Tag Archives: Anger

What My Mental Illness Feels Like #Write31Days

31 Days of Mental Health

Welcome to day 29 in the #Write31Days challenge on mental health. Phew, we’re almost done. I truly find it a challenge and unfortunately don’t find it particularly rewarding.

Today, I’ll give you a glimpse into my unquiet mind by describing what it feels like tohave my mental illness. I have been diagnosed with borderline personality disorder, which is characterized by self-regulation difficulties. It also overlaps with other disorders.

Once, years before I had been diagnosed with any mental illness at all, I read a description on a Dutch site of the “borderline feeling”. It described a starting point at which you are feeling fine, or at least appearing as though you are fine. Then, a minor annoyance occurs. You start feeling frustrated, angry, infuriated. Then you feel sad, depressed, depserate. Fear and then panic also comes in. Finally, all feelings tumble over each other and create a big emotional whirlwind. That’s what the experience of BPD is like.

I can illustrate this with an example. This afternoon, I was feeling slightly on edge because it was time to make afternoon coffee and no-one was available to assist me. Then, when I noticed the nurses were flipping through some seemingly unrelated photos at the nurse’s station, I completely lost it. They had told me they were busy and now they were just chattering! I can’t even remember how the situation progressed, but within minutes I was banging my head, screaming and then ran off. When I came back to the unit (I had the sense of rationality to find my way back myself), I accused the nurses of faking being busy and ignoring me. They had truly ignored me (or been oblivious to me at least) when i stood at the nurse’s station and I still cannot be sure what thing was keeping them so busy. That being said, I couldn’t politely ask them whether they truly didn’t have time to help me make coffee.

We had a group discussion, in which I was again relatively calm. Then we had dinner, after which I went on the computer for a bit. I still was feeling slightly on edge but not over the edge. I wanted to talk to the nurse, so made use of my daily talk time to discuss my tension. However, I couldn’t get it out clearly what I was feeling and why. At that point, all emotions started coming together and I became angry and depressed and fearful at the same time. I went outside, accompanied by the nurse, to blow off some steam.

Usually, this feeling I had in the evining for me is triggered by some flashbacks or relivings of past “trauma”. I put that between scare quotes because the events I am reliving can be relatively minor. However, they can cause distress nonetheless.

During such episodes I also often feel dissociated. I used to completely regress into a child mode, but now I just feel as though I’m small and start speaking or babbling incoherently but don’t fully act like a child.

When an episode is severe, I may resort to self-destructive behaviors such as binge eating or self-injury. Usually, these behaviors temporarily relieve the tension but obviously they aren’t the solution. I often relapse soon after I engaged in destructive behaviors. With PRN tranquilizers, especially benzodiazepines, the same used to be true: they temporarily calmed me down, but when they wore off, I was increasingly agitated. Research shows that borderlines often become more agitated and may become aggressive when given benzodiazepines, because benzodiazepines reduce their anxiety and thereby their impulse inhibition. I do not personally experience this.

Advertisements

Feelings and Autism #AtoZChallenge

Welcome to day six of the A to Z Challenge, in which I focus on autism. Sorry for being a bit late – I have been quite tired lately again.

As I said yesterday, today I will focus on autistic people’s experience and expression of feelings. It is a common yet tragic myth that autistic people do not have feelings at all. Autistics, especially the ones who are very much in their own world or who seem very self-absorbed, are often thought of as not having emotions. The truth is, everyone experiences emotions, we just experience them different from non-autistic people.

An example is the fact that I did not feel particularly sad at any of my grandparents’ funerals. However, I did not have a particularly strong bond with any of them so did not naturally feel sad, and I indeed wasn’t aware of the social requirement of displaying emotion. By the time my maternal grandma died in 2007, I had rationally learned the appropriate emotional response, but none of my family members showed it so I felt a little confused.

