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

[Jaquta]

My belief is that health professionals 'should' have known better (as well as done better).

The new T was not a good match.  I wondered whether two sessions was enough time to evaluate whether we could establish a therapeutic relationship.  I felt it was.  I felt if I didn't feel safe, didn't feel contained and the boundaries were arbitrary then I couldn't trust her or her ability to treat me.  I am not prepared to enter into a damaging relationship with a T again.  I think I did bring past issues with health professionals to the sessions with me but I also think she handled the situation badly.  I felt she was unskilled and inexperienced.

I don't know what the next step is likely to be.  Currently I have been offered one session per week with the husband of the T I had issues with.
My GP feels input and therapy from outside the local service would be appropriate.
There is also a very small chance that the service may fund an intensive six month program at a private clinic.  I'm not sure.  Currently, I'm just hoping I don't find a letter in the mail, the day of my appointment, to say the doctor is on annual leave (as has happened before).

bpd-ocd makes me feel very limited and vulnerable.  I wish I didn't have these issues and that I had more mature defense mechanisms.

How does one define OK?  I accept my insecurities, lack of trust and confidence, my deficits in relating and my expectations all make any therapeutic alliance difficult.
Turning up for an appointment is often challenging enough.  Perhaps I am too rigid but from past experiences there is usually always a need to protect myself (or protect the T).
I expect I will have to work with what the service chooses to offer me next.  If that doesn't work then I will go back to reading Kernberg's book on T-F-P.  That sounds a little narcissistic but I meant the service had the ability to offer different treatment based on what worked for me with my last T or they could continue offering treatment that has been harmful.

Resistance is a weakness but also a strength.
I have found that the adversity I have faced, within the mhs specifically, has made me stronger and more resilient in some respects.

Work on it intelligently and not as I currently do.  And also take action instead of avoiding.

Thank you for your time and support.

J

[Ted A Grossbart, Ph.D.]

I'd be very ready to believe you have gotten treated badly by professionals who should have done better.  

Hopefully this new therapist will be skilled and a good match for you.  It sounds like you can do very useful work with the right person.  

The bpd-ocd blend sounds right.  Any situation that produced significant fear would qualify as trauma/abuse.  

I think the key foe you will be to find an OK therapist and just keep working on it.

tg

[Jaquta]

Thanks for your response.

Therapy is a sensitive subject.  I have been in and out of therapy.  I have had issues with health providers (and perhaps they also with me).

After my last T left I was told there would be a short transition period before the new T came on board.  This date kept getting extended.  Once she was available I however became unwell.  (I developed a post-operative infection following surgery for breast cancer).
I had several sessions with the new T.  I felt she didn't understand boundaries or containment (hence me.  Perhaps that doesn't follow).  I personally was not impressed having the number of sessions reduced or being told it would take four to six weeks to do a psychological assessment or being asked to spend my therapy time completing anxiety and depression questionnaires.  I personally felt it was inappropriate.

I have a psych appointment this Wednesday.  My understanding is that I am to be referred for an independent review by a specialist in personality pathology.  After Wednesday I should have a better idea of possible treatment options.

I would love to explain the anger behind my comments but it is long and complicated.
(I was sectioned and threatened with, but not given, ect and that is in the middle of it all somewhere).

I think I read somewhere in my medical records a note saying I existed on an ocd-bpd continuum.  Nobody has specifically said I have ocd though.

I am not open to receiving dbt.  This too, is part of my history with the local mhs.
I think, for me, dbt represents a treatment or group of providers who don't get me.
My last T said dbt and cbt impinge on my sense of self as my issues are earlier.
Even if I were receptive, they don't run dbt programs here.  Psychologists and CMHN's, etc attend conferences and workshops but I believe they are largely unskilled and dbt is never offered in its entirety.

All problems?  I don't understand my anger, nor is it directed at you.  I guess the question of therapy evokes a lot of negative and painful memories for me.  I struggle to understand how a mhs can put a patient through so much unnecessary trauma.
I don't know if I'm prepared to give it more time.  I feel tired and defeated.

