder.    Borderline Personality Disorder is characterized by individuals that have had a lot of trauma in their life are terrified of being hurt again. They begin to struggle with desperately not wanting to be alone-to an unhealthy amount, and not being able to let people into their inner world/vulnerability. This is often described by a push-pull relationship (e.g. get away from me, but please don't leave me). This struggle sometimes has self-harming behaviors, such as, abusing alcohol and drugs when upset, attempting suicide, or cutting behaviors. It is the feeling overwhelmed by intense emotions that leads to these behaviors. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237   Treatments:  These people often end up with a Bipolar Diagnosis and seemingly helpful professionals trying to promote medications. While this can be helpful, it often is not always helpful for those with Borderline Personality Disorder. The best strategy is a treatment modality called Dialectic Behavioral Therapy (DBT). Dialectic Behavioral Therapy was created by someone who struggled with Borderline Personality Disorder and the concept focuses on teaching people skills to deal with the intense emotions that become overwhelming. It encompasses group skills training classes, and also, having a therapist who you meet with that can help talk about issues and reinforce how to use these skills in your day-to-day life. I know people who describe it as having been life-changing.  Here's more info about it:  https://www.webmd.com/mental-health/dialectical-behavioral-therapy       This type of approach is best practiced in person. However, I know that we are in a pandemic and in-person isn't always available. If you choose to work with a therapist on Betterhelp ask for a therapist that works with Borderline Personality Disorder using Dialectical Behavioral Therapy. If you want to look for an in-person-setting googling Dialectical Behavioral Therapy and your area should bring up the nearest agency. Or you can find people on the link below.  https://www.psychologytoday.com/ca/therapists   Sincerely, I hope this was helpful, and I wish you the best. James 
(LPC, C5597, MA.)
Answered on 10/27/2021

I think I am Bipolar

Hello Minhea,  You are wanting confirmation about being diagnosed with bipolar disorder. I will provide you some information about BPD including diagnosis, symptoms, and treatment however you must speak with a licensed therapist or psychiatrist to get validation of this diagnosis. I will answer your question however it is not a confirmation of your diagnosis.  Some people are more prone to these cyclical changes in mood, also known as cyclothymia. They experience a more or less regular alternation of periods of happiness and sadness, without this phenomenon preventing them from living normally.  As long as it remains bearable, cyclothymia is not a real disease. Bipolar disorders, formerly called psychosis manic depression are characterized by changes in the mood disproportionate in their duration and intensity. Cheerfulness becomes exaggerated euphoria, sadness is expressed by deep depression. The behavioral disorders that accompany these phases deeply disrupt the life of the affected person and degrade their family and professional relationships. Bipolar disorder is an illness that can be serious and requires long-term treatment.   The symptoms of bipolar disorder are cycles of alternating phases of excitement, also called mania, and depression. These cycles are often linked by periods when the mood is normal. They vary in intensity, duration, and frequency from person to person. The alternation of symptoms can be impressive, between hyperactivity, aggressiveness, absence of inhibition, then sadness, depression, and total demotivation. According to the symptoms, sometimes referred to as bipolar disorder type 1 and type 2. Type 1 bipolar disorder is characterized by one or more manic or mixed episodes with or without major depressive episodes. Bipolar disorder type 2 combines at least one major depressive episode with hypomania.   A person in the manic phase is unusually euphoric, energetic, hyperactive, or aggressive. The individual is elated and conceives of unreasonable confidence in himself.  He no longer has inhibition, does or says what goes through his mind, without worrying about the consequences of his actions and words.  He has a very high opinion of himself and does not take any criticism. He is irritable and gets carried away over nothing. His thinking is accelerated. He talks a lot, follows several ideas at the same time, digresses from one topic to the next without always a logical connection. He is teeming with often incongruous projects, moves constantly never feel tired. He may forget to eat for several days and sleep little. His sexual urges are heightened. This state can last for several days or even several weeks. Some sufferers enjoy these manic episodes in which they feel invincible and think that nothing and no one can resist them. Some of them prove to be very successful professionally or very creative, during a manic phase. But mania has mostly negative consequences. The person can act thoughtlessly and cause real upheaval in their life (quitting their job or spending recklessly, for example). Sometimes people with bipolar disorder end up in trouble with the law for crimes committed during manic phases. What is hypomania? A hypomania is a mild form of mania. The person is very energetic, behaves impulsively or recklessly, frequently quarrels with those around him. Her condition is agreeable to her and she denies being sick all the more easily as her troubles do not interfere too much with her daily life. Hypomania is often an early sign of bipolar disorder.   When the depressive phase sets in, discouragement sets in within a few days or weeks. The higher the manic phase, the deeper the depression will be. From hyperactive, the person becomes indifferent to everything, downcast. The symptoms are those of severe depression, such as sadness, overwhelm, slowing down of thought and movement, constant fatigue, lack of motivation, sleep, and appetite disturbances. These manifestations last two to three times longer than the manic phases, often from several weeks to several months. Suicidal ideation is common. Suicide is wrongly considered by the patient as the only way to free himself from his illness and no longer subject those around him to it.   In some patients, there are so-called mixed phases. During these periods, the person simultaneously presents symptoms of mania and depression: restlessness, disturbed sleep, and appetite, suicidal thoughts, etc.   Mixed phases are sometimes observed between the end of a panic attack and the start of a depressive episode. A cycle is made up of a manic phase, a depressive phase, and possibly the normal phase that separates them. The length of a cycle is very variable, ranging from a few hours to a year or more. The frequency of cycles is also very variable. Most untreated patients experience eight to ten manic depressive cycles in their lifetime, but others will experience several cycles in a year. The disease is said to cycle rapidly when the person develops more than four cycles in the year. Treatments and living conditions influence the frequency of repetition of cycles. A patient who is well cared for and surrounded will be more likely to see the cycles spaced out.   When the background treatment with mood regulators is effective, the intensity and frequency of manic cycles decrease significantly, allowing the person to return to a normal life. After several months of treatment, the cycles may become less frequent until they disappear completely. For this reason, all people with bipolar disorder should be treated.   Without treatment, cycles continue and their frequency may increase. The intensity of manic and depressive phases can also worsen. In some cases, ill people develop symptoms of psychosis, hallucinations, and delusions, insistently defending false and illogical beliefs despite evidence to the contrary. The complications of bipolar disorder are manifold. Left untreated, an estimated 25% of people with bipolar disorder make one or more suicide attempts. The risks of alcoholism and drug addiction are significant and the associated behavioral disorders can have serious consequences, including divorce, dismissal, or imprisonment. Bipolar disorder sufferers often resort to a mixed combination of treatment: talk therapy and medications. I would recommend talking with a psychiatrist for a medication consult after being diagnosed. Talk therapy can be provided by a licensed therapist.     
Answered on 10/27/2021