I also sometimes will focus on a detail in a situation and respond emotionally to that. For example, when a fellow patient in the psychiatric hospital told us that he had been diagnosed with incurable cancer, I did rationally feel sad for him. However, I ended up laughing out loud when someone used a funny nickname for a nurse. This emotional tesponse to a detail in a situation rather than to the big picture, may be one reason autistic people are accused of lacking empathy.

I for one have very strong feelings, but I do not always identify them correctly. Until I was in my late teens, I used “good” and “bad” only when talking about how I felt. Even now, I mostly register primary emotions – anger, sadness, joy and fear -, and even confuse sadness and anger sometimes.

Some autistic people, like myself, feel very intense emotions. In some, these emotions might spiral out of control so that fear becomes panic and anger becomes rage. This is particularly true of autistic people with a condition called multiple complex developmental disorder. People with this condition also often have thought disorders. For example, they might make illogical leaps in thinking. I do not have this diagnosis, but it is very similar to the combination of autism and borderline personality disorder, which is my diagnosis. For this reason, I will illustrate this problem with a recent example from my own life.

At my husband’s grandfather’s funeral, I did not display much emotion as I didn’t feel particularly attached to the deceased. I must say here that, in the days prior to the funeral, I had turned my phone off for an unrelated reason. In the night following the funeral, the emotions of the funeral caught up with me and I began to think that my father had died and I hadn’t heard my mother’s call about it because my phone had been turned off. At first, this was just a scenario playing in my head, but I rapidly grew very upset at this scenario and had to take some emergency tranquilizer. I also became very angry, which shows the confusion between anger and sadness I mentioned earlier.

In short, autistic people do have emotions, some very intense ones. They however may have trouble identifying their own emotions and expressing them appropriately.

Borderline Personality Disorder and Anger

As you may’ve noticed, I like to pick my topics for my blog posts in the “mental health” category from recovery or awareness challenges. I don’t usually finish the challenge or answer the questions exactly as they’re asked, but I like to get them to zap me out of writer’s block. One such challenge is the “31 days of BPD” challenge. It asks 31 questions – one for each day – about life with borderline personality disorder. The first one asks you to describe why you were last very angry.

Now the thing about anger in my case is that I don’t usually remember why I get angry, or even what happened. Another thing is that I tend to get angry over the slightest things but then get to make my anger about lots of big and only partly related issues.

For example, a litle over a month ago, I got angry because the staff were decorating the unit for Christmas. I don’t even remember what exactly preceded my blow-up. I ended up running off the ward, wandering, and eventually taking some of my cltohes off so that I froze. When security got me back to the ward, I went into seclusion (voluntarily). I was determined I wasn’t going to go back to my ward. I was angry at the staff on my ward in general for there not being enough support for me or structure to guide me through the day. I eventually even said I wanted to be discharged if my only options were to stay in seclusion or go back to my ward (which indeed were my only options). Eventually, I did go back to my ward.

When I’m angry, I don’t really pick fights or become particularly angry at a specific person. Even when I do direct my anger at someone in particular, I usually don’t mean to single them out for my rage. I don’t ever become physically aggressive towands people, but I do usually shout obscenities and may direct my aggression towards objects.

For me, anger is usually accompanied by a fight-or-flight response. I usually flee in anger indeed, as was the case with the rage over the Christmas decorating I experienced last month. It seems in a way anger for me is close to other emotions, such as anxiety.

It is also closely related to sadness. I usually can’t cry unless I’ve been angry first. Often, also, when I’ve been depressed for a while, it tends to turn into irritability and may even turn into rage. The same occasionally happens with excitement, where I get so excited it turns into rage. In fact, any strong emotion in my case can turn into anger. It’s probably because, with BPD, my emotions tend to shift so rapidly. Maybe even anger is the only “bad” emotion I know.

Post Comment Love
Mama and More

Mental Illness and Causing Emotional Harm

On day four of the recovery challenge, we’re supposed to honestly say whether we have emotionally harmed anyone (besides ourselves) with our addiction/disorder. This is a hard one for me, because with respect to my eating disorder, my answer would be “No”. That doesn’t mean I’ve not harmed people emotionally because of my mental health problems.