They could possibly all be related.  The depression more because my life isn't working (or working well).  The depression followed a near drowning which occurred several days after my mother was discharged from hospital (she was in hospital for six weeks with a broken back and severe head injuries.  I saw her have seizures, stop breathing and being intubated).

I was disciplined as a child.  I have jumped off the roof of a two-storey building to avoid being beaten.
I have a memory of going to the park (after being told not too by my mother).  I recall being approached by a person and then being half way home, crying and running.
I have another memory of running into the bathroom and standing on an old travel iron.  I remember there being blood.  I'm not sure if these events are related.
One night I saw a man's face at my bedroom window.  After that I would close all my curtains so as not to see any darkness from outside and I would take all the linen to bed with me and surround myself with that.  Again, I'm not sure if they're related.  I know towels had been placed in my bed to keep the weight off my foot (after having injured it).
As an adult I wonder if I was not followed home.
Back then I was scared to go to the toilet at night as it was at the end of a long hallway and it had a dark window.

As a teen I was knocked off my bike by a car and then run over.  I'm not sure if the repetitive behavior existed prior to that.  Possibly, but not to the same degree.
This happened several months after a severe asthma attack.  Since then I don't like people touching me.  Or being near me.

My previous T said stuff that happens at home could legally be defined as sexual abuse.  I think I am possibly very sensitive but I also think my family are disrespectful.

I think mh professionals have also abused their power.

I had nearly a year with a very good psychologist and I had noticed some changes.  I feel disillusioned and overwhelmed again.  Sometimes I don't care and just want everything to stop.  Sometimes I worry about where I'm at but don't feel as though I can ask for help.  Nobody has helped in the past.  There is a fear I could be sectioned and forced to take medication and be given ect.  One doctor spoke to me about risk matrix's and he gave me the impression my life was worth no intervention.  After the break down in communication between the mhs and myself (I was discharged because I felt what they were offering was doing more harm) I became quite unwell.  One night I went to hang myself (I had googled poisoning monographs and ld 50's, etc extensively and had found a site that recommended a particular way to hang oneself -it sounded reasonable) however I saw the phone and felt I should ask for help (which was a difficult thing for me to do).  I called the local psych emergency team and they somehow managed to escalate the crisis.  I was shattered so went to bed and set my alarm for several hours later.  I was too tired then.  It was difficult dealing with feeling out of control and feeling rejected, useless, worthless, stupid, hopeless, helpless, etc.  The psych emergency team (PET team) told me to half smile (dbt skill), take out the rubbish, there was nothing they could do to help and that someone who was unwell was coming in.
I became extremely angry and wanted to kill them.  They laughed at me.  Conservatively I felt I could kill three or four of them.  By then I was very unwell.
My GP said he was blunted to the safety stuff.  I felt humiliated asking for support.
After being in hospital I took all my discharge medication and was in icu for a week.  Looking back, most of the time I wish it had been fatal.  Several years ago I had four family members die within the space of one month.  I seemed to develop a fear of death after that.  Although sometimes I feel nothing or just apathy.  What is the point?

I was told by my coach when in elite sport to hang myself by the rope from the branch of the tree.  I personally felt he was going to strangle me with it.   Is that abuse??

Sorry for the novel.  I guess I am very stressed.

If abuse is the common theme then I'm missing some insight as the maladaptive behavior still exists.

J

[Ted A Grossbart, Ph.D.]

You certainly sound like someone who would benefit by getting back into therapy.  It sounds like you can add OCD to the list of things to work on.  

You seem like someone who might benefit from a DBT program.  Do you know if there are any in your area?

Impossible to say how long it will take to work this out. Keep in mind that all the problems are treatable over time.

You have a bunch of different issues and diagnoses but I wonder if they are all part of the same thing.

Do you have an abuse history by any chance?

tg