Repetitive behaviors

[Jaquta]

Hi
I have a tendency to repeat certain behaviors.  This can be extremely time-consuming and is enormously stressful (and embarrassing, and distressing, etc).  The behaviors can cause bleeding, pain, infection and tardiness, etc.
Worse than the behaviors are thoughts that repeat themselves.  There is a desperate need to continue behaviors until I have counted the right number or completed specific alphabetical sequences or it feels right.

I have previously been diagnosed with severe depression, anxiety (GAD, NOS) and bpd.

I have emotional difficulties regarding medication and I am generally non-compliant.

Over 12 months ago I was prescribed 30 mg of Buspirone but discontinued it due to debilitating fatigue.
I did decrease the dose but then it was said to be sub-clinical.

I'm not sure what my question is.
Treatment for this behavior??  A possible time-frame?  Is it treatable?

I have been in therapy but are not currently.  My previous T left the mhs last September.
I was told that one way to reduce the behavior was to do mindless activities mindfully.  I think the behavior did decrease (I'm not sure why exactly: taking medication, mindfulness strategies, decreasing asthma medication and caffeine, ...??)

Is the anxiety causing this behavior the same as that for the pd?
My understanding is that part of that anxiety is created by un-integrated splits.

I am tired of this behavior affecting and dictating my life.  I have been having strong suicidal thoughts and urges but they are possibly the cumulative affect of severe stress and other issues.

J

[mbobbie]

A related discussion, My behaviour was started.

[Jaquta]

Thanks Kathy434.  This is turning out to be a very bad day.  Scary bad I should say.  People have responded to previous posts I've written and have directed me towards community forums, have wanted to know more about me and to give me time.
I find this extremely threatening.  It kinds of mirrors what the expert in the emotional eating forum was saying, that I reject people and their support, rendering them powerless to help thus giving me a sense of power and control.  This is something I need to work through.
My T said we would look at the consequences of behaviors and then look at the feelings and the needs driving them.

I rarely re-read anything I've ever written so in a sense it does become upsetting that other people see and read it.  It is almost as if I put stuff out there and move on in a sense.  That could be another way to manufacture control too.  It keeps me ahead and not accountable.
There are other reasons too why I would find it threatening.

I don't mind (too much).  I've put stuff out there on a public forum, I accept that.
Also, I can't expect to make comments on others posts without allowing them the right to remark on mine.  I'm happy to listen to feedback from others.  Maybe even some I will find useful.

I'm sorry about your history.
My greatest regret is not having that worldly perspective when younger and even now to a degree.  I think that changes a lot how you see and experience the world.
I have been so caught up in my own internal world I have neglected to look at reality of the day.  I am trying to change this.

You were much braver than I ever was.  I kept withdrawing and not engaging.
Sometimes you also have to trust in order to allow others to help (like you taking medication for example.  That was way more trust, and confidence in someone elses ability, than I could ever give).

My T has certain qualities which makes me think I am judged.  Time will tell.

What I have found useful has been self-disclosing on the forums.  It helps to be accepted regardless.  I feel accepted on this forum even though aspects of me feel rejected.  I think rejected is the word.  It's hard to explain.

I'm not entirely convinced about the getting better bit but I can definitely see that there is room for improvement.  Maybe one day I will just wake up and find myself there.  I expect it is just a mental block or way of looking at things.  Maybe that way I don't have to take or feel responsible for everything.

I don't generally journal.  It was something I use to do in the past.  When I was sectioned my parents gave the doctors my diaries.  Nowhere feels safe.  Having a dialogue with my family rather than them needing to read about it in my journal would probably be better.  Both are too threatening though.  My family use things I say to attack me.  I am very defensive about what I choose to share with them.

I enjoyed aspects of the Dr Burns book too.  My particular favorite was about the baby ducklings.

Thanks for your support and encouragement.  I will try and take some of your advice and try and relinquish some of my control.  Baby steps!

Thanks a lot.

