BPD - Manipulation and Attention seeking.

Attention-seeking and manipulation 

This is a follow-on from my post An Episode from the Borderline -  Life with BPD.

BPD has a terrible reputation and stigma attached to it with regards to attention-seeking and manipulative behaviours in sufferers. There may be some who are like this, just as some everyday ordinary people are like this, but I've never encountered manipulative behaviour in the BPD sufferers I have met.

These are uncomfortable topics for me. I have been accused of both in the past and it really hurt. It's hard to admit, but to a certain extent the attention-seeking bit was true. It wasn't the "Hey, I'm so brilliant, look at me!" attention-seeking. It was the "Help, I'm in such desperate pain, nobody can help me, I don't know what to do and nothing is working.." 

Very different.

I hated it and I despised myself when I felt myself slipping in to it. 

It left a lasting negative impact on my confidence. 
Any triumphs, achievements, illnesses, successes etc, I now play down for fear of being labeled it again. 

I would disagree on the Manipulation one though. Manipulation requires a degree of cunning and planning and I'm just not capable of that mentally.

It is possible that whatever I was supposed to have done at the time was interpreted this way by someone inexperienced or uninformed or who didn't give a stuff, but unless I ask them, I guess I'll never know..

When I see others display attention-seeking behaviours. Instead of being quick to label, I look beyond their actions and ask myself, "What in their lives are they lacking that they feel the need for more attention?", and "Are they being neglected? Abused? Ridiculed? Criticised or bullied? Are they lonely or starved of love and affection?"

Somebody who has all their basic needs met, does not feel the need to act in this way. 

Maybe the person in question feels they can't ask for what they need - they might see it as a weakness to ask. Whatever has brought them to these behaviours is a desperate cry for help.

A baby cries when it wants something. It's natural and instinctive, but over time it is conditioned to suppress this.

We are social animals and all need attention, kindness, companionship, love, cherishing and nourishment, encouragement and support..

It's okay to want attention! Some people need more than others. I know I can be quite a needy person sometimes, and things can tumble if my basic needs aren't met..but that's just who I am.

The attention-seeking/manipulation reputation runs rampant in psychiatric hospitals....but I believe this is down to uninformed and inexperienced staff.

The BPD diagnosis itself comes with such a stigma..it's automatically assumed that you are going to be a non-compliant, troublesome patient if they see this in your notes.

I hope this will change..and I believe it is starting to.

In the past, I've been involved in talking to psych nursing students to banish some of that stigma and myths...it was a really positive experience, and I hope the next generation of psychiatric nurses will look beyond the diagnosis and see the person for who they are..

An Episode from the Borderline - Life with BPD.

I thought it was high time I wrote something about that grossly misunderstood illness: Borderline Personality Disorder. (Actually the 'Borderline' bit of my blog name isn't to do with the disorder - it's that feeling of standing on the edge of life and looking in..of being on the Border Line and not quite belonging).

  

I was diagnosed with BPD in 2006, quite late on in my time in the psychiatric system. They've always said it was rather an iffy decision. Often the diagnosis is given when the doctors haven't the foggiest idea of what's wrong with you. If you are young, female and have a tendency to self-harm, your chances of getting the diagnosis will be higher. (BPD is the only mental health disorder in DSM IV-TR that lists self-harm in the diagnostic criteria).

It's not nice to be told you have a Personality Disorder. When I was told, it made me examine every single little thing about myself that might have led to this diagnosis. Was I some sort of psycho? Was I even a real person? I didn't seem to know anymore.. 

What did my personality even consist of? Was it my intellect? Was it because I possessed an earthy sense of humour and cracked up at the mere whiff of a fart joke?

Was it my personal habits? (Okay - I drink out of my cereal bowl when I'm feeling too lazy to spoon it all up), or that I laugh too loud or frown when I smile??

Was I too shy or too sensitive or too tomboyish? Was I considered not Normal? And what was normal anyway? I thought I was just like everybody else..

