BPD Trait: Treatment Resistance

A friend of mine recently asked me about boredom and quickly losing interest in things for folks with Borderline Personality Disorder (BPD). I figured it was probably related to the depression symptoms of BPD and didn’t think too much about it after that. Recently I’ve started to turn this question over in my head again which I’ll return to in a little bit. First a little backstory.

Recently, I acquired a copy of “I Hate You - Don’t Leave Me” and decided to reread it. Man, it’s annoying how accurate this book is still. While I had all but considered myself in remission, as is generally the case over time and practice with most BPD folks (long term recovery is as high as 86% according to the book), I currently display five of the nine diagnosis traits - five being required for a diagnosis. Whoops.

Just before rereading this book, another friend of mine said that spending lots of time alone is the ultimate practice in self love. Man, she was not kidding. When Nicholas and I hit the road and I began my relative isolation (while I interact with Nicholas daily and see others occasionally, I spend a good 10 hours a day by myself six days a week), I didn’t realize how little alone time I really got before. Living with my mother and a rotation of roommates throughout the years, along with working 40+ hour weeks meant that I didn’t really spend all that much time by myself. Nicholas could even come and see me during his breaks at work and to be honest, any extended period alone ended up being filled with someone’s company or sleep. Probably the longest stretch of time I sat alone would be playing video games. I thought I was a hermit then - what a joke!

So now that I have copious amounts of time to myself, I’ve been trying to work on long term self improvement. I’m a big fan of “speak less of your plans, you’ll get more of them done” so I’ll spare you all the nitty gritty but one aspect of this work on myself should be pretty obvious given the posts in this blog: tackling the multifaceted problem of a personality disorder. After being on Lexapro for three years, I lost my insurance which triggered the decision to go off of my medicine. I tapered very slowly, even supplementing the decrease in my SSRI with a dopamine booster (Welbutrin). That turned out awful but the theory was sound. After two months, I was totally off my antidepressant and began the very horrible period of SSRI withdrawal. I’d like to write a whole piece about this sometime but it’s really not the point of today’s post.

At first, with the SSRI cessation symptoms, I was back to FULL BLOWN CRAZY. It was rough. And I lost friends over it. After a monthish of daily meditation, the beginning of a workout routine and so very much patience from those who stuck around, I made it through my chemical rock bottom and started to feel normal again. Carly, without an SSRI. Before Lexapro, there was Celexa. Before Celexa, Paxil. Before Paxil, Prozac. Before Prozac, Zoloft. I had made it through almost every brand of SSRI (with some other non-SSRI antidepressant/mood stabilizers along the way like Lithium and Effexor). The whole thing was pretty scary but I needed to know - what was I like without the drugs I had been taking on and off for the past 10+ years of my life? Did I really need them?

Well, my anxiety came back pretty hard. That was a bumpy road that was lined at first with too much Xanax. My mood fluctuations returned - down, down, literally laying on the floor of my hotel room just to fling back up an hour or two later. The rage was probably the worst of my returning symptoms but like most of these issues, was immensely helped by meditation. I am, as I mentioned above, far from “cured” but the reality is that all these symptoms are very mild and infrequent, with their severity and frequency decreasing as long as I maintain discipline and keep hitting the mat, keep going to the gym, keep paying attention and keep working at it.

Probably the most obnoxious however? The boredom! I get an idea for a novel, so I passionately write a few pages. Then days later, I’ve already lost interest. I start a new book and after 150 pages in, finishing it seems like a chore. Anything to provoke some kind of excitement in my life seems so welcome. As I tell my husband this, he begins to ask me very strange, pointed questions. “Do you feel like you’re playing pretend, like you’re not being your true self? Do you feel like you want to run away from your life?” Confused, I tell him no and ask him what made him think I felt these things.

”Well, that’s what you told me this time last year,” he informs me. Wait, last year?

I’m confused so I ask, “What does that have to do with how I feel now?”

Not unkindly, he shrugs and offers, “You get like this around this time every year.”