J

[kathy434]

I hope this doesn't cause you distress, but I read your communication with Dr Grossbart with extreme interest.
Growing up  in an abusive home was very destructive to me.  Worse yet was that I had kept such secrets so locked away from my consciousness that I had absolutely no idea that they were tearing me apart for many years.  I am sure now that I was perhaps the healthiest person in my family, and I was anything but healthy.  I never knew that what went on inside our home didn't go on inside everybody elses home too.  It was too traumatic for me to even think about, much less mention it to somebody and perhaps learn that there were families where there was laughter, love, protection, responsibility, boundaries, accountability, compassion, sympathy, risk taking, kindness, etc.  I spent much of my life pretty numb and disengaged, unable to trust even myself much less others on basic decisions in life.  My life decisions were seriously affected.
When therapy started for me 26 years ago, I had been in a deep major depression to the point of total loss of orientation.  It appears that our therapies sort of paralleled each other in the beginning.  Unless a theripist has actually experienced some of my abuses, they didn't seem to have a true understanding of my mental state.  However, I kept trudging through therapy, raw as it was, and one day about eight years later I met a therapist who genuinely knew my pain and confusion.  She and I started making good progress then.  After she left to continue her education I was floundering again, unable to trust and it was difficult to talk.  I finally met a doctor who literally saved my life.  He was what I would equivalent to a Psycho-pharmachologist (Psychiatrist with advanced knowledge of medications)  During that one hospitalization moment, I learned through word of mouth what a fantastic doctor he was.  I marched up to him and asked him if he would be my doctor.  After one or two consultations, he diagnosed me right on target and put together a coctail of meds that literally yanked me into normalcy.  I took these meds faithfully, every doseage, for over 10 years and remained relatively stablized.  I was able to then work with my PhD through talk therapy, and I read tons of books on mental health that gave me insight into not just myself, but into the family dynamics I was raised with.  One book that I have always kept close at hand is a paperback by David D. Burns, MD., titled "Feeling Good...The New Mood Therapy".  It challenges our belief systems that have not worked for us in the past, and guides us on how we can adopt new belief systems.  This book was like my own personal doctor, anytime, 24-7.
While I am not totally recovered, and realize I may never reach that point, I have reached the point where I am not taking any meds but one, and I am feeling wonderful today.  
I guess what I am trying to say is that I saw myself in you, appreciate where you are at your struggles right now, and I want to encourage you to hang in there and keep plugging toward a healthy future.  It involves lack of trust, but taking a risk anyway, and disclosing little bits of yourself and your life and in return learn you are not negatively judge by your therapist. Take it in baby steps, risking rejection, and getting friendship and compassion and a little healthier instead.  What happened to you was never your fault and you didn't deserve it ever.  You may feel very distrusting and confused right now, that is normal.  But to get better, you must allow yourself to take itty bitty risks and disclose some thing ever so small.  You will get better and one day really enjoy your life.
Another thing I would like to suggest before I close this is to buy yourself some spiral notebooks and write in them whatever comes to mind be it crazy or not, just write it down and this will begin your journey of journaling.  Talking to your "friend" who will never judge you but allow you to express tremendous emotions and tell your story to the paper.  The journals must be for your eyes only.  Nobody else, unless some time in the future you decide you want to share it with another.  But you must now be secure that what you write is for your eyes only.  Hide it safely.  It is amazingly revelating and healing, and you will find answers to many of your questions without knowing it.
I care about you.  If ever you want to communicate with me, I am available.
kathy434.

[Jaquta]

I feel my contribution here has been very limited.  I feel I have taken much, much more than I have given.  I also feel that you don't appreciate my input either.  Maybe in another time or place I would ask myself why that bothers me.  For now I'm happy to leave it at it triggers feelings of rejection and defectiveness in me and leaves me feeling insecure.

I think open discussions have many advantages plus some disadvantages.
I think in some cases a lay persons opinion can balance up that of a professional.  As a negative I believe if an expert is overly distracted by other responses then they may overlook what was being asked of them in the first place.