I've always believed your personality is what makes you, YOU, and when I was told on that fateful day back in 2006 that I had a Personality Disorder, it crushed me. In the space of a few seconds, the Kerry I had known and thought I was...was a completely different girl.

At the time, I was pretty much told "You have this disorder", (gee..thanks), but I wasn't told what it was or what the symptoms were, or even how to manage it.

For inspiration I looked on Amazon to see what books I could find on what it was all about and how to cope with the condition. 

BIG mistake. 

To my devastation I came across books such as "Splitting - Protecting yourself while Divorcing someone with Borderline or Narcissistic Personality Disorder", "My toxic BPD Mother - 'A shattered Childhood'", or "Surviving a Borderline Parent", and probably the worst of all, "Borderline personality disorder, How to spot it - a checklist" written by an FBI special agent. The product description ends "Practical, fast, easy to read...this guide sheds light on a disorder that afflicts many, with serious consequences for the rest of us"..

Well excuse me while I go and find my axe for my morning spree.

I cried when I saw those books. What sort of person was I? Did people really think I was like this? I hid in my flat for weeks while I tried to process what I had read. It totally destroyed my confidence, and paranoia set in big time. I somehow felt I was a defective person, and that is still carried with me today.

The name "Borderline Personality Disorder" is misleading - Go to Wikipedia, punch it in and you'll get a rather hefty explanation of the whole BPD thing. It gives you the facts as they are, but written in a sensitive manner whilst addressing the stigma, myths and background surrounding the name of the diagnosis.

(Manipulation and Attention Seeking Behaviours will be covered in a later post).

BPD has a huge criteria and believe it or not, there are 256 combinations that would land you with a diagnosis. I have the DSM IV-TR sitting in my bookcase in the hall, and once for a laugh, I flipped through all of the personality disorders. I spent the entire time going "That's me..that's me...OMG, that's me...definitely me..WTF?..I have ALL the personality disorders in the book!..."

I think most of us would recognise aspects of ourselves in the pages of the DSM. It doesn't necessarily mean you have any of those things...it just means you're human. All of us have traits in our makeup that we're less than happy with..

I hate the term "Borderline Personality Disorder". Personally I prefer "Emotion Dysregulation Disorder" because that's what I have. When you get past all the stigma and pare it down to the bare bones, it just means I have a problem with controlling my emotions sometimes. That's it...No questionable personality..no morning rampages with my axe..no stalking sprees..

Once I had got over the initial shock and found out what it was all about, a light went on in my head. It described me very well and explained so many things that were a bit 'off' in my life which I didn't have any answers for. It was a huge relief and I was able to lump all these things together and store them away in my mind. 

As time went on though, anything that went wrong in my life or relationships I blamed on the disorder and I was very passive about doing anything to sort the situation. 

For a while, I even shunned the diagnosis altogether because the stigma of it got me very paranoid. I felt much better after that, and more like a 'real' person. But underneath I knew it was still there, lurking in the undergrowth waiting to be dealt with. 

There is a debate amongst doctors whether the patient should even be told at all. There is concern the sufferer may react badly to the stigma of such a diagnosis and having a Personality Disorder foisted upon them. I can relate to this. But despite all the anguish it caused, I'm glad I was told. It explained a lot that was going on, and now I know what the problem is, I can do my very best to put things right.

So what does an iffy BPD diagnosis mean for me?

Impulsivity: In the early years my diagnosis, impulsivity was a much bigger problem than it is now. 

In the past this included suicide attempts, self-harm episodes, overspending or bulimic binges, and buggering off somewhere when things got too much. 

Now it tends to mean ordering in a pizza when I can't be bothered cooking and not telling my boyfriend, or buying a dress or two in the sale when I hadn't planned to spend any money. Yes, I still feel the need to bugger off sometimes, but now I talk it through with folk before I go.