Generally speaking, it is not cool to admit you’ve harmed others because of your mental illness. Then again, a lot of family members of the mentally ill do consider being victimized to abuse by the mentally ill person a regular consequence of mental illness. Why is it that people with mental illness don’t want to admit that they can do harm with their disorder? Probably it’s because we don’t want to be seen as bad people, and actually many of us have experienced abuse ourselves. It seems pretty much impossible to find someone who will admit they’ve been abused and yet they are harming others themselves. There is a forum on iSurvive for abuse survivors who abuse others, but that’s about it. I understand it is hard for victims to admit they cause harm to others themselves, but you have to be completely honest about your own actions in order to heal.

I have caused emotional harm to others because of my mental health conditions in several ways. The first is engaging in the addictive behavior in front of others. I have never binged in front of my husband or parents, but I have self-harmed in front of them.

Then there is the emotional unavailability because of the addiction/disorder. I remember one day my mother wanted to talk to me and I ignored her and started eating candy. I also believe that I may not be as available to my husband as I could be. I don’t know whether this is due to my eating disorder – as I said, I don’t binge in front of him, but food is on my mind often. It also could be my general self-centeredness which may or may not be due to any of my mental health conditions.

Then there is the anger issue. This is not caused by my eating disorder or self-harm, but more often the other way around. Both my borderline personality disorder and my autism though have caused me to act out towards others. This is the worst way in which I’ve harmed people emotionally. Except during my teens according to my mother, I haven’t been physically violent, but I have been verbally aggressive often. I can’t be sure that the urge to overeat has never contributed to this behavior. IN fact, usually at least compulsive or rigid behavior has. I mean, if I’ve gotten it in my head that we’re going to do X, the idea of doing Y often sets me off. It is possible that X more often than would be considered normal involves food.

The thing is, mental health problems make people emotionally hurt others. They also are common in people who have been the victims of emotional or other forms of abuse. This is why the cycle of abuse usually doesn’t end with one victim. And it has to end. If you’re suffering with an addiction/disorder, admit that it causes harm to others too. That doesn’t make your own traumatic experiences not valid.

The Five Stages of Grief in the Recovery Process from Binge Eating

When browsing blogs on mental health on Mumsnet, I came across a blog on recoveyr form alcoholism. While there, I found a post on the five stages of grief in substance abuse. You are probably familiar with Elisabeth Küber-Ross’ five stages of grief in bereavement. These same stages apply to some extent to those recovering from an addiction:


  • Denial: people feel that they do not have a problem concerning alcohol or substances. Even if they do feel as if they might have a small problem, they believe that they have complete control over the situation and can stop drinking or doing drugs whenever they want.

  • Anger at the fact that the addict has an addiction or at the fact that they can no longer use alcohol or drugs.

  • Bargaining: the stage where people are trying to convince themselves or others that they will stop substance abuse in order to get out of trouble or to gain something.

  • Depression: sadness and hopelessness, which usually happen during the withdrawal process from alcohol or drugs.

  • Acceptance, not merely as in admitting you have a problem with alcohol or drugs. Acceptance involves actively resolving the addictioon.

I do not have an alcohol or drug problem, but I do exhibit disordered eating. I wonder to what extent these stages of grief apply to the recovery process from eating disorders, in my case mostly binge eating. Denial is certainly common in individuals with all types of disordered eating. I for one was in the stage of denial up until quite recently. This is not merely not being aware of the problem, like I was in early adolescence. Rather, from my teens on, I did realize to some extent that my eating habits weren’t normal. I remember one day buying five candy bars at once and eating them all in one go. When my classmates pointed out that this was outrageous, I shifted from lack of awareness of my eating disorder into denial.

As I said, I stayed in denial for years. I continued buying sausage rolls for lunch every single day until the end of high school, then at blindness rehab ate candy and chips everyday. I gained rougly ten pounds in those four months at blindness rehab, thereby reaching the upper limit of a healthy BMI.