I think that you have the right to run your forum as you wish.  Your forum is also unique in that you respond to most members posts (regardless of how many times they post under the same question).  This I think is extremely helpful.
I expect some forums couldn't manage that just through the sheer volume of posts and interest.  I wonder if one could tease out the prevalence rates of certain diseases via the number of posts to a particular forum??

That discussion was going somewhere.  It is only through dialogue that issues can begin to emerge.  Perhaps they would have in time?  I do understand what you mean though. I perhaps shouldn't have responded as the conversation left me feeling frustrated.  I was leaning towards deleting it but then submitted it instead.

I have been feeling extremely tired, stressed and frustrated so I should temper my posts and be more vigilant about what I do send.  I can't see that happening though.  I like to write about what I think and feel and if that is hurtful and damaging, which I hope it isn't, to work through it.  Perhaps it is also because the experience is so new to me (describing thoughts and feelings) and it is something I am excited about testing.  A bit like at home.  We've just got power and lights on in the house (after 20 years without).  It's novel for a bit.  I'm still learning about relationships.
Also impulsive vs compulsive (regarding posting)??

I feel I have also triggered something in yourself which makes me want to analyze that as well.  I won't probe out of respect to you and your privacy.

My binge eating has improved slightly and I think I am at least eating with insight and not doing it mindlessly.

Thanks very much for your time, input and patience.

J

[Ted A Grossbart, Ph.D.]

You have made substantial contributions that I am sure people have appreciated.  You are correct that open discussion has a place on the expert forums as well.  I was not clear on the different formats myself.  

In that one instance my concern was adding momentum to a discussion that seemed to be going nowhere.

tg

[Jaquta]

I will try and remember that next time I reach for food.

I think stupid and naive just about covers it.

Yes, you did explain (and perhaps even caution me about) boundaries a while back.
Just as an aside, many of the other expert forums are open forums and discussions are even encouraged.  This material tells me a little about you and a lot about me.  I think it is more about my experience of arbitrary boundaries than about authority figures.
Do my comments dilute your discussions that much?  I think perhaps you have structured your forum like a therapy session and that is where and why the additional comments are unwelcome and unwanted.

If my comments to previous posts were inappropriate and unhelpful then could you please delete them.  My comments were never intended to prevent people from having open discussions here.  Thanks in advance for doing that.

J

[Ted A Grossbart, Ph.D.]

The question, "What am I really hungry for?" can be useful.  Not just what food, but what on a deeper level.  If you can feel things in your heart, you don't have to feel them in your refrigerator.

As to your services as my unhired and unpaid assistant, you are clearly bright, thoughtful, and have (unfortunately) great experience in the mental health realm.  Most of your responses have been right on.  

It is tricky as this is supposed to be an expert forum, not an open discussion, which is available in other sections.

Use your best judgement as to where the line is between adding a bit odd helpful information now and again and overdoing it.

tg

[Jaquta]

I was just wondering if you had any suggestions for breaking the cycle of compulsive over-eating?

I limited my caffeine intake with success but have had limited (no) success with food.

I have still been feeling uncontained and have been feeling increasingly suicidal again.  I suppose I have been feeling stressed and trapped and overwhelmed.

I was just wondering if there was a good place to start to address the over-eating.

Sorry for responding to some of your posts too -I couldn't help myself.  I don't like to see people rejected or drifting.  Although that is only my perception and based on a lot of my own experiences.  I trusted that you would answer posts when you were available to.

J

[Jaquta]

Trauma, abuse, emotional pressure -> anxiety -> coping mechanism -> increased anxiety.
Just thinking aloud.  That's the consequence of the consequence again.  Increased anxiety through excess caffeine consumption, etc.

?Stealth antidepressant.  Am I depressed?  I was said to have severe chronic dysthymia.
In John Gunderson's book, Borderline Personality Disorder: A Clinical Guide, there is a table with the 'sequence and timetable for expectable changes in BPD during therapy.'  Depression only turns to sadness in year five of therapy.

I think I probably feel tired from stress, anxiety, disturbed sleep, the effects of binge eating or restricting, etc so caffeine is used (?subconsciously) as a pick me up.