I’m not sure what’s going on

Hi! My name is Christina Gilkey and I am a licensed clinical social worker.  There are a number of questions to ask when riding a "rollercoaster" where you find yourself experiencing good days and bad days.  On those bad days where you find yourself zoning out for hours, struggling to comprehend what is happening in your environment, feeling like you are in a dream, experiencing a distorted vision, lacking in personality and interests, and feeling disconnected can you think of any type of pattern that is occurring leading up to those days?   If not, it would be helpful to develop a simple log where you can document things daily like mood, sleep, nutrition, stress level, hydration, substance use (if any), missing medication doses, and social interactions.  A proper log would record these things daily and have at least one month of information. Any and all of these things can affect our mood.  It's important to seek out any organic influences where a lifestyle change could make a big difference and also would be very beneficial information for your physician to have if you decided to seek a professional opinion related to a diagnosis or being prescribed some medication to help with regulating your mood.  Another thing to consider is to have experienced any kind of physical trauma such as a head injury?  If so, I highly recommend a medical appointment where you can get a full evaluation including a CT scan to determine if there is a biological issue causing the changes in mood. Have you experienced any other type of traumatic event such as witnessing any violent act, a physical assault, a natural disaster, etc?  Have you experienced any significant loss of a job, your home, or a loved one? If so, you could be experiencing symptoms of Post Traumatic Stress and I would recommend you see a mental health counselor and/or psychiatrist to see if you meet that criteria.  One other thing to consider is seeking an appointment with a Licensed Clinical Social Worker or Psychiatrist to inquire about a different mental health diagnosis that would require a full assessment and at least 6 months of past history in order to determine if you meet the criteria for a number of other disorders that could be impacting your mood. This is a complex process that requires a licensed professional to gather an abundance of information in order to make an ethical diagnosis or rule out any disorder.  Too many people who are not trained, experienced professionals like to put labels on others and this can be very damaging when it is inaccurate so if you are curious about a possible mental health disorder, please go see a licensed professional for a full assessment.  The other important thing is to have a strong network of social supports; people who care about you and will check in on you when you are experiencing bad days.  It is important for you to know you do not have to suffer in silence.  There is no shame in seeking help. There is no shame in telling someone you trust so they can be there to support you until you are able to get an appointment with a professional to help you navigate and better understand your situation.  I hope this has been helpful!
(MSSW, MSCFT, LCSW)
Answered on 10/27/2021

Will it go away?

If you are feeling detached from your thoughts, feelings and possibly having an out of body experience or you are disconnected from your surrounding environment, but realize your perceptions aren't real, these are symptoms for depersonalization and derealization.  Before you can get to an answer, it is necessary to perform a differential diagnosis so as not to miss other key pathologies such as physical disorders such as a seizure disorders or even brain diseases. To put your mind at ease, this type of disorder occurs in young adults and rarely occurs after about age 40.  Having out of body experiences, for instance is very common, occuring in about half of the population. Typically stress or trauma of an intense nature can bring this on.  Anything from an accident you witness or being exposed to violence or war are precepitating factors.  Even sleep deprivation can be a cause. The actual origins of the pathology remain unknown. Associated anxiety may become a larger issue than the actual disorder and likewise depression over thinking there is something wrong with you often surfaces and causes even more alarm to the person experiencing it. So, to more directly answer your question, "will it go away", the answer is it depends on the severity and frequency and the modes of treatment available to you.  Clearly, the recommended course would be interventional psychotherapy which could include anything from cognitive behavioral therapy to dialectic -behavior therapy or techniques such as meditation and relaxation tehniques, clinical hypnosis or medications to treat depression and anxiety caused by the symptoms.  If treated early the prognoisis is better than if left to fester.   Recognizing the onset of the symptoms to catch it before it becomes anxiety producing should help mitigate the risks of reoccurance.  Having a support group to help you when you start manifesting the symptoms can also lead to a favorable outcome. So, if it never goes away, at least you can keep it in check. Knowing how to recognize the symptoms, making every attempt to control the unset, and finally knowing the available treatment options will result in great self-confidence that this set of issues can be treated successfully.    
(M.S., Ph.D.)
Answered on 10/27/2021

Why can people be diagnosed of more than one mental illness?

