Category Archives: Diagnostic and Statistical Manual

Identity Disturbance…

Identity Disturbance is a relatively and equally fascinating new term to me and since I haven’t researched it to my satisfaction to be able to write about it, I thought I would begin here by re-blogging this article from The Bernard Bert-A Borderline Adventure.  This author did a great job of streamlining and breaking down the components of this condition.  Hoping this continues to shed some light on the many shades of mental illness and reduce the stigma attached.~~Thanks!  Little L~~

broken heart

 

Identity Disturbance, November14, 2013

Identity disturbance: markedly and persistently unstable self image or sense of self.

“Identity disturbance has many different aspects/features making it a very complexed issue even if it is a lone problem, but with the added factor of other BPD symptoms, it can be an overwhelming and complicated thing to understand and deal with!

In a 2000 study of patients with identity disturbances, Tess Wilkinson-Ryan, and Drew Westen identified four types of identity disturbance:

Role absorption (in which patients tend to define themselves in terms of a single role or cause),

Painful incoherence (a subjective sense of lack of coherence),

Inconsistency (in thought, feeling, and behavior),

Lack of commitment (e.g., to jobs or values).

A stable sense of identity means being able to see yourself as the same person in the past, present, and future.Identity is quite broad, and includes many aspects of the self and is probably made up of your beliefs, attitudes, abilities, history, ways of behaving, personality, temperament, knowledge, opinions, and roles.

A healthy identity includes the ability to choose an appropriate avenue for industry, achieve intimacy with another, and find a place in the larger society by having developed a sense of continuity over time; emotional commitment to a set of self-defining representations of self, role relationships,and core values and ideal self-standards;development or acceptance of a world view that gives life meaning; and some recognition of one’s place in the world by significant others.

“Who are you?”  – If asked this question, many people with BPD would be unable to answer and will only be able to reply with – “I don’t know”, “I’m not sure” or “It depends on who I’m with.”  This uncertinaty makes them feel empty and lost, confused and lonely.

Considering that identity is comprised of stability, continuity, understanding and acceptance of ones self over time, it is painfully obvious to see why this doesn’t happen in the self identity of someone with BPD.Nothing is stable, everything is changing and totally reactive; all that is left is a fragmented self left with a chronic feeling of inner emptiness caused by the inability to integrate into a coherent sense of self identity.

These unanticipated changes can range from relatively minor things, such as changes in appearance, to aspects central to the life of the individual, such as gender, sexuality and life goals.

People with Identity disturbance may experience:

Experiencing frequent changes in sense of self-worth.

Difficulty committing to roles and occupational choices.

Feeling conflicted or unsure about own gender or sexuality.

Feels as though he or she is a different person depending on who they are with.

Does not know who own self is.

Tends to feel empty inside – hollow, something ‘missing’ and a desire to fill the void.

Who they would like to be are unstable and ever changing.

Views & feelings of self change rapidly or unpredictably .

Has memories only available under certain states sometimes feels unreal.

Tends to feel like a “false self” whose social persona does not match inner experience.

Some of the noticeable changes for those who know the person with the identity issue are:

Lack of consistently invested goals, values, ideals, and relationships.

Their personality changes dramatically periodically.

They are “chameleon-like” depending on who they are with.

Values tend to change frequently / does not seem to have a constant set of core values.

Difficulty choosing and committing to an occupation.

Beliefs,actions and behaviors often seem contradictory.

Has trouble committing to long-term goals or aspirations.

As a way to ‘fit in’ they may:

Identity seems to revolve around a “cause” or shifting causes.Defines self in terms of a label that provides a sense of identity.Depend on relationship to a charismatic other. Tends to be in the orbit of a strong personality.People with BPD can be very “chameleon-like” in an effort to integrate.

The tendency to confuse one’s own attributes, feelings,and desires with those of another person, especially in intimate relationships, means that when a breakdown in a relationship occurs it can lead the person with BPD to fear a loss of personal identity.