It took several more years before I moved into the stage of anger. By 2008, I was convinced I would die young, and my unhealthy eating habits were one reason for this. I hated myself and my body, yet didn’t stop eating unhealthy amounts of candy. If anything changed at all, I binged more.

I don’t know how I maintained a relatively healthy weight until 2012, but I did. I did start purging in 2011, which can be seen as either a response to anger or a form of bargaining. After all, bargaining can also be seen as trying to reduce the (effects of the) addiction while not completely trying to abandon it.

I reached overweight status in 2012, then obese a few months ago. I started going to a dietician in 2012, then quit going again, went back in the fall of 2013, quit again, and recently started going again. I am still at the stage of bargaining regarding my disordered eating. When told I just need to stop buying candy, I object. Instead, I want to lessen my candy consumption, keep it under control. Yet isn’t the whole point of an addiction not the substance, but the lack of control? I know that one difference between food and alcohol or drugs is that you can’t completely abandon food, and my dietician said that getting fruit or veggies within easy reach as a substitute for candy, is unlikely to work. After all, I’m going to keep the idea that food is an easy way out of emotional stress.

Multiple Complex Developmental Disorder (McDD)

Multiple Comlex Developmental Disorder (McDD) is recognized as a subtype of PDD-NOS in the Netherlands. It is an autism spectrum disorder in which people also suffer from emotion regulation problems and thought disorders. Its proposed criteria according to the Yale Child Study Center are as follows:


  1. Impaired social behavior/sensitivity, similar to that seen in autism, such as:

    • Social disinterest

    • Detachment, avoidance of others, or withdrawal

    • Impaired peer relations

    • Highly ambivalent attachments

    • Limited capacity for empathy or understanding what others are thinking or feeling


  2. Affective symptoms, including:

    • Impaired regulation of feelings

    • Intense, inappropriate anxiety

    • Recurrent panic

    • Emotional lability, without obvious cause


  3. Thought disorder symptoms, such as:

    • Sudden, irrational intrusions on normal thoughts

    • Magical thinking

    • Confusion between reality and fantasy

    • Delusions such as paranoid thoughts or fantasies of special power



In The Netherlands, slightly different criteria are used. For example, social disinhibition is proposed as a possible symptom in the social impairments category.

In the Dutch Wikipedia, McDD is referred to alternatively as juvenile schizophrenia and juvenile BPD. However, most parent-directed sources highlight the intense anxiety which is at the core of McDD. Psrenting, therefore, needs to be aimed at providing structure and boundaries and helping the child reduce their anxiety and emotional lability. Parents need to refrain from showing too much emotion to prevent the child from absorbing the parent’s emotions.

Children with McDD often experience psychotic symptons or full-blown psychosis in adolescence. The emotion regulation problems become less pronounced as individuals with McDD grow into adults, but social problems an thought diosorders often remain significant. Antipsychotic medications can be used to help reduce psychotic symptoms. Even so, most McDD individuals will need lifelong support.

I do not have a diagnosis of McDD, although I think I may meet its criteria. I remember my parents were asked about thought disorder symptoms and unprovoked emotional outbursts at my first autism assessment, but they said I didn’t have them. In reality, I had a lot of bizarre thoughts as a child and still do have them sometimes, and my parents were confused about the questions on unprovoked outbursts. I have, interestingly, foudn that antipsychotics help more with the emotion regulation problems than with the thought disorder symptoms. This does mean that I suffer in silence soometimes, because I do have strange fears and bizarre thoughts, but am too drugged up to act on them.

When I Shouldn’t Reach for My Meds (But I Do)

Today, I had a discussion with my psychiatrist. I’ve been feeling okay overall, but, when my therapist and social worker got talking to me about going into supported housing, it caused me to be irritable for days. I notice this a lot lately: when I’m able to stay in the present and just do my thing, I’ll still have some mood swings, but they aren’t nearly as severe as when I need to focus on the future. My therapist and I are clearly not on the same page in terms of my goals, and this causes me intense frustration. I’ve reached for my PRN medication almost everyday last week, even though it isn’t effective. At least the though that something would be numbing me and I had some control over my emotions was there.