Mental health is a confusing subject area, sometimes! People can have 1, 2, 3, or more diagnoses, but all would be accounting for a different branch of what's going on with that person. A lot of symptoms overlap, yes, but each diagnosis is unique in its own regard. You mentioned that you have Bipolar Disorder, BPD, and an eating disorder. Those sound accurate in their diagnosis, given that each is in a different area of mental health, as well as each separate in how it presents. That being said, it does make living difficult sometimes, having several diagnoses. I'm sorry that you struggle with those and I'm sorry to hear that you often feel tired. I don't blame you -- it's difficult to wrestle with yourself all of the time. That being said, it is possible to live a life that you're comfortable with. Some diagnoses are simply there -- thanks, genetics! Bipolar Disorder is probably something that runs in your family, which declares that the diagnosis is NOT YOUR FAULT. Is the diagnosis unfortunately your responsibility to manage? Yes. But it was never your fault in the first place. Medications, reaching out to your positive supports, and reaching out to professionals can all be exceptionally helpful in battling the symptoms that make your life difficult (i.e. mood swings, your ups and downs, feelings of emptiness, etc). Don't hesitate to reach out for support -- it is so necessary for the proper treatment of things like this. You are strong -- you have made it this far! Asking for help can be really difficult -- one of the toughest things in the world to do. That being said, no one was meant to navigate life alone let alone a life that is riddled with emotional difficulty. Identify who your biggest supports are -- the people that help you to feel safe -- and reach out. Your diagnoses can certainly be managed and your life can certainly become more comfortable, but don't be afraid to lean on others in order to beat that tiredness. With hard work and treatment, your diagnosis of an eating disorder can be placed in the status of "in remission," which is when you cease to display the symptoms of that disorder (including the distorted thinking patterns). Bipolar is something that you'll likely wrestle with forever, that that doesn't mean you can't live your life comfortably -- it is possible to have this diagnosis, while also living comfortably, but that's possible through treatment. BPD is likely a result of some difficult things you've been through -- it is generally a result of some sort of trauma. I'm sorry that you've endured something difficult, albeit I'm assuming, but those things will need to be addressed in order to help you move past some of those traits of BPD that make your functioning more difficult (i.e. having stable relationships with others, any level/type of self-harming behavior, etc). I urge you to reach out, because you're worth that! You deserve a life that is comfortable -- a life that isn't so tiring. You aren't alone -- help is here. Reach-out. Grab that life you deserve and enjoy the life that you've created for yourself. 
(MS, LPC, NCC)
Answered on 10/27/2021

Am I a narcissist? Am I a sociopath?

It sounds to me like classic projection. Perhaps she feels like these traits are ones that she sees in you because she has a familiarity with them because she carries these traits if that makes sense. Oftentimes people tend to project onto others what they see in themselves whether it's something they like or dislike. Calling somebody a narcissist is really dangerous because there's a lot of criteria that go into meeting that label… Often times what people mean to say is that you have narcissistic tendencies… But so can a person that's very confident. More than having treats, one needs to ask themselves if the behaviors that they exhibit as a result of those traits are harmful. Sometimes being confident can be seen as narcissistic… Sometimes people around you that feel less, project what they are ashamed of not having. So there's a lot that goes into these things… The fact that you are seeking out a question to answer, tells me that you were likely not a narcissist. A true narcissist would make the effort to investigate this further. Some thoughts I have on this, are, what is the state of the relationship; What prompted these conversations, and what do you guys want to do with that? It sounds to me though that there's an unhealthy dynamic at play and perhaps that is why she is sharing some of these views with you. Again, a narcissist or sociopath wouldn't be very concerned with what somebody else thought about them… Much less find help for it. It could be that confidence or an approach you have towards the relationship that bothers her. Additionally, people don't always know what they are saying when they say it… I'm wondering if she took the time to research what a narcissist or sociopath was before she said that to you? People often derive these definitions from movies or TV… And use them incorrectly. I would be happy to help further if you have any more questions so just let me know. But for now, definitely try to get to the root of why these conversations are being had in the first place.
Answered on 10/27/2021

Is there a way to be tested for osdd?