The large inconsistencies in behavior,over time and across situations, lead to difficulty integrating multiple representations of self, a lack of a coherent life narrative or sense of continuity over time;and a lack of continuity of relationships that leaves significant parts of the BPD’s past “deposited” with people who are no longer part of the individuals life , and hence the loss of shared memories that help define the self over time.

One contributing factor to borderline identity disturbance is dissociation.  When we compartmentalize our experiences rather than integrating them into one meaningful whole, our sense of self fragments causing  us to feel lost, empty, and confused.

As this empty feeling and loss of inner self becomes more problematic and chronic (in some cases) a refuge world or fantasy self can at times take the stage by means of dissociation from the painful reality the BPD is forced to live in if they remain in their current state consciousness/awareness – making it similar but not the same as DID  – Key points of difference are that those who suffer DID (dissociative identity disorder) usually remain unaware of their other fragmented selves (referred to as alters) which are more concrete, unique individuals, accompanied by blacked out memories/loss of time, whereas BPD’s remain more coherent through their changes in persona.

Identity disturbances in individuals with BPD usually reflect efforts to preserve a sense of self-worth in the presence of interpersonal turmoil.

Because of the inconsistencies in what the person with BPD is doing and saying, non BPD’s may accuse them of “faking it” “Lying” or “putting it on” but this really isn’t the case, they just may not be aware of it and by saying these things to them may actually hinder their progress in changing thier behaviour by making them doubt themselves,their worth and their relationship with you and others.

Other issues that may arise are eating disorders, substance misuse or reckless/impulsive behaviours, (these may also a seperate issue for people with BPD regardless of whether or not the have identity disturbance); all which may feel like a form of control over their lives that they are lacking in other areas.

If you have the associated,emotional instability,impulsive behaviour and black and white thinking of BPD you may have difficulty forming a coherent sense of self because your internal experiences and outward actions are not consistent. In addition, many people with BPD come from chaotic or abusive backgrounds which may contribute to unstable sense of self. If you determine who you are based on others’ reactions to you, and those reactions have been unpredictable and/or scary, you have no framework for developing a strong sense of identity.

However, it’s not all bad, on the positive side of things not knowing who you are allows you to start from scratch, experiment, explore and to build yourself up into the person you want to be!

So how do we tackle this issue and find out who we are?

Treatment/therapy with a trained professional is the most highly recommended way to deal with these issues as they can help to guide you through the process of self discovery; but there are also things you can do yourself too.

One way is by observing your own emotions, thoughts, and feelings, in addition to others’ reactions to you.

Questions and reflection on things like:

How do I want to be seen by others?

What are the things most imporant to me?

Who do I admire and what positive traits do they possess that I respect and could incorperate into my own life?

What am I passionate about?

What talents/attributes do I have?

Another way is to try and work out which areas you would like/need to focus on by writing a list which includes:

Intimate

Relationships

Parenting

Family

Friendships/Socializing

Education/Personal

GrowthCareer

Recreation

Spirituality/Religion

Physical Health

Helping Others

Goals

Values

How would you like to act/react to each section? What can you do to make this possible?

These are the things that help to give us identity and allow us to form a more stable sense of self. Due to the complexity of the issue, the road to ‘finding yourself’ is a life long journey of discovery and one which may take you to some upexpected, intense and even pleasurable places emotionally!

No one can tell you who you are, they can discribe you but ultimatly it is up to you, you are the one who can make the changes, the one who can decide as to how you act and what you believe and stand for.  Who/whatever you decide to be/do, remember that you are worthy of love, to be treated with respect and to live a life that you want and deserve.

I hope that this helps explain a little of what and why we feel this way and, fingers crossed, we can start to finally build the jig-saw of ourselves that has been in so many pieces for so long! ~ Emma.”

