Fitting a Square Peg in a Round Hole on a Spectrum

Mental health diagnoses are a funny thing.

Categorization and organization of the world around us seems hard-wired into human nature. Everything labeled and grouped into sets and subsets from the natural world – plants, animals, colors, types of minerals, etc. – to the built world – vehicles, styles of houses, library books, etc, – to types of people based on a plethora of categories – occupations, social affiliations, social status, and country of birth.

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So it shouldn’t be of any surprise that people have sought to categorize our mental states, particularly those that don’t fit into what is considered the elusive well-adjusted normal functioning individual, and put a label of this or that disorder on it. It has its uses. Falling into a diagnosis allows for treatment to be guided in a certain way, which can have a positive outcome. It sure makes medical billing easier (and the cynic in me suspects in this day and age, this is probably the most important reason behind having those diagnosis numbers in your chart – so that someone gets paid).

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But I don’t feel it’s all that simple. Mental disorder can be more of a spectrum than a set of boxes where you go down the row checking off the contents listed on the outside and when you find the correct one you then crawl inside. The DSM seems a little weird to me with it’s “if you have 6 of these 9 symptoms, these 3 of which are MANDATORY”, then you belong here. Okay, but what if I have 6 of those symptoms, but only 2 of the mandatory ones or what if I have all 3 of the mandatory symptoms, but only 5 symptoms overall? Where do I fit then?

It’s hard to make room for all gradients of shading and degree of experience that exist in the real world of human experience.

And that’s the harmful side – people (including therapists) judge you, not based on you as an individual, but because you are seen as your diagnosis, no matter how typical or atypical it may manifest.

I have several categories of mental disorders that can be applied: anxiety and depression, social anxiety, PTSD, and borderline. They are all fluid and interact with each other in a unique way. If I isolate one, lets say social anxiety – how I experience it and express it may be completely different than someone else for a plethora of reasons. Yet, my diagnosis code simply says 300.23. But I know from being in an online support group years ago, that there is a huge range of experiences and behaviors among people with social anxiety. The way I experience it, on the more severe end of the scale, although it waxes and wanes over time, can be very different than the way it manifests in the life of another individual.

And so it is with BPD. And this is especially true when it comes to someone who falls under the label of “Quiet Borderline”. Go into any non-quiet BPD group and one thing that you see over and over again are people talking about their violent outburst of anger – throwing things, calling names, tearing another person down, exploding over trivial things. I honestly can’t relate to this at all. I am not saying the anger isn’t there, but it almost never expresses itself outwardly. It festers within – whether it’s part of BPD splitting when thinking about others (something I do quietly within my own head) or, more commonly, turning inward and destroying my own psyche. Self-harm and suicidal thoughts are a product of that anger. But I can’t even imagine flying off the handle regularly at other people. I am a tried and true conflict avoider. I don’t ever want to be around others who are arguing and raising their voices; that’s a survival “I need to get the hell out of here!” situation. Hell, when I was a kid, I couldn’t even be in the room when the Phil Donahue Show was on because people would disagree and argue with each other and it was too uncomfortable for me to even be safely in the living room with these people on the television. So I sure don’t want to be personally involved in angry conflict.

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I’m also not particularly impulsive. I am not anywhere near what someone would consider a risk taker. I don’t have an addictive personality.

But all the other traits of BPD – oh hell yeah, I have all that in spades!

And I’m betting that others with the quiet form of BPD may not relate to those in the non-quiet BPD groups for the same reasons. But I would also bet that not all quiet BPD experience it just as I do. Because my life experiences, my genetic make up, and my other psychological issues all have an influence on how my BPD is expressed.

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So here’s to all of us square pegs trying to fit in a round hole on something that is a spectrum. Don’t get too caught up in what you are supposed to be. Just be and try your absolute best to deal with the unique challenges living with a mental health disorder (or multiple disorders) brings.

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Please Please Me…no…wait…I mean You

People Pleaser.

Who would guess that something that sounds so innocuous and maybe even slightly positive on the surface could have such a dark and insidious effect on my life? For me, it is entangled so centrally around the core of my being that I haven’t a clue of how to excise it from my psyche. Its tentacles are interwoven with that other beast that has so much power over my thoughts and actions – my intense fear of abandonment and rejection.

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It’s been a part of me for so long that I sometimes wonder if it isn’t a congenital condition. Originally this post was going to contain specific examples of my people pleasing ways from my formative years as a burgeoning BPD. Then, as I started writing, I discovered there is so much to unpack, it deserves it’s own post. So, instead, I will leave that for another day and focus more generally on adult life.

People pleasing can be an impediment to building good, healthy relationships, with friends, with colleagues, with romantic partners, and even with therapists. Basically anyone I interact with can be affected by my people pleasing ways.