Dissociation disorders often occur due to early trauma. Like any diagnosis, there needs to be specific symptoms/criteria present either through self-report and/or through collateral (friends, family, clinicians) in order to make a proper diagnosis. Many people experience dissociation at times; however, there are those when it has become so life disruptive it is considered a disorder and may require treatment. Common types of dissociative symptoms are, depersonalization-feeling detached from the body or a feeling of being outside their body watching themselves, derealization-feeling that the world is not real or has changed in some way, and dissociative amnesia-loss of time or unable to recall specific events that can't be better explained by the use of a substance. In order to get a better understanding of what you are experiencing, I would consult a psychologist who can provide psychological assessments to determine why you are experiencing a loss of time. There is not a specific test that I know of that can say yes, you have a dissociative disorder however, assessments, history, and dialogue with a trained professional can assist in determining whether a dissociative disorder would be an appropriate diagnosis. Other disorders that are marked by dissociation are personality disorders such as borderline personality disorder (BPD). BPD's criteria consist of fear of abandonment, dysregulated mood, impulsive behaviors, self-harming behaviors, dissociation, etc... Posttraumatic stress disorder (PTSD) is another disorder that can be associated with dissociation. In order to know for sure, I would contact a psychologist, explain your concerns, and be evaluated. There are treatments such as Dialectical Behavioral Therapy (DBT) that have proven to be very effective for these types of disorders. Providing specific, thorough details about your history, such as, how often you feel you have "time gaps/amnesia" and what are the circumstances, family dynamics (parents divorced, married, multiple marriages, abusive, caring or loving), past traumas (especially during early development), substance use (how much, how often), past hospitalizations, past diagnoses, losses, stressors, etc...will be an important part of this process. The more information you provide the easier it will be to make a proper diagnosis. I would suggest you begin to log your gaps in time, note the circumstances surrounding gaps, and what you might have been thinking or feeling prior to the episode. This will be useful information to the person who evaluates you.  I hope you find this information useful. 
(MA, LPC)
Answered on 10/27/2021

Can you help me to stop gambling?

Hello, I understand that you are having difficulty with gambling and urges to gamble that have caused negative consequences in your life.  Your question of can someone help you stop gambling, I would say yes, there is professional help, but you must ultimately be the one who is ready to make the changes necessary to combat the urges to gamble.  With proper psychoeducation, a solid support system, and learning/practicing techniques, you should be able to exercise improved self-control over these urges over time.  However, changes don't happen immediately or overnight and require dedication and some work on your end.  There is not a professional who can do the work for you, but a therapist can stand beside you and offer support and opportunities to learn.  Oftentimes, the urges to gamble have roots in a desire for instant gratification and the feeling that you get when you do win money from gambling.  The "high", the chase, or intensely pleasurable feelings you get from participating in gambling, the risk, the thrill, and sometimes the winnings are what you seek.  This is the feeling that you would potentially focus on in therapy and try to identify ways to replicate parts of it in other healthy activities.  Support is crucial.  There are Gambling Anonymous groups that focus on the 12 steps which many find helpful.  The group format with others who share your struggle can instill a feeling of belonging and help keep you accountable.  Gambling Disorder is the only addiction disorder outside of substance use disorder that has made it into the DSM V (Diagnostic and Statistical Manual of Mental Disorders fifth edition).  What that indicates to clinical mental health professionals, is that this disorder should be treated in a similar treatment modality as with other addictive behaviors.  Behavior modification, emotion regulation, and healthy habits that become long-term life changes can be achieved with psychotherapy and the motivation of the individual seeking help.  Better Help is a platform where individuals do not receive diagnoses but therapists provide their expertise and non-judgmental listening ears to allow people to learn about themselves and find solutions to their problems.  So, in short, yes, gambling is something that you can be helped with.  You are brave to reach out and admit that this has become a problem in your life.  I wish you the best of luck on this journey!  
(LPC, NCC, SAC-IT)
Answered on 10/27/2021

Can I change my narcissistic ways?

Hi Mac! Thank you for asking such an insightful question. Many professionals believe that narcissists cannot change. This is because they feel that narcissists aren’t really aware of their narcissistic tendencies. These issues are often deep-seated, and self-preservation stops them from even recognizing their problems. Mac, you are ahead of the game. You are aware and admitting you might have Narcissistic Personality Disorder which is already a step forward. So first, what is Narcissistic Personality Disorder? Narcissistic Personality Disorder is one of several types of personality disorders—is a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. There are a few things you can do to change narcissistic tendencies.  Know what your triggers are. Narcissistic behavior often emerges when a person suffering from Narcissistic Personality Disorder gets “triggered.” Recognize what your triggers are. For example, you often feel a surge of anger when someone you perceive being of a “lower status” challenges your authority in the workplace. Or you may notice that you are often dismissive of other people when they suggest ideas. Believe it or not, narcissistic people have serious self-esteem issues. Because of this fragile self-esteem, they need to project their superiority and put other people down. What narcissistic people need to do above all else is to practice self-love. Narcissist people are often impulsive and make decisions without thinking of the consequences. If you display narcissist tendencies, it’s important to emphasize thinking first and reacting later. Train yourself to be empathetic. Express genuine interest in and curiosity about people in your life. Listen at least as much as you talk. Be careful not to thoughtlessly intrude upon others’ personal space, use their personal property, or take up their personal time without permission. Practice gratitude in your life. Gratitude requires a whole lot of humility—something narcissists often have difficulty understanding. But if there is one way to quench an inflated ego, practicing gratitude will certainly do the trick. This is because gratitude shifts you from thinking about yourself to feeling grateful for other people and things in your life.   So, Mac, you have taken a big step in admitting you have narcissistic tendencies. I hope this has been helpful and wish you luck in your journey to wellness. 
(LCSW-R, CLC)
Answered on 10/27/2021