Depression can result from any one of those alone.  So if I address my caffeine intake and sleep and diet, etc I will feel less depressed and have more energy.

Thanks for that feedback.

J

[Ted A Grossbart, Ph.D.]

Caffeine or any other speedy drug can definitely increase anxiety of any sort including performance or social anxiety.  The anxiety can then trigger OCD symptoms, and/or trips to the bathroom.

People also sometimes use caffeine as a sort of stealth antidepressant.

tg

[Jaquta]

My 'new' T was away today, so no therapy.

I have another question about ocd.  This is very embarrassing for me.

Some of my repetitive behavior is about spending forever in the toilet.  I felt this stemmed from severely over-training and subsequent asthma attack and asthma meds.  That's not true.  I felt it was the result of being hit by a car and being knocked off my bike and then being run over.  Which happened several months after the asthma attack around the anniversary of my grandfather's death.

Anyway, I saw my GP today (and yes I did mention the skin stuff) and he said I was addicted to caffeine.  He said I must be peeing a lot.

Caffeine can make one more anxious but how does that affect my behavior.
Is ocd (I should have asked him about diagnosis) the result of anxiety because of too much caffeine?

This particular repetitive behavior occurs particularly when I'm in social situations.
Performance anxiety??  And when I am about to exercise or compete.

If the physical need to go to the bathroom doesn't exist, then that would make it an emotionally induced event, and perhaps only mildly influenced by caffeine consumption??

I was just wondering about the influence the caffeine was having.  Cause and effect.
It doesn't explain the underlying stuff though, does it?

J

[Jaquta]

I get despondent because it feels like forever.  With the right T, things feel achievable (even if they are difficult and challenge me).

You're right, a crisis is not the answer.  I feel like I'm hanging in there, but not by very much.  I'm tired and feel overwhelmed and just want everything to stop.

My GP (as well as MedHelp) is my support.

I feel I am fair to myself (if not the T).  I think my last T provided a useful reference for me.  Usually I would take full responsibility for a relationship not working but I understand now that relationships are/ can be extremely complex.

I'm not feeling very positive about the upcoming therapy.  My first therapy session with him will be tomorrow.  I'm not sure if comments about object relations and male T's will influence the therapy.  (Meaning I think it might).

I have learned that crises provide a lot of information and provide opportunities for growth and development.

Thanks for your feedback.

J

[Ted A Grossbart, Ph.D.]

I think your issues are all treatable but it takes the right therapist and the ability to keep at it for a long time.  Books, forums, and other adjuncts can be very helpful, but ultimately it is long term therapy that will be key.

I would not suggest provoking a crisis as a way to get a system to respond.  Your GP sounds like an important part of your support team.  It is very fair to leave a therapist or system that is not helping--although that can be difficult to evaluate in the heat of the moment.

I'm glad to hear the new therapy is happening.  Expect crises, but take them if possible as the beginning of productive therapy not the end of it.

tg

[Jaquta]

Thanks for your responses.

With regards to the parent/ picking issue, perhaps it is both.  Perhaps that is also symbolic of the invalidating environment.  I was referring to my father and I.

Not knowing what to discuss, or at times not being able to discuss, do seem representative of fear.  My fear is of being judged or more specifically being exposed.  My fear would then be about my vulnerabilities and insecurities.  Which could come back to issues about identity.

I'll respect your, and others, space and let you answer the questions.

Self-disclosure issues do seem complex, especially when one is impulsive and lacks boundaries.  Perhaps it comes back to trusting people and their integrity.
Abandonment/ engulfment??
I am very sensitive about my repetitive behavior (ocd) and also about skin issues.
I am wanting to run.  Not because I don't want to confront them but because I am sensitive, fearful and ashamed.  Perhaps I am frightened because I have mentioned them to you.  Perhaps I am waiting to be reprimanded and thought badly of.  Maybe subconsciously I am wanting to leave the bad here with you.  Perhaps it is because talking about them makes them feel real.  Perhaps what I am afraid of is what the behavior is defending.
I actually thought I had a way in to discuss some of these issues with my GP.  Last week he said 10% of his workload is performing skin cancer surgeries.  Maybe next week?  Would the grossbart.com site give him an overview without me needing to explain?  So, I'm avoiding.