People pleasing has led me into some very bad situations, including some very abusive relationships. BPD warps my thinking and makes me think “If I just do x, y, z they will stay and it’s okay because if I do those things maybe they will love me better. If they say they love me sometimes, that means I’m worth something.” These are things if you heard a good friend saying you would want to give him or her a big reality check and help them figure out a way to get out of the relationship. But when you are in it yourself and in that mindset, you are able to excuse all kinds of horrible treatment because the fear of losing someone seems worse than the fact that they are actually taking advantage and using it against you to perpetrate abuse.

Even in generally good relationships, be they romantic or friendships, I sometimes have a habit of making other’s needs a priority and putting self-care on the back-burner. Because I’m afraid if I don’t, I will face rejection or abandonment. Trying to be the be all and end all for another in order to win undying gratitude and love is a losing proposition. You can’t, no matter how hard you try. Even though I’m aware of all this, it is still something I struggle with.

It can also come into conflict with your own expectations. “If I’m willing to do all this for someone, why won’t they do x for me?”. It builds resentment in your relationships with other people based on unrealistic expectations. The ugly, selfish side of people pleasing.

Even in casual and/or professional relationships, I find people pleasing sneaking in. For example, I feel like I need to tell my doctor what she wants to hear. I need the approval for the things I’m doing right. I’m not always completely honest about things I fear she might disapprove of. Moreover, if I’m having a health issue, I don’t know how to advocate for myself and demand that it be taken seriously and get proper care. Because to be pushy would make me be seen in a negative light and I would no longer be “liked”. So I just go along to get along and often suffer because I simply can’t stand up for myself. Not just in a medical setting, but just about anywhere in life. My picture should appear next to the definition of “unassertive” in the dictionary.

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I mentioned therapy. I have a hard time with therapy. I’m so reticent and reserved around people I don’t know; especially when the connection is purely professional without a personal and emotional connection. I know there are people out there who can jump right in spill everything in their head at the moment, but that’s not me. To me it’s just strange trying to talk to a virtual stranger about your inner thoughts. Sometimes I don’t even know how to remove thoughts from my head and push them out of my mouth with someone I’m emotionally connected to. How am I supposed to do that with someone I have no real personal-level give-and-take connection with? I’ve had more than one therapist tell me that getting me to talk was like pulling teeth sometimes. Believe me, it’s just as frustrating from my side of the room. It’s not that I don’t want to or that I’m purposely being stubborn and restrained. I simply don’t know how to communicate what’s in my head with most therapists. However, on rare occasions, I may find one that understands how to get me to open up a little better. I start to actually get some real therapy. But herein lies the rub. In steps people pleasing, poison in hand. It’s often so stealthy that even an experienced therapist doesn’t recognize it seeping in. I want my therapist’s approval. I want positive feedback. So I start telling her what I think she wants to hear. I leave out the things that may make her view me in an unfavorable light. I want to be the good one. The client that isn’t any trouble. The one with demonstrated self-awareness and impressive deep insights (but not so demonstrated that I show the worst of me or the hardest struggles). The one that follows the treatment plan and never backslides or goes off-track. The success story. And then, according to her, I’m “doing so well”. I’m released from treatment. Have I actually made any progress? Maybe in the beginning, there was the potential to make progress, but my people pleasing interfered and now I can’t go back because “I’m better” and to go back would be to admit failure. It would mean disapproval. It would risk being revealed as a fraud. It would risk rejection.

It’s not that I’m not aware of my people pleasing and how it affects me and the relationships between me and everyone I interact with. But it’s often like being on a train where I’m just a passenger and not the conductor and I don’t know how to take over the controls.

 

Absent Friends

I have no friends.

Sure, I have acquaintances. I’ve been involved in dog sports for many years. It’s a fishbowl; it’s not hard to gather acquaintances.

But I am talking about real friends. People who know me. The kind of people who would invite you to join them for coffee and a chat, a cookout, a hike/walk, go the the movies, etc. But, more than that, someone who you could talk to when times get hard and you really could use someone to help talk you down or sort out the confusing thoughts running through your head. People who might check in with you every so often to see how you are really doing and who genuinely care about the answer. People who know you might not have anywhere to spend a holiday or may be facing a birthday alone and will extend an invitation to include you at their holiday table or make sure you’aren’t spending your birthday just lying in bed writhing in the pain of loneliness wishing someone would at least call to acknowledge the day.

And, no, it’s not something I expect to be a one way street. In fact, when I do see one of my acquaintances struggling with something, I do check in with them and ask how they are doing. And, if I’m capable of it at the time, I ask if there is anything I can do for them. How I ache for someone to take notice of me in the same way.

I don’t have anyone like that. I don’t have a support system. And it’s really hard to fight your way through a particularly bad mental illness patch when you don’t have a support system. In my own case, the lack of support feeds into my dark thoughts and spiraling depression and anxiety. “No one cares about me”. “If I tapped out, no one would miss me. I wonder how long it would take for anyone to even notice.” “I don’t know why I can’t connect and make friends. There must be inherently defective about me.” “There is something wrong with me. There is something wrong with me. I don’t know what it is, but there is something wrong with me and I don’t know how to fix it.”