How to prevent being aquaholic

Dear Khalis,   Thank you for your message and for sharing with me how you've been interacting with yourself, especially how you've been handling unpleasant feelings and emotions when it comes to the urge to drink water. As you said this has also affected your life significantly. Perhaps by addressing how to handle unpleasant emotions/urges in a healthier manner, we can dive into addressing the issues in your life as well?   Often the experience we've had about anxiety (or any strong emotion such as stress/depression) was so terrible (even physically) that our body sort of becomes traumatized to it. We naturally become nervous about these unpleasant feelings because we don't like these sensations and experiences. As a result, we would do everything we can to avoid/fight these anxious feelings, often using numbing techniques such as using substances or distracting ourselves. Yet only to find that the anxiety gets stronger over time because we have never been able to make peace with it.   Therefore rather than trying to "change" / "fight" / "get rid of" these unpleasant sensations, perhaps the best thing that we can do is to make room for these feelings and even sensations while staying on track to do what brings us meaning and fulfillment. Floating without judging / blaming ourselves through the anxiety experience, while focusing on making room for anxiety can be helpful.   Here is a short video put up by the author of the book "The Happiness Trap" which does a good job explaining this concept:   Please take some time to watch this and share your thoughts later :) I also highly recommend picking that book as well to supplement this therapy process.   https://www.youtube.com/watch?v=rCp1l16GCXI    We as human beings do not like suffering, therefore often times we would be doing our best to fight it. However just like the analogy of swimming vs floating that we have talked about before, the more we fight it, the faster we sink. While if we can learn to float with these waves, we will realize that we won't sink.   Radical acceptance / Expansion is about accepting life on life's terms and not resisting what you cannot or choose not to change. Radical Acceptance is about saying yes to life and all that life brings (including all sorts of emotions such as joy, sadness, peace, and pain), just as it is without forcing our ways into our lives.   Why do we want to accept life as it is? Because with anything that we do in life that brings us meaning and fulfillment, it always accompanies a wide range of emotions, we can't possibly just choose the ones that we like and fight/avoid those that we don't like. Learning to experience all emotions as they are, is a sign that we are living our lives to the fullest.   To do so we must learn to accept (and make room for) any unpleasant sensations, feelings, or thoughts that we experience.   We don't want to fight it because the more we fight, the stronger they will come back.   We don't want to avoid it either because the more we avoid it, the more we'll be afraid of it.   So the key here is to make room for these sensations, feelings, and thoughts, while continuing to do what brings us meaning and fulfillment in life.    Learning to "co-exist" with these feelings will naturally reduce their intensity.   Floating is a form of learning to accept these feelings and make room for them.   Let me give you some practical guidelines on what I mean by accepting these feelings and make room for it.   You can look up the "expansion technique" under Acceptance and Commitment Therapy (ACT) for more information as well.   How to accept our emotions (and make room for them):   1. OBSERVE. Bring awareness to the feelings in your body.   2. BREATHE. Take a few deep breaths. Breathe into and around them.   3. EXPAND. Make room for these feelings. Create some space for them.   4. ALLOW. Allow them to be there. Make peace with them   Some people find it helpful to silently say to themselves, 'I don't like this feeling, but I have room for it,' or 'It's unpleasant, but I can accept it.'   • When you're feeling an unpleasant emotion, the first step is to take a few slow, deep breaths, and quickly scan your body from head to toe.   • You will probably notice several uncomfortable sensations. Look for the strongest sensation - the one that bothers you the most. For example, it may be a lump in your throat, or a knot in your stomach, or an ache in your chest.   • Focus your attention on that sensation. Observe it curiously, as if you are a friendly scientist, discovering some interesting new phenomenon.   • Observe the sensation carefully. Notice where it starts and where it ends. Learn as much about it as you can. If you had to draw a line around the sensation, what would the outline look like? Is it on the surface of the body, or inside you, or both? How far inside you does it go? Where is the sensation most intense? Where is it weakest? How is it different in the center than around the edges? Is there any pulsation, or vibration within it? Is it light or heavy? Moving or still? What is its temperature?   • Take a few more deep breaths and let go of the struggle with that sensation. Breathe into it. Imagine your breath flowing in and around it.   • Make room for it. Loosen up around it. Allow it to be there. You don't have to like it or want it. Simply let it be.   • The idea is to observe the sensation - not to think about it. So when your mind starts commenting on what's happening, just say 'Thanks, mind!' and come back to observing.   • You may find this difficult. You may feel a strong urge to fight with it or push it away. If so, just acknowledge this urge, without giving in to it. (Acknowledging is rather like nodding your head in recognition, as if to say 'There you are. I see you.') Once you've acknowledged that urge, bring your attention back to the sensation itself.   • Don't try to get rid of the sensation or alter it. If it changes by itself, that's okay. If it doesn't change, that's okay too. Changing or getting rid of it is not the goal.   • You may need to focus on this sensation for anything from a few seconds to a few minutes until you completely give up the struggle with it. Be patient. Take as long as you need. You're learning a valuable skill.   • Once you've done this, scan your body again and see if there's another strong sensation that's bothering you. If so, repeat the procedure with that one.   • You can do this with as many different sensations as you want to. Keep going until you have a sense of no longer struggling with your feelings.   • As you do this exercise one of two things will happen: either your feelings will change - or they won't. It doesn't matter either way. This exercise is not about changing your feelings. It's about accepting them.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 10/27/2021

Time to let go or worth fighting for?