The Bernard Bert

 

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my spa day at the psych hospital

imagesIt’s been over a month since I made the pilgrimage to the psych hospital for an evaluation.  My emotions have settled down a bit and I’ve had contact with all the practitioners in my life who require a visit after such an incident.  I’m also able to write about it with a caustic and a wise ass dark humor that I lacked in previous weeks.  I suppose on this matter too, I’ve found my voice.  I should know by now that given enough time and perspective, I usually do find my voice.

The prompting incident was another perfect storm containing all the ingredients for me to “drop my basket”.  In Rebecca WellsDivine Secrets of the Ya-Ya Sisterhood, Vivian Abbott Walker has a breakdown and is hospitalized in some asylum for months.  She won’t discuss the issue for a long time but eventually coins a phrase to describe her mental collapse where she hallucinated, beat her children all the while forgetting how to chew food and pee in the toilet.  Months later, she finally confides and describes to her Ya-Ya’s how she “dropped her basket”.  In the absence of a better term, I’m going to borrow hers.

In a 6-day rampage of unmanageable BPD symptoms, gross lack of familial support and triggers out the whazoo, I finally consent to let a friend drive me to one of several major hospitals in St. Louis for an evaluation.  I had nothing to lose.  I had been crying for days, couldn’t remember when I’d eaten last, only slept because of the inordinate amount of anxiety medication combined with several other chasers of alcohol, Vicodin and Benedryl.  It was a sure-fire combination to collapse into something resembling sleep but a losing combination in terms of maintaining equilibrium and optimal functioning of the body.  Unconsciousness is the desired state for me when I’m so grossly triggered finding my reality irretrievable. No matter how many DBT skills, prayers, affirmations, walks in the woods, music and every other distraction skill I applied, nothing was working.  I was scared shitless and needed a person.  A real, live, breathing person to sit with me while I piggybacked off of their energy and found my center once again.  And to make matters worse, I had been left alone for 5 days, scorned for the burdensome person that I was which was the tipping point to my basket drop.

This is the truly horrible part about Borderline Personality Disorder, which I probably have as a result of early onset trauma.  It forever changes how our brains work and makes us a scary group of people to be around causing this paradoxical conundrum where even though your loved ones don’t want to hold onto your psyche at this particular moment, its about the only thing that actually works for me.  The DSM, the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association classifies BPD with a list of symptoms that the candidate will have at least 5 of the 9 listed.  And even though, there were many symptoms, BPD related or not, swirling around in this muck of 6 days, it was one in particular that probably defines most of my issue of that time.  #1 on the list is “frantic efforts to avoid real or imagined abandonment”.  Yes, my efforts were frantic.  I called pretty much everyone I knew in person as well as sought out online friends and even a guy standing outside the convenience store smoking in an effort to make some physical, face to face contact with someone.  Pretty pitiful, huh?  And yes, my abandonment was real AND imagined, I had both to contend with.  And damn, I didn’t do well and definitely “dropped my basket”.

Enter Cindy and Kathy, my two saviors of the weekend.  They sat with me one night until I felt well enough to be in my house alone.  They brought food and conversation and did a fabulous job of distracting me, giving me some solid ground to stand on.  That lasted one day before I was back in the muck; crying, not eating, mixing meds and smoking cigarettes, a habit given up over a decade ago.  When, in 3 more days, I still hadn’t emerged whole, it was Cindy who declared it time to go for an evaluation.  I didn’t argue, just packed a bag and grabbed my insurance card and off we went to the psych unit of her choice.  Now, it sounds like I’m gonna start doggin’ on the state of psychiatric options and hospitals in general, which I’m not.  For at this particular moment, I was damn grateful that I lived in a city where I had an actual choice of which one to go to and that I had insurance to get in the door.  There were certainly patients in the waiting room who didn’t possess the golden ticket of primo insurance that I had, which made me cry even harder.