Of course, being with someone makes the impulsive side of things more difficult, and I think some of my impulsiveness was due to my single life, (I had lived on my own for 10 years before I met my boyfriend and very used to my own ways).. I have to think twice now before I do anything..which is maybe a good thing!

Almost all of the impulsive behaviours were because I felt myself to be in an emotional situation that I didn't know how to deal with, and these brought some temporary relief.

Intense and rapidly changing Emotions: This is something that challenges me day to day, but is improving as time goes on. People in my circle do find it baffling - I can be in the depths of despair thinking This is the End, yet once the conflict has been resolved, I can be back to my usual self very quickly.

Sometimes I overreact to things and feel things for longer and more deeply, whereas in the same situation, the average person would just feel a mild twang.

Fear of Abandonment: This is in the criteria but not entirely accurate for me - I don't fear abandonment, I expect it.

Fear of Rejection: This is getting better as time goes on, but it used to bother me a lot... Everyone wants to be liked..don't they? 

Now I can see that I don't always take to everyone I meet, so why should I expect others to? Everyone is different and has different tastes. I try not to give a stuff about whether someone likes me or not..but sometimes it's difficult if I'm feeling a bit low for whatever reason.

Sensitivity: I am very sensitive to the way others treat me.*  I'm always being told I'm far too sensitive, which drives me mad. This is a lot better than it used to be, and back then, God help you if you had done something to cross me! Now I know that other people have their own battles and journeys and my being hurt was not always intentional...Just me being over-sensitive again!

*This is a tricky one though.. People with BPD have very high standards in how they treat people. They are often very kind and caring and go to great lengths to make sure others are comfortable and happy. The downside is that we expect the same in return, and when it doesn't happen, it's a bit of a blow and can cause a lot of anguish.

Poor Sense of Self: I think this, and not knowing my path and place in the world are the biggest problems I face in my life. It's not necessarily solely related to BPD - I believe there are other things in my life that contribute to this. 

I also get bored very easily and find it hard to stick to things once I lose interest. I'm unable to see the long term, and sometimes feel a bit trapped if anything like that comes up. This is something I am currently working on.

Several people I know of my generation would tell you they have no idea of what they want to do, or where they are heading or who they are, and that commitment scares them. None of them have mental health issues.

Black and White thinking: Guilty! This happens when I feel stressed or backed in to a corner and I can only think Black or White and forget to look for the Grey. People close to me have told me that my voice tone changes when I'm in this state of mind. I've never noticed it myself!

Chronic feelings of emptiness and loneliness: Even when I'm with people, I can sometimes feel desperately lonely. It's a hard one to describe..most people (myself included) find it very difficult to understand.

The feelings are usually more noticeable in the evenings.

Sensory Overload: Apart from my dodgy hearing, my senses are very acute. I've read that many BPD sufferers have faster visual perception and sensory reactions than the average person.

It's exhausting at times, and simple things like shopping in a busy mall, too much information to absorb, or too loud a film with subtitles at the cinema can be overwhelming. I used to feel really silly because a day at the shops totally knackered me for some unknown reason. Since then, I've met others who experience the same and I don't feel as bad about it.

This overload can lead to:

Dissociation: When things get too much, I just zone out and shut down completely. I've been told my facial expression goes flat and I totally withdraw. 

It's not pleasant, but since taking precautions to reduce some of the stressors, thankfully it doesn't happen very often.

In the past, I've lost days to dissociative attacks.

When an attack is about to happen I start to lose concentration and focus, and can feel my eyes glazing and head clouding up. It helps if I stop and take a wee break with a cuppa, go for a walk or have a short nap.

Treatment 

Sadly, there is not much out there by ways of treatment for BPD leaving sufferers feeling let down. Talking therapies seem to have a much better outcome than medication and it's just finding the right one to suit the individual.

I tried Cognitive Behavioural Therapy (CBT) for a while - it aims to challenge thoughts and change negative thoughts in to positive ones. I agree with the concept behind it, but I didn't have that much success with it to be honest - if ALL of your thoughts are negative, it can be bloody exhausting and depressing to change every single one of them into a positive thought. 