This is a revelation. You’d think that I’d notice my moods repeating annually but as self absorbed as I am, I fail to miss the bigger picture apparently. I know I get itchy every May, with the earth bursting forth with life. Most of my high school relationships came to some kind of climax at the onset of spring, with many breakups taking place in my birth month. And I’m definitely a victim of Seasonal Affective Disorder (no surprise considering I lived in Michigan for most of my life). But fall boredom? As far as I’m concerned, this is new information.

So what to do? I’m not sure yet! I never claimed this was an advice blog c; If anything, more like observations and speculations on life, with a good focus on the strange, multifaceted issue that is BPD. The interesting part of this is that despite being on Lexapro for the past three years, I still had plenty of BPD symptoms. To be honest, though, this isn’t a surprise to me. Depression and anxiety are just two pieces of the strange, everything-but-the-kitchen-sink kind of disorder that is BPD. In “I Hate You - Don’t Leave Me”, they share a graph that shows how BPD relates to other mental health disorders, including the various symptoms of each of those disorders that may present in folks with BPD.

 A graph showing BPD in relation to other disorders from “I Hate You - Don’t Leave Me: Understanding the Borderlie Personality” by authors Jerold J. Kreisman, MD, and Hal Straus

A graph showing BPD in relation to other disorders from “I Hate You - Don’t Leave Me: Understanding the Borderlie Personality” by authors Jerold J. Kreisman, MD, and Hal Straus

As you can see, it’s a pretty mixed bag! In my personal experience, almost every single one of these symptoms has applied to me at one point or another. This is why a proper diagnosis of BPD can be so hard sometimes, especially when you consider that about 90% of patients with the BPD diagnosis also share at least one other major psychiatric diagnosis (again, this stat is pulled from “I Hate You - Don’t Leave Me”).

When I first entered the mental health circuit, I was diagnosed as “rapid-cycling” Bipolar 2. At 14, they started me on Lithium, Zoloft and Effexor which turned me into a monster. I stopped taking all of my medication at once and I became an even worse monster. I swore off of medication for quite a few years.

I was extremely depressed around the ages of 19-20. I thought I must have Major Depression and maybe the manic moods from my youth were just part of being a hormonal teenager. I ended up giving Prozac a brief try as it seemed to work well for my mother. I was inconsistent with how I took it, drank too much and didn’t like the side effects. At some point, I switched to Paxil as it was supposed to be more mild.

Around the time I was 21, a therapist told me I had enough Attention Deficit Disorder (ADD) symptoms for a diagnosis, though the Big Psychiatrist Man never slapped that label on my file. To avoid interactions, I was pulled off of my Paxil and I began taking Adderall instead. Technically I was discharged and considered asymptomatic at 22, which is a giggle to me now. The people pleasing qualities of my BPD were so intense I legitimately convinced my counselor that I was better. What a trip. But he had also suggested Borderline Personality Disorder to me and gave me my first copy of “I Hate You - Don’t Leave Me”. I remember devouring it overnight, feeling like someone had written a book about me. The path to true recovery began here.

My anxiety reached its peak after an intense 2CB trip around the time I was 23. I began having panic attacks daily - this is around the time I started Celexa. With my previous therapist’s suggestion of BPD, my acceptance of my now-obvious ADD nature, I figured I probably had Generalized Anxiety Disorder (GAD) as well with a period of Panic Disorder thrown in there. It took an entire year to get past the panic (my advice? don’t snort drugs, kids), and my anxiety was still a Thing but I could leave my house again. After upping my dosage a few times, the Celexa created uncomfortable side effects so I switched to Lexapro. I wasn’t on it very long before I decided to take a sabbatical.

I functioned alright. Until I didn’t. I began doing Night Audit shifts at the hotel and the long hours of solitude paired with never seeing the sun anymore reinvigorated my panic something fierce. I had to call my mother or Nicholas most nights because I was so scared of a blood clot causing a stroke or aneurysm and no one finding me until breakfast bar came in at 6am. The panic got so bad that I decided it was time to give Lexapro a real try. So I remained on it for the three years I worked at the hotel, upping the dosage each time I was promoted and my anxiety raised. When I quit, my anxiety was basically nonexistent. Go figure.