I thought that self-help books or clinical texts might help me.  I'm very shut-down on reading at the moment though.  I bought a copy of Dr Gould's, Shrink Yourself: Break free from emotional eating forever, but I haven't been able to read it.
The psychology adviser, who will become my new T next week, gave me a book on sleep to read.  I have also had limited luck there, although for different reasons.

I have trouble carrying through with most interventions.

I have been trying to take more responsibility for my parents farm (while they are finishing their house) but it has been stressful.  Almost too stressful.
I am extremely stressed and feel burnt out.

Forums have been my main support and I do feel like I've had some pretty big break throughs on them.  I feel Dr Gould (expert on the mh and emotional eating forums) has been very supportive (and patient).
Even talking to you, I feel I've learned a lot about myself.  
I expect I would be lost without these inputs.

I was wondering if stopping my weekly GP visits and interactions here would precipitate the crisis necessary for my mhs to become more involved.  I feel they should be doing more.  My GP feels they should be doing more as does my previous T who believes all I'm going through now is unnecessary.

Your last comment makes me feel a little anxious as I did continue to work and persevere with a T (the wife of the one I'm to see now) and it was extremely damaging.
Is it advisable to continue with a T or approach that has proved ineffective in the past?
What are your thoughts on when a system lacks the skill and experience to deal with a patient?  Is it fair to brush them aside?

From your experience, can much change for a person with a pd?  What can a person hope for or even expect?

Sorry for the long post.  I appreciate your time.  (And am in awe of speaking to professionals from such recognized institutions.)

J

[Ted A Grossbart, Ph.D.]

These are important questions.  The toughest situation is when people who are bright, thoughtful and troubled, clearly need therapy, but have had bad experiences with the mental health system that have left them unwilling to go back.

I'm happy to answer questions, but clearly you and others in your situation need more.  

I read people's other med help postings only to get an overview.  The question on when to disclose and when to protect is complex on the web as in life.  I don't think you have mentioned anything that should be cause for concern.  Feeling unsafe and the closeness-distance issues you describe are part of the problems you are grappling with.

I think the biggest question is what can you do for therapy or a more effective therapy substitute.  I suspect forums will provide some support but no real progress over time.  

I think what it will take is a person or system where you can get into some of your classic dilemmas and struggles but stick with it and keep working and working on it and keep the relationship intact.

Any ideas?

tg

[Jaquta]

I have a problem!  Well lots actually but they can be overlooked for a bit.
I first posted here because I felt uncontained.  Posting helps me to feel contained.
My concern is that I'm not backing off and are harassing people.  Harassing you.
I understand I am doing this because I have emotional needs, but ... it's frustrating.
Sometimes it feels extremely important for me to have contact and to feel connected.  Later, I feel like a complete idiot!

I'm not in therapy and therapy seems unlikely at this time.  How can I contain my behavior without making a nuisance of myself and feeling ashamed afterwards?

I do have a genuine interest in mh issues and do have issues with repetitive behavior.

Also, do you have any advice about self-disclosure?
I saw you mention you had read another member's profile.  It makes me feel a little uncomfortable thinking an expert may have read my profile, or worse yet, my posts.  It makes me feel a little self-conscious and a little (a lot) defensive.
I share quite a lot of personal stuff (thoughts, feelings, experiences, etc) on forums I visit regularly.  When I read the number of monthly visitors to this site I freak out a little.  What if someone I know is reading what I've written?  I like feeling like I can share and be honest about my feelings.  How much do you think a person needs to protect their identity here?  (This is perhaps even the first time that I have acknowledged having an identity.)
It's difficult trying to access support (and at times offer support) without revealing a small part of ourself.
I don't understand why I suddenly feel unsafe.  Perhaps I have regressed to splitting forums due to stress and lack of containment.