My psychiatrist pretty much said that situational frustration is not a reason to reach for meds, and he’s right. That’s one of the main reasons I stopped my Risperdal, which had been used to make me just numb enough not to have a crisis while living independently, but not so numb that I didn’t feel the intense pain anymore. In a way, I want nothing to do with my increased dose of Abilify either. It wasn’t increased now, but it’s been increased twice since I came here seven months ago, while I’d been stable at a moderate dose for three years before I cam here. Medication isn’t a cure for shitty circumstances.

Yet I reach for medication everytime I feel frustrated. It’s probably what I’ve been learning to do. I can’t get more support if my therapist doesn’t want me to get it, and it’s still a fact that in psychiatric institutions, patients have little say in their treatment, unless their treatment goals are in line with the latest treatment philosophy. Back when patients had to be locked up for the rest of their lives, people wanting to move into the community, were medicated, secluded and otherwise forced into submission. Now that psychiatric services have to face budget cuts and their philosophy has changed to rehabilition, patients like me, who cannot cope with this pressure, are, albeit more subtly, still forced into submission. Still, the only way to numb the agitation that I feel at people trying to control my life, is to reach for my meds. It isn’t going to get me out of this vicious cycle, but then again, what is?

Stages of Adjustment to Blindness

Today on the Psych Central blog, I found an article on coping with chronic illness. According to Donna White, the author of the post, people who are facing a chronic illness go through the five stages of grief populated by Elisabeht Kübler-Ross as occurring in bereavement. These stages are denial, anger, bargaining, depression and acceptance. This post inspired me to pull out Dean Tuttle’s 1996 book Self-Esteem and Adjusting with Blindness. He describes not five but seven stages of adjustment:

  1. Physical or social trauma. This is a situation or circumstance the awareness of which brings about severe anxiety, discomfort and/or turmoil. In blind people, this may be the onset of blindness or vision loss (for those losing their sight later in life), becoming aware of one’s blindness (for the congenitally blind), or the knowledge of impending vision loss (for those who know they will lose their sight at some point before actual onset of blindness).
  2. Shock and denial. This involves mental numbing, including feelings of detachment or unreality, as well as the cognitions involving denial. Denial can be partial or full.
  3. Mourning and withdrawal. This stage happens when people become more aware of the reality of their situation and the psychological defense mechanism of denial decreases. Characteristics of mourning include self-pity and a sense of helplessness. People in this stage often withdraw from their physical or social environment. Hostility may also be part of the mourning phase.
  4. Succumbing and depression. This phase involves a gradual awareness of more specific consequences of vision loss. When these (real or perceived) consequences exceed a person’s ability to cope, they may fall into depression. The succumbing phase is characterized by negativism and pessimism.
  5. Reassessment and reaffirmation. This phase involves the re-evaluation of one’s situation. Anger, depression and self-pity begin to recede and people re-examine the meaning of their life, their values and beliefs and habitual patterns of behavior.
  6. Coping and mobilization. In this stage, individuals manage the demands of their social and physical environment and direct their energy towards the tasks of everyday life.
  7. Self-acceptance and self-esteem. Having a positive self-image is the last stage in adjustment. Accepting one’s blindness is a prerequisite for this. However, a positive self-image is far mroe than accepting blindness. It involves the realization that one is a valuable person. This means confronting one’s beliefs about oneself and one’s blindness, and challenging negative ideas about oneself.
I was unable to see where bargaining fits into the seven-stage model. Bargainign is where I believe I’ve been stuck for years, although I may confuse bargaining with partial denial.

In 2004 and 2005, when an online friend had sent me Tuttle’s book, I had done a series on my old blog on adjustment with my vision loss and actually the reality of finally having become totally blind. I guess in the next few weeks, I will revisit these posts. I realize I’m actually back where I was in 2004, realizing I’ve become totally blind and (now truly) there is no way this can be fixed.