I struggled by for years, despairing that I would ever be at peace with my mind. At the end of my tether, feeling desperate and totally disillusioned by the National Health Service, I decided to go to a private therapist. I wish I had gone to him years ago. 

He gave me the tools to find the inner peace I was looking for. He made me realise that I'm just an ordinary person with troubles, not some dangerous person waiting to strike at her next unsuspecting victim without any warning, destined for the state hospital forevermore, Amen. 

It costs..but it is worth it. An investment for the future..

For me, Mindfulness Meditation has produced the most dramatic results in dealing with this condition. It has calmed my inner chatter and I feel more balanced within myself. I am able to cope with people and situations without overreacting in the way I might once have.

I hope this, along with grounding myself will lead me to discover my Sense of Self and Purpose that I lack.   

Out of all the BPD sufferers I have met over the years, no two have been alike. What I did find fascinating was that they were probably the nicest and most interesting people I have ever met. Vivacious, quirky, magnetic, and very kind and compassionate. Not the monsters made out by those books from Amazon..

Having a BPD diagnosis isn't a death sentence. There's hope for me yet, and the prognosis is good. There's a very good chance that I will not meet the criteria several years down the line.

It isn't all bad y'know!  It can be wonderful at times. Those intense emotions? It's not just the bad ones I'm stuck with. All the good emotions..happiness, joy, pleasure, compassion, love and excitement and so on.. I feel them much more than the average person. And all those amazing feelings make up for the crappy things a personality disorder can bring.. 

Anorexia.

It gets on my nerves when the glossy girlie magazines are often blamed as the cause of anorexia. It wasn't like that for me, and the anorexics that I have come in to contact with rarely mentioned the images in magazines as the cause of their illness. Instead the reasons ranged from trauma, neglect (emotional or physical), being afraid of sex or growing up, to have some control in a chaotic life, the many forms of abuse, lack of self-esteem, being in the shadow of a dominant sibling, a dominant mother, and many, many other reasons. Every anorexic is different, and the reason(s) that he or she became that way also differ.

A person suffering with anorexia is often seen as attention-seeking, fussy, stubborn, or the whole situation is a silly diet gone wrong, or a way to manipulate people, revenge, or the person is just being plain awkward and "for F*** sake, why can't you just EAT?"

This was something I heard frequently when I was ill. Unfortunately, not being able to eat is the tip of the iceberg. It's more complicated than just shovelling food into your mouth, chewing and then swallowing. How do you explain to someone (if they are even willing to listen), that being presented with a meal is like attempting to climb Mount Everest with a broken leg? Or that the innocent action of a friend inviting you out for coffee can evoke extreme terror and the probability of you saying "no" is about 99.99%? Or the only way you can go to sleep at night is with the knowledge that you haven't eaten today, that you've notched up 1000+ calories on your exercise bike, and as you slump in to bed exhausted you are so hungry that it's painful. But you feel safe. And clean. As you drift in to sleep, you dream about food. Every night. Huge banquets. You can taste it in your dream. It's wonderful. But then you wake up and realize that you will never be able to attend that banquet or eat that food for fear of the consequences-whatever they may be.

During your waking hours, you think about food constantly. You salivate and your tongue craves the feel of food on it. You gaze longingly into the windows of cake and chocolate shops, savouring every smell hoping it will satiate your desperate hunger. But it doesn't. You want to go in and buy the whole shop. But you can't. You mustn't. It would be weak. Your bathroom scales are your best friend and your worst enemy. They determine your mood for the day. You also develop an uneasy relationship with your toilet. The fear that any food has been ingested is so great that you will go to great lengths to get rid of it. Vomiting, laxatives, ipecac, enemas and colonic irrigation to name a few. After a while, the laxatives don't work any more. Your body has gotten used to them and you need more and more just for them to take effect. When they do, you are perched on the toilet for hours in the middle of the night with stomach contractions comparable with what I imagine childbirth to feel like. They also make you have cold sweats, palpitations and chest pains which make you think you are having a heart attack.

