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

[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

[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.]

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]

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

[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

[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]

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.]

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]

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

[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]

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

[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]

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.]

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]

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.]

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]

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

[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

[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]

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

[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

[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 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.]

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