I was led down and around several corridors which I realize later put me way in the back of the ward in some sort of lockdown room.  I was asked to undress into paper scrubs which is a far cry from the old paper gowns that didn’t close in back.  My clothes were taken from me and within minutes a team of interns with a doctor arrived in a hysterical entourage of tall, rolling, podium like things with computers mounted on top.  When they were speaking to me, all I could see was the back of the screen, not their faces, which made them look like a team of rectangled shaped droids with lab coats and feet.  I found this really amusing and wondered if this would qualify as real or imagined abandonment.  Let’s just say, given the situation, a friendly pat on the arm or some eye contact would have gone a long way.  After giving them all their pertinent information, I was then left alone and I mean left alone.  I didn’t see anyone for hours until I peeked out and told the nurse that finally looked up from her desk computer screen (Is there a theme here?) that I had to go to the bathroom, could she point the way?  She promptly walked me back into the room and opened a low set of cabinet doors which popped out a toilet seat.  She assured me that it was much more convenient for me to pee in this little toilet in the wall than to have to go down the hall but I knew better.  This was the upscale version of a jail cell.  My bladder and I made peace with our given situation as I didn’t feel that as I was shoeless and in paper scrubs in a lockdown room, that it just wasn’t a good time to fuss.  I settled onto the exam table, curled in a semi-fetal position, pulled out my iPod from my purse (which by the way, still was in my possession and contained several prescribed controlled substances) and began to listen to my relaxation tapes.  More hours went by but again, I had my entertainment and a potty, so I was pretty good.  The nurse had given me a cup of water and a few graham crackers from her stash of snacks.  Plus I’d seen a few people who seemed relatively caring and I felt a sense of relief that if nothing else, I was among people.

Then, whack.  As I’m achieving a blissful state of relaxation and calm, thanks to the tools I brought instead of what was offered, the door slams open with the salty, seasoned veteran of the social work brigade.  Now again, you think I’m gonna complain about her but I rather liked her.  She took one look at my iPod declaring it a weapon of mass destruction and exclaiming how I could hurt myself with that.  She took it really well when I told her if I wanted to do that, I would have done it in the three hours prior.  Out she went to scold the graham cracker nurse then charged back in with her exasperated intern following behind.  “Are you suicidal?”, she asked.  “No, I’m Laurel”, I replied as I extended my hand to shake hers.  This didn’t faze her as she went on to rapid-fire questions faster than the intern could write them down.  The poor thing didn’t have a robotic scooting computer podium, so I slowed my answers down to accommodate her pace.  No, I didn’t harm or cut myself.  No, I haven’t harmed anyone else.  No, I don’t abuse alcohol or drugs.  She proclaimed me fit to go home unless I opted to stay for the accommodations of graham crackers,  tap water and the potty in the wall.  I declined and called another friend to please come get me.

Another hour later, I was given my iPod, my clothing including my bra which apparently posed a huge threat of strangulation to me here in the hospital.  I will have to draw some stern boundaries with that brassiere when I get home to never threaten me like that again.  The nurse presented me with my bill for the day and asked how I wanted to pay.  I told her that in my despair and turmoil, I hadn’t even considered that to which she replied that I could mail it back with payment.  A hundred dollar day that could have been spent at the day spa with seemingly better results.  I’m thinking a massage and a pedicure.

Again, I will practice gratitude that a clean, well staffed, teaching hospital was available to me.  If I was more chronic, the doctor explained, this might be the place for me.  Since I’m fairly functional with an acute crisis, under the care of a psychiatrist and therapist, there aren’t services there for me.  In other words, there isn’t a place for those of us in between.  One must be out of control, harming themselves or others and pose a huge threat to society before the psych hospital is the place to be.  OK, now I know that.  But I still wonder where then, does one like me go?  Where is the tribe of caring people who will help soothe the ravaged soul, bring tea and sing and rock me until my jangled self comes together.  Shouldn’t there be such a place?  I rely so heavily on myself for self nurturing and awareness but accepting my circumstances and limitations prompts me to always have a Plan B.  I’ll keep looking, it has to be out there somewhere.  At least, I know now where it isn’t.


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