I was fairly uncommon in that my anorexia wasn't about my weight or body image. It was about what putting on weight represented. Growing up. Becoming a woman. Sex. A boyfriend. Motherhood. A job. And just being in a world that I felt too young for and which I hated. At my lowest weight of 69lbs and a BMI of 9, I could see how thin I was. I looked like a concentration camp victim. I looked disgusting. But I felt safe.

In hospital, being stuffed up with food, calorific nutrition drinks, drips and a nasogastric tube terrified me. It brought me closer to a life that I was frightened of and one that I didn't feel ready for.

I have photographs of myself from those days. I used to be proud of them-the achievement of getting that thin! But now when I look at them, I feel sick.

I didn't really know all my reasons for becoming ill until far on in my recovery process. I made a conscious decision to become anorexic. Initially it was to buy time until I worked out what the hell I was going to do with my life after the devastation of the breakdown. I'd devoted my life exclusively to music and that had gone. I was left with nothing. I needed something to focus on. Anorexia fitted the bill.

As a person, I am determined, goal orientated, a perfectionist, single-minded, stubborn and I like my own way. These qualities are fatal in an anorexic.

Looking back, I'm not surprised I ended up that way, and my reasons for becoming so were much more complicated than I'd originally thought.

I mentioned in a previous post that I'd wanted to be a nun for years. Now I can see that my motives for that were not fully religious, but an escape from the world, living in an ordered environment with somebody telling me what to do 24/7 for the rest of my life.

I'd felt a decade too young for my age. At university when my contemporaries were talking about jobs, in the back of my mind was a small voice telling me that I felt about 12 and too young for all of that. My childhood home-life was complicated; single parent, dominant younger sibling, and my own personality as a child, blah blah, which stunted my emotional development. I also believed I needed to punish myself for my failures. I felt I didn't deserve to live a normal life or to have love, so I deliberately destroyed the potential for both. There are other layers to the onion which I won't go in to, but it was definitely not a glossy magazine that gave me the idea to embrace an eating disorder!

It's hard to say if I regret those years. I do and I don't. I wasted a decade of my life which I can never get back. I am now left with osteoporosis, dodgy teeth, digestive troubles and food intolerances. I had no periods for 8 years and it's unknown whether I will have trouble conceiving when the time comes to have children.

Sometimes I feel very old for my 34 years.
Despite all this, I learned a lot. About me. About people. About life.

I feel a much richer person having come out the other end. I hit rock bottom and survived, and I found that life is not as scary as I once thought it was. Yes, I get anxious about all the crappy little things, but my attitudes towards the bigger picture have relaxed significantly. It irritates me when I see parents pushing their children to be something they clearly don't want to be which can cause emotional damage in the long run. As long as that child is healthy and happy, who cares if he wants to be a barista rather than a barrister?

I learned that life is precious and fragile and should never be taken for granted. I also learned that life can be very cruel.

I'll talk about my path to recovery in a later post, but I am extremely glad that I have no lasting food issues from those years. I put this down to my reasons for becoming anorexic in the first place-buying time and hiding from life rather than a distorted perception of my own body.

It's a sad fact that people have fewer expectations of you in the midst of anorexia, and now that I am recovered this is the thing I find hardest to deal with. I could never go back to that way of life, but sometimes when I'm having a crap day and stressed with the demands on me, I occasionally yearn for that simpler life where the only things I worried about were my weight and when my next binge would be. (I had bulimia alongside my anorexia, but I'll talk about that in time). Then I remember the fear that surrounded those years, how lonely it made me and how I nearly lost my life on several occasions. It makes me realize how lucky I am to be alive and how far I have come since I decided to face my fears and make the decision to recover.


Kerry.