Hi Dan, I believe the answer to you about whether to stay in the relationship will come to you in time after you have communicated clearly to her what you need in the relationship.  Try to give her direct examples of how she can support you and listen to your feelings in a nonjudgmental, nondefensive way.  Take some examples of some moments where you need that support and show her directly how you need her to listen to you.  Do this in a way that is not critical of her but just wants to connect with her on a deeper level.  Explain that sometimes in relationships we need to learn how to listen to each other and be instructed as to what each other needs.  This is a normal part of relationship work and means there needs to be active communication rather than assumptions of mind reading.   If after providing these direct examples, she shows that she does not care to do that kind of work for the relationship, then you will have a closer answer as to how to proceed.  Sometimes we have feelings of love but just don't know how to communicate well in relationships.  Our perceptions of our behavior are often misguided as well, where we think we are being supportive but actually only fulfilling our own needs.  If she has patterns of wanting you to be responsible for her feeling state as well then that would need to be addressed in a similar way.  Walking on eggshells in order to be in a relationship will come at a significant cost to you where you will not feel like you can be yourself.  Everything will be about pleasing her which will lead to continued dissatisfaction with the relationship.  If there is no positive reception towards working on the relationship in this way then you will come closer to your answer as to whether the relationship can be saved.  This at least gives her the opportunity to learn if she is interested in doing so and will help you feel that you have tried all that you could in this situation.   Best Wishes, Melissa  
(MA, LPC, CAADC)
Answered on 10/27/2021

How to deal with my mental illness on top of overlapping personality disorders?

Greetings Jason, I read your question, and because you have not yet received treatment, it is not yet know that you are dealing with BPD (Borderline Personality Disorder).  It is important that you find a therapist who specializes in mood and personality disorders. Other mood disorders such as OCD, anxiety, and depression can also be challenges that accompany this condition.  We call these co-occurring disorders. As a therapist, I would like to provide you with psychoeducation regarding BPD. First, let's look at BPD and the signs and symptoms:   People with a borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly. People with a borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships. Other signs or symptoms may include: 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 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) Distorted and unstable self-image or sense of self, 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 a borderline personality disorder. Self-harming behavior, such as cutting, recurring thoughts of suicidal behaviors or threats, intense and highly changeable moods, with each episode lasting from a few hours to a few days, chronic feelings of emptiness, inappropriate, intense anger or problems controlling anger, difficulty trusting, which is sometimes accompanied by an irrational fear of other people’s intentions, feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality.  BPD can be challenging to regulate, however it is possible with becoming proactive in continuing with consistent mental health care.  I suggest that you seriously consider ongoing therapy in order to receive a proper assessment and diagnosis of your symptoms.  If in fact you are diagnosed with BPD, there are effective treatments such as Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) which have been proven to be successful in treating BPD.  DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help with controlling intense emotions, reducing self-destructive behaviors, and improving relationships.  CBT will help identify and change core beliefs and behaviors that underlie inaccurate self-perceptions as well as, perceptions of others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors. Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as: mood swings, depression, and other co-occurring mental disorders.  Just know that you can find balance, and improved mental health with the right interventions.  I hope this information will be helpful in creating greater awareness regarding what you may be experiencing.   Tami Robinson, LCSW/Therapist                                                                                                                    SoulPath Counseling and Therapeutic Services, LLC
(MSSA, LCSW)
Answered on 10/27/2021

Is there a way to get rid of BPD and DID without medicine ? Or at least tolerate it better ?