BPD Subtypes

When searching for information on BPD, I came across a set of subtypes that describe the various features of BPD. These subtypes are:

  • Discouraged: this type of borderline is either avoidant, believing no-one will like them anyway, or overly dependent on others. They have an intense fear of abandonment. Borderlines of this type may also suffer from depressive symptoms.
  • Impulsive: this is the most hated BPD type among professionals. People who are primarily impulsive tend to act before thinkign. This includes violence or other antisocial behavior. Conversely, they may also engage in constant approval-seeking.
  • Petulent: borderlines of this type use passive-aggressive behavior, including emotional or physical self-abuse, to get their needs met by others. They have an intense fear of abandonment,, unstable self-image, and inability to express their needs properly.
  • Self-destructive: this includes depressive and self-harming tendencies. People of this type may not have many BPD traits other than self-injury and affective instability, so they may not technically meet the criteria of BPD.
Please note that people with BPD may have some features of one type and some of another. I, for one, have features of the discouraged and petulent types.

All types except for the petulent borderline operate in an abandoned child mode. Petulent borderlines operate in an angry child mode. I do see this point, but I want to stretch that the angry child usually masks the needs of the abandoned child, as my therapist explained. I myself cannot feel sadness unless I’ve first expressed intense anger or rage. Yesterday, I found myself in such a situation. I had had a minor conflict with my husband which led me to fear abandonment. As I got back to the ward, the nurses were assuming I’d had a good day – after all, it was my anniversary -, and were encouraging me to think positvely. Now I could and maybe will at one point write up a whole post on the positivity paradigm, but suffice it to say I snapped. I had a rage that, after a lot of back-and-forth screaming between me and the nurses, led to me running off and wandeirng around grounds screaming. I could only start to feel the sadness and fear of abandonment after I’d blown off some steam and calmed down again.

Autistic Processing Difference vs. Cognitive Distortion

Today, I experienced a combination of emotional turmoil and sensory overload. Which came first is hard to tell, as I was having oversensitivities already for an hour or so, but the actual reaction, which is either a meltdown or an emotional breakdown, was caused by frustration. Given that both autism and borderline personality disorder come with distress tolerance issues, it is hard knowing which is to blame. It doesn’t really matter, except that the two require different approaches. BPD treatment involves skills training in distress tolerance, learning to shift your idea that you can’t handle frustration to the idea that you prefer not to get furstrated. Autistic distress tolerance issues involve an increased need for routine and time to adapt to a sudden change in that routine.

When sensory overreactivity comes into the equation, it gets more complicated. If this is assumed to be an emotion regulation or distress tolerance issue, people need to learn to accept that sometimes there’s noise they don’t like. When people still didn’t acknowledge my autism, I was often told that it’s other people’s right to make noise, as if I was depriving them of that right with my reaction to overload. In autism, however, noise can be painful, and the right approach is to allow the autistic quiet time away from the overloading stimuli.

Now that I write this, I notice that I’m connoting that the treatment I assuem is perceived to be right tfor BPD is really not that right at all. In fact, I believe that you cannot assume that a problem with distress tolerance is ever true unwillingness to accept that things can’t happen on your terms all the time, which is what is assumed in personality disorders. There are some people who are truly unwilling to take others’ feelings into account, but this si much rarer than the assumption that people are unwilling to take others’ feelings into account. I realize that cognitive distortions are not necessarily willful, and that the thought that you can’t handle any frustration is not the same as the thought that the world revolves around your need for gratification. What I mean to say, however, is that most people, and especially autistic or otherwise neurodiverse people, do not just think they have difficulties. We genuinely do process stimuli differently, and this means that “can’t” is not just a cognitive distortion most of the time. That doesn’t mean that autistics doon’t have cognitive distortions, too. What it means is that you need to take into account autistics’ genuinely different processing style when assessing or treating cognitive distortions. As I was being told for the umpteenth time that my daily living skills deficits are largely due to fear of failure, I begun to wonder whether NTs can truly evr make such a judgment.