I feel like asking questions is using you/ taking advantage of you.
Why am I even doing this?

J

[Ted A Grossbart, Ph.D.]

It may be aspects of the child that the parent has trouble loving, accepting or valuing or frequently an aspect of the parent themselves that they can't accept when reflected in the child.

I think the book is well worth it.  It is a very intense but valuable read.

OCD is usually triggered by some emotional pressure but not necessarily trauma/abuse.

Not knowing what to discuss can come from many sources.  Everyone experiences it at some point.  My hunch is that for you it would more often be fear.  

I'm really not sure on policy on discussion between questioners on expert forums.  This is usual on the open forums, not the expert ones. Let's try  if you have a specific answer to a specific question chime in briefly.  For on-going dialog go to the public forums.  We'll see how that works.

tg

[Jaquta]

Also, not knowing what to discuss in therapy, is that due to lack of containment?
I was going to add some of my thoughts, feelings and experiences to volumes post but didn't know if that would be welcomed.  Is it OK to comment on someone else's post?

J

[Jaquta]

I was just wondering what the ?implications were when the parent is doing the picking (pulling, squeezing, scratching, etc) to the child.
It almost suggests there are elements in the child the parent detests. ??  Does that mean they also were bullied/ picked on?

Would the book you recommended be worth investing in?

Were you suggesting that ocd was associated with abuse and trauma?  Does trauma (and/ or abuse) underlie every anxiety?

J

[Jaquta]

Perhaps I'm in denial about any abuse or trauma.  It could be that I minimize these aspects of my life.
I've had nightmares since I was, I say, 9, but possibly even younger.

C-PTSD seems to fit too.  (I did a Wikipedia search).  I feel I can relate to most of the elements: captivity, psychological fragmentation, loss of sense of safety, trust, self-worth, tendency to be re-victimized and loss of a coherent sense of self.

Other points that were made that were of interest to me:
-pervasive negative impact of chronic repetitive trauma
-increased attachment in the face of danger
-compulsive repetition of the trauma [this is something I did when I was younger to other people]
-gaining control over ones current life
-timing, intensity and duration of the abuse [affecting/ influencing bpd diagnosis]

I'll see if there's a copy of that book at our local library.

It sounds unethical.  On a personal level it makes me feel unsafe.  Or rather it makes therapy feel unsafe or threatening for me.
It's possible he would be professional but it feels very awkward and uncomfortable for me.

Out of all the options the T suggested, this is the only one the doctor/ director made available to me.

The question I now have to ask myself is, is this better than nothing?
Currently, I don't think anything is worth it.  Not really.  Is some sort of illusion, perception or expectation of life worth this degree of hurt, hardship and heartache??

J

[Ted A Grossbart, Ph.D.]

I was impressed that many people with similar problems have histories of abuse and trauma either major or somewhat subtle but nonetheless quite destructive versions.  You might google 'complex PTSD' and see if it rings bells.  Another good resource is the book Trauma and Recovery by Dr. Judith Herman.

  "Currently I have been offered one session per week with the husband of the T I had issues with. "

Does this sound worth a try or too poisoned by the wife problem?

"My GP feels input and therapy from outside the local service would be appropriate. "

This sounds worth following up on.

"There is also a very small chance that the service may fund an intensive six month program at a private clinic."

If this turns out to be an option let me know the details.

tg

[Jaquta]

In your first response you asked about an abuse history.  Do you have time to briefly explain the significance of this?  I don't understand what it is I need to work through with this.

J

[Ted A Grossbart, Ph.D.]

Keep pushing for what you feel is most likely to work.  Certainly consider other systems if available.  The picking is definitely related to both OCD and BDD.  It also goes with having been picked on growing up.  See grossbart.com for more details.

tg

[Jaquta]

Whoops sorry I forgot to ask.
I have read some of the posts about compulsive picking, etc.  I have had a tendency to do stuff (pull hairs, pick, scratch, whatever) after I developed facial hairs from taking asthma meds.
Is this ocd related behavior or is it possible it could be bdd?  I was just wondering.  Was curious and interested.

J