I am so sorry to hear that you are struggling with symptoms of BPD and DID and it was really brave of you to reach out.  You can definitely get better without medicine and therapy can be a helpful step with that.  It will be important to recognize when your feelings have a purpose versus when they do not.  We of course want positive feelings in our lives, but sometimes negative feelings are there for a reason and we need to live out that purpose in order for it to get better.  If we do not live out the purpose of our feelings, it likely leads us to feel worse.  For example, something as simple as having anxiety about needing to get the chores done has the purpose of getting us motivated to get the chores done.  Therefore, if we do not live out that purpose and the chores remain undone, that can lead to more bad feelings, such as, “I am lazy” or “I am worthless.”  This is a simple example of how if we do not pay attention to our feelings and live out the purpose, they can become much, much worse.  So, I would encourage you to try and separate out the thoughts that have a purpose from the thoughts that do not have a purpose and are more intrusive.    For the ones that do have a purpose, it can be helpful to allow yourself to think through the anxious thoughts because anxiety has a nasty way of going to the worst possible scenario.  If you can wrap your head around that scenario, it can make it less scary.  For example, I had a client that was very anxious daily about being single for the rest of his life.  Thinking to that extreme is clearly anxiety and it just lingers there.  So, then he was able to think through that scenario and come up with a plan to make it less scary.  He then came up with that if he really is going to be single the rest of his life, which is highly unlikely, he is going to work towards being able to live close to the ocean since that is a dream of his.  Thinking about it now does not make him as scared because he recognizes he could be happy with that. So, try to think through specific things you are anxious about that have a purpose and make sure you have a specific plan on how to improve those things. For example, having a specific plan for how to address specific triggers that you have with your BPD.    Intrusive thoughts tend to not have a purpose and it can be really helpful to try and overpower those before they are accepted as truths.   We can have power over our thoughts and I want to help you not engage in these thoughts that make you so upset.  The easiest example of this that I can think of is if I went skydiving.  If I went skydiving I would have some obvious, rational, anxious thoughts.  If I really have a desire to skydive though I will need to not engage in those thoughts.  I might have thoughts such as, "My parachute could fail, I will hit the ground, I am going to pass out, etc."  However, since I really want to follow through with skydiving, I would want to stop those thoughts in their tracks with, "I know this is going to be really fun, they inspect the parachutes ahead of time, people hardly ever get hurt doing this, etc."  By focusing on those thoughts and not engaging in the others, I would be able to follow through with skydiving. Try to sort through any thoughts that get you down about yourself and that you can’t handle all of this and try to overpower those.  These types of thoughts are very common when dealing with these kinds of mental health issues.   As you do those processes it can be helpful to validate yourself as someone of worth and someone that has been able to cope with big challenges throughout your life. Something that could be helpful for you is what I like to call centering thoughts.  These are thoughts that are predetermined and unique to you for you to turn to in low moments.  They need to be powerful enough to bring you back to your center.  It is important that these thoughts are accessible for you to look at when you need to.  Some clients prefer to read and re-read them and some prefer to write and re-write them until they feel better.  I have clients that write these somewhere they will see daily such as their bathroom mirror or phone background, while others simply have them in their phone to pull out when they need to.  An example of a centering thought would be from a client I had that related to nautical themed things and her thought was, "I will not let this sink me."  Another example is from an Olympic skier that actually had difficulties with negative thinking getting in the way of her performance so she went to therapy.  She mentioned that she learned about centering thoughts to battle all of the people telling her she “should be” or “should do.”  To battle those thoughts, she uses the simple centering thought of, “I am.”  She can then remind herself that she is good enough, that she is confident, and that she does want to still compete, which really affirms her own feelings and not others.  Hopefully you can come up with something that helps validate your abilities to move forward and your worth.   I hope that some of this is helpful and that you can apply it to your circumstances.  I hope that you can lean on some family and/or friends through this.  Doing so can help take weight off of your shoulders as well as hopefully get some valuable advice from them. Try to take the healing one day at a time and adding one positive thing back into your life each day. Please contact 9-1-1 if you feel like you want to take your life and they can connect you to resources that could be really helpful.  I wish you all the best and I hope that you are staying safe.
(MA, LPC, NCC)
Answered on 10/27/2021

What are some tips on coping with a bipolar parent?

Bipolar Disorder is a diagnosis whose symptoms create an erratic and sometimes create gret chaos in the person's life who has the diagnosis but also in the lives of those who regularly come into contact with them.  What seemed fine two or three sentences ago can just as suddenly turn dangerous and lead to a hospitaliztion as you notice.  It can also just as quickly destroy the peaceful setting of a wedding and create forever negative memories of something that should be beautiful and wonderful.  It is, however, as you probably already realize something that is difficult to manage.  Setting boundaries is healthy but it can be difficult to navigate the emotions of another person who is hearing or receiving the boundary setting.  The timing of setting boundaries needs to be chosen with the greatest of care.  It seems that you have been managing this dilemma for a while and would like some guidance. It would be important for you to share how the person diagnosed with Bipolar Disorder has been affecting your life.   You say that this happened 3 years ago so I would ask that you prepare a time line of how she affected your life prior to the diagnosis and since the diagnosis.  No piece of information is too miniscule.  They are all very important to resoling your dilemma and determining how to begin setting boundaries.  Please be as specific as you can concerning any past interactions and attempts to work with her mental health symptoms.  What was successful and what was not successful?  Are you aware of the National Alliance for the Mentally Ill a/k/a NAMI?  There are many groups throughout the United States and they provide resources at their websites and meetings that are educational and supportive.  You can reach then at www.nami.org.  You may find that their availability is limited to or heavily internet or virtually focused today.  That would be a good resource whether virtual or in person.  Bipolar Disorder is best managed through a combination of counseling and medication.  Medication is going to be generally a lifelong situation as it is a chronic disease much the same as diabetes or heart disease.  She will decompensate from time to time so finding successful responses to her symptoms that you can use on a regular and steady basis.  This is likely to reduce the chaos and change for you.  Read a good book on Bipolar Disorder. The best writer I know is Kay Jamison who wrote An Unquiet Mind and who is a medical professional diagnosed with Bipolar Disorder.  You will find that a search of "Bipolar Disorder" on Amazon will produce family books for those who love a family member diagnosed with Bipolar Disorder.
(Psy.D., LISW-CP/S, CACII)
Answered on 10/27/2021

if i was sure of having a specific mental ilness, can i tell my therapist?