I detail these stories partially because I want to illustrate how immensely useful my medication has been at points. Were it not for my Lexapro, I probably wouldn’t have been able to do my job. It only went so far however because I reached a breaking point where I realized my anxiety was because I hated what I was doing. The people pleaser in me, as usual, wanted to just grit her teeth and do it because I knew my manager and coworkers were counting on me but looking back, I know now that it was only a matter of time before something happened that gave me an excuse to leave the job I never really wanted to stay at anyway.

But what can an SSRI do for poor impulse control? For the listless boredom and rage of a borderline? The narcissistic yet dependent behaviors? Not a lot. While I stopped wanting to kill myself, stopped cutting and stopped having panic attacks, a host of other symptoms remained. Only through years of practicing the techniques I learned from Cognitive Behavioral Therapy (CBT) did I lessen these habits. This is likely what I must do with my incessant loss of interest in everything I start. I’ve already done a pretty bang up job of not reaching out to men for sexual attention like I normally would when bored of my life. The temptation to start a tiny fire to my life is there but I know that while it might dazzle for a second, I’ll ultimately miss the things I burn.

While I still have dark days, they are few and far between now. I have had my moments where I’ve asked myself, “Should I go back on my SSRI?” but then I remember the nonexistent sex drive, the teeth grinding, the nausea and I ask myself what I ask about everything - “Is it worth it?” So far, no. I’m not going to kill myself. I have no urges to cut. Meditation and working out seem to be doing a pretty bang up job of keeping me level. If my depression darkens with the days as we approach this winter, it’s likely I’ll start up an SSRI again for a few months because after running the gambit with these drugs, I feel confident that I know when I do and do not need them.

Does this mean I think everyone’s depression symptoms are solvable by sitting on a mat daily and running a treadmill? Fuck no. Please believe me when I say SSRIs saved my life and I’m immensely grateful they exist. But I keep thinking back on people in my life telling me I need to go back on my medication and it pisses me off all over again. I try not to take it too personally - those people were concerned about me and with how bad my cessation symptoms were and I don’t blame them. But I’m not going to keep taking a drug indefinitely just because stopping it is hard!

And when someone says, “I’m good, I know what I’m doing, I just need you to LISTEN,” then fucking listen! I know it’s 100% hypocritical of me right now to say we need to cut back on insisting we know what’s best for one another and just try to be there for each other more but through the ups and downs I’ve learned you can give a suggestion but leave it at that. Ask questions, offer your experiences but don’t assume you know what’s best for other people. Because even if you do, the odds that they’re going to listen to you are pretty slim anyway. It’s best to be supportive and let them figure it out for themselves.

On the flip side, sometimes you do need to intervene. While I very briefly had some suicidal idealization, it was never to a point that ever elicited a serious reaction. That sounds crazy, I know, but the folks who stuck by my side and listened (!) knew that I wasn’t going to kill myself. However, having recently lost someone who touched my life to suicide reminds me of the severity of mental health disorders and how important it is to not just dismiss someone when they’re hurting. It’s a scary, uncertain trapeze act of allowing the people in your life the agency to make their own decisions and stepping in when you believe them incapable of making safe decisions.

The most control you have is over your own actions so I recommend everyone start by looking inward first. Don’t believe the shit that SSRI changes your personality or makes you a zombie (unless you’re literally 14, then there’s some merit to these claims). For adults, SSRIs and other drugs that help with neurotransmitters can make a world of difference. If you’re like me and you have a personality disorder, however, I hate to tell you that treatment doesn’t just stop there. And truth be told, even with “relatively simple” disorders like Major Depression, therapy (with a good therapist), will always, always, always help. At the very least, grab a book. I’m just about to start The Dialectical Behavior Therapy Skills Workbook myself.

Even folks without a diagnosis can benefit from these tools - think of it as preventative maintenance on a car. If you keep up on oil changes, your car is less likely to break down. If you engage in therapy and CBT/DBT skill training, when a traumatic or stressful life event occurs, you’ll be that much more ready to face it. And of course, be there for one another. Personally, I’m always happy to listen. Just know I keep a brutal sleep schedule so I might be a bit useless between 8pm and 4am. But no matter what, don’t give up. No matter how treatment resistant our shit might seem, nothing is unsolvable. And it always gets better.