It is a large black viper that stabs its long, sharp fangs into my very soul and slowly injects its venom. Day after day, month after month, year after year. It causes excruciating pain and lasting damage.

I am fortunate in that I have an amazing partner who understands me better than anyone ever has and hasn’t given up on me. I treasure her and her love and commitment to me. But, she has her own mental health struggles and simply isn’t capable of being my support system if we are both marching down our own separate dark paths at the same moment.

How to make a friendship is a skill of unparalleled mystery to me. How does one do it? How do people make the connections they have in life? How do they build a support system? How do you connect with someone to the point that they care about your thoughts, your opinions, your well-being? I don’t know.

People/therapists say join groups with mutual interests and be yourself (or sometimes they say, just be nice). I’ve been doing that for years. As I mentioned, I’ve been involved in dog sports for a long time. I know a lot of people. Superficially. I talk to them and still remain hopeful that we can spark more of a connection, but it never seems to do more than float at the surface. In the meantime, I see them form connections with each other. They leave a trial/class and go out to eat together. They invite each other to gatherings. They do activities together outside of dog sports. And I’m left behind wondering “Why not me? What’s wrong with me? What am I doing wrong?” I feel like an outcast. I feel invisible.

It’s a life-long pattern. I love solving puzzles, but I can’t come up with the key for this most essential of solutions.

Introducing “Quiet” BPD

So what exactly is the quiet form of borderline personality disorder? What does it look like?

When most people think of BPD, they think of someone with a predilection for uncontrollable outbursts of anger. They are drama creators. Public and in-your-face, with hair-trigger tempers. In fact, explosive anger (inappropriate, intense anger or difficulty controlling anger) is one of the 9 criteria for the diagnosis of BPD. But, like most things in life, everything falls on a spectrum and not into neat categories that can be packed into a box. To be diagnosed with BPD you need to hit 5 of the 9 criteria so, although a propensity toward angry outbursts is the one criterion that can be easily recognizable to the outside observer, not all of us with BPD display this trait.

With quiet BPD, the anger is internalized and turned on the self. We often keep our struggles invisible as best we can. Even with those closest to us. The observer may only see calm surface with perhaps some very slight ripples from time to time, but below, in the depths, there is a a powerful and destructive turbulence ripping everything apart destroying our sense of self and how to simply “be” in the world. And especially how to engage and interact with others. Sometimes I rise up through the depths to the surface, but inevitably the current drags me back down again. And I drown.

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The inspiration for me starting this blog was an article I saw posted online 11 Hidden Signs of ‘Quiet’ BPD that I felt hit on everything I deal with on constant basis and how those of us with the quiet form of BPD experience the world. It sums it up pretty well; I personally can check off all 11 of these signs.

I have struggled with the quiet form of borderline for as long as I can remember. It is a life of unrelenting anxiety and fear. Of self hatred, insecurity, and lack of self-confidence. Of dissociation and mentally shutting down and shutting people out. Of isolation and loneliness. Of sometimes intrusive, dark and suicidal thoughts. And, most of all, of the profound longing for connection and understanding that has so much sway over my life. And, when I do manage to make a connection, the unbearable dread of abandonment. Establishing and maintaining relationships with others is HARD – the hardest thing I deal with. It’s the thought that I’m too damaged and intrinsically flawed to have real connections. That nobody could possibly like or care for the real me. The internal struggles I go through as I negotiate interpersonal interactions and relationships can be an unimaginable mind fuck. It leads to self-sabotage. It leads to a self-fulfilling prophesy of broken relationships.

To continue to exist and fight the battle is a bravery that few, if any, will ever see or recognize. It’s not on display. It’s held close to the chest. Because revealing it feels too vulnerable and risky.

Yet, here I am. Writing it down and putting it out there for the first time in my life. For the whole world to see. It feels naked and raw. But I need to do it.

I intend for subsequent posts to take a more personal turn. To explain what it is like to inhabit my mind with all this background noise informing my actions and reactions. To put my failures out there. And hopefully some triumphs too.

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Introducing Myself

Hello and welcome.

My name is Dawn and I struggle with a number of mental health challenges: borderline personality disorder of the quiet variety with avoidant PD traits, social anxiety, generalized anxiety, PTSD, and depression. Good times! Especially navigating anything in the social realm. (Understatement).

The thing is, I keep this all hidden as best I can. It’s a secret. And I’m very good at keeping secrets. I’ve had a lifetime of practice.

But over time, my voice has gotten pushed down and down to the point where I’m not sure I even remember how to use it anymore. Am I even important enough to presume it’s okay to speak and give expression to my thoughts? Do they matter? Do I? Can I manage to find my voice buried deep down and force it out? I figured I’d give it a shot to come out and talk about the really deep down stuff that no one can see beyond the small ripples at the surface. This feels scary and vulnerable to me, but also necessary.

Bear with me, as my voice has become rusty with disuse.

And so I take the first step on this journey…

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