Hi Sarah, what an interesting question!  Therapists are all very unique human beings, just like their clients!   So we can't ever predict for certain how a given therapist might feel or act when faced with a given situation... it would depend on so many things, like the therapist's philosophy of practice, approach to counseling, and his or her values and personality.  It's true that when people feel annoyed (which is a mild form of anger) they sometimes cope with that discomfort poorly, by lashing out.  But a well trained will be able to recognize if he or she ever feels annoyed with a client, and will know what to do about that, rather than lashing out at you by doing something like selecting a diagnosis in an "oppositional" manner, just to prove you wrong.  My suggestion is to talk about the elephant in the room, Sarah!  In other words, let your therapist know that you have this worry that he or she might become annoyed with you if you suggest a possible diagnosis.  I think that genuine disclosure on your part would go a long way in to helping to ensure that your therapist keeps an open mind to suggestion of a diagnosis.      But can we go a little deeper here and talk about the whole concept of "diagnosis?" The practice of labeling/categorizing people and their psychological problems, oh boy!... I know it's a very popular practice, but it's definitely got its pros and cons, Sarah.  It can be helpful in some ways but can really be counterproductive and growth-sabotaging in ways too.  I wish I had time to say more about the potentially damaging effects of "diagnosing" someone.        The diagnosis of psychological issues is FAR from an exact science. If you went to 5 different therapists, I'd be amazed if they all diagnosed you with the same "mental illness."  So how can we then say that self-diagnosis is "dangerous" if it's so highly subjective to begin with?     The only real problem I see with self-diagnosing is that many people might not be able to look at themselves very objectively, meaning they might be in some level of denial or self-deception regarding their thoughts, emotions, or behaviors.   But you are saying that you feel you have "BPD," or its latest flavor/incarnation "quiet" BPD.    So evidently you're not in denial, but do guard the opposite problem, Sarah!... OVER-identifying with a potential diagnosis.  Diagnosis is just a theoretical construct, ONE way of "seeing" the unique being that is YOU.  To over-identify with that theory, as if is some fact, would be limiting at best.   Bear in mind, the Medical Model (which includes diagnosis) is just one way to look at people and their challenges.  It's a problem-saturated way, rather than an empowering way, in my view.    The diagnostic categories and criteria change every so often.  Supposedly that's based on emerging research but it seems likely that all sorts of factors (including cultural ones, politics, and the pharma industry) impact WHAT is studied and HOW it is studied and how we as a society choose to view and label human challenges.  After all, not all that long ago homosexuality was seen as a mental health disorder!   A diagnosis won't resolve anything.  It's just a shorthand way of identifying a group of symptoms that tend to "travel together."  At best, a diagnosis can help you and your therapist apply some potentially effective solutions, based on what's worked for other people who have a similar set of symptoms.  And yes, that can be helpful!   But don't let the diagnosis limit you or define you. don't take it all that seriously.  Treat it like an interesting acquaintance, don't fall in love with it.       My best advice:  Make a list of specific positive changes you wish to see in YOURSELF, and in your relationships with others, and in your life.  Get to work on those goals with a supportive and empowering therapist who takes an approach that resonates with you. You can do that with or without a diagnosis, at least in my view!   Good luck to you!   Maya    
(MS, LMFT)
Answered on 10/27/2021

BPD?

Hi Maya!! Welcome and thank you for your question. All of the diagnoses you have identified have overlapping symptoms. There are many symptoms and patterns that are similar such as poor impulse control, emotion dysregulation, sensitivity, mood swings, depression, anxiety, and others. These symptoms are not the only symptoms but are often experienced by many people with the diagnoses you have identified.  All of these diagnoses have many contributing factors. There are genetic components and environmental components that result in presentations that could be equal to any of the above. In order to determine what diagnoses exist; it is important to complete a detailed biopsychosocial assessment. It is also important to note that all of these diagnoses can exist. Sometimes it is not an either-or scenario but an also or and scenario. People can have multiple diagnoses, and we identify this as comorbid or co-occurring. This also depends on which diagnoses exist together.  If there are symptoms that have been identified, and they have become unmanageable, it may be important to connect with a therapist and begin identifying what symptoms exist, how they are presenting, as well as how life is impacted. It can also be helpful to know that all these labels are treatable. The above diagnoses may present similarly and have similar origins. There are generally reasons these symptoms have presented and identifying the reasons and contributing factors can result in behavior changes and improved quality of life. If we are able to identify how the symptoms started and when they started we can learn useful interventions to change the responses and expressions of hurt, anger, shame, etc. We may also find that these labels are inaccurate and a different label is more appropriate. Labels or diagnoses are simply frameworks to practice. Some people have some of the symptoms and do not fit the diagnostic criteria as it is written, but the interventions remain helpful. Treatment is individualized and I invite you to connect with a clinician who can, with your input, develop a treatment plan that is most effective for you. The two of you can develop measurable goals that you assess often to determine growth. 
(MSW, LCSW)
Answered on 10/27/2021