Tag Archives: BPD

Friendship and Borderline Personality Disorder

The second question in the “31 days of BPD” challenge asks why your last friendship ended. Now I don’t have any friends (unless you count my husband) and haven’t had any in a long time.

Friendships for me were usually short-lived. I had one friend in elementary school who stayed friends with me for the three years that I attended that school, but we didn’t have much contact after I left the school. I’d call her a few times, but she’d never call me and I eventually gave up.

With my seventh grade school for the blind friend, the same happened. We were good friends for the entirety of the year I spent in that school. I’d say we were best friends, but in all honesty she was my only real frined even though I got along quite well with my other classmates and some older girls too. Anyway, after I left the school to be mainstreamed, I spoke to her a few times on the phone, but I’d always ask her to call me and she never would.

I think I must’ve burdneed her with my problems, being bullied and isolated in mainstream school, but I don’t remember. This was in any case what caused my few mainstream school friendships to end. Right when a girl started hanging out with me, I’d open up and tell her my problems. While that wasn’t the actual reason my friendship with four girls in seventh grade mainstream education ended, it probably did contribute.

This was the only friendship that truly was broken. I reemember it was at the beginning of eighth grade. We’d had to do a graded music performance, which I apparently screwed up. I don’t remember how, but somehow I screwed it up, giving the other girls a bare pass. They ignored me for a week, one girl in particular but she was supported by her three friends. Then, when I apologized for whatever I did wrong, they said they forgave me but never quite grew the friendship back.

This all happened when I was a teen, and I’m not sure it’s truly BPD that caused me to be overly open. It could have been my autistic social cluelessness combined with the fact that, well, everyone needs someone to support them and I didn’t have any adults who did. However, rapidly growing attached to people is a common BPD trait. I am not really sure I have this trait, as it’s not really that I overestimate how close I am to people.

With my now husband, I saw him as an acquaintance when he was visiting me on the psych unit on a weekly basis. I didn’t grow a true attachment to him till we started dating. However, I did open up to him too soon, sharing my suicidal ideation at his first visit to the hospital.

This could be related to BPD in a way, in that I particularly open up a lot when I experience strong emotions. Another thing, however, is that I open up more to people I barely know than to those who should be close to me, like my family. I don’t have a clue whether this is a BPD or an autism thing or not.

Linking up with Saturday Sharefest at the Recovery Bloggers Network. The Recovery Bloggers Network is a new project, where I and another blogger hope to connect bloggers who write about mental health, addiction, recovery, or healing from trauma or abuse.

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.

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Things People Don’t Tell You (or Even Know) about Borderline Personality Disorder

Having borderline personality disorder, I have severe and rapid mood swings. Usually, people with BPD experience chronic, low-grade depression, but it can worsen or spiral down into anxiety, paranoia or anger at the drop of a hat. I have experienced that during severe mood episodes, I have similar experiences that are listed as those common in mood or anxiety episodes for people with depression, bipolar or anxiety disorders. The difference is the episodes are usually more severe but last shorter.

Today, I came across a list of things people don’t tell you (or even know) about depression. I can relate to many of these and could add a few that apply to my BPD moods specifically.

1. Most of the things people tell you, are not going to register with you and/or aren’t helpful at the time. “Just accept that you feel like crap”, “just act happier”, or “it will get better”. When I’m in a BPD mood episode, I usually can’t see beyond this episode and am utterly overcome with emotion. Telling me to “just” accept it or “just” act ahppier will seem totally unhelpful, even though it is particularly the “just” bit that is making it unhelpful. It’s not easy, but acting opposite to emotions and acceptance of one’s emotional state do help.

2. It physically hurts. Particularly depression and anxiety can cause physical symptoms. I often experience a heavy weight on my body when in a depressed state. Intense fatigue is another symptom. Anxiety can come with a lot of physical symptoms, such as a racing heartbeat, chest pains, lightheadedness, etc. When you experience these symptoms for the first time, do see your doctor to make sure it’s indeed anxiety and not a physical health condition.

3. Your relationship with food changes to “it’s complicated”. Many people with BPD also experience eating disorders, usually of the not otherwise specified type, where they alternate between anorexic and bulimic or binge eating episodes. Mood episodes can, as the author of the article I linked to says, also cause you to overeat or forget to eat.

4. Some “friends” will let you down, and that’s okay. Being BPD, we often tend to cling to people and have severe fears of abandonment. However, those friends who let us down during a mood episode, probably aren’t worth our frantic efforts to keep them. Friendships are generally hard for borderlines, so especially when not in a severe mood episode, it may be helfpul to invest in interpersonal skills.

5. You feel like you’re absolutely losing your mind. When in a severe mood episode, I can’t see beyond this episode and usually think it is worse than it is. Even if I do recognize that my symptoms are mood symptoms and I’m not going to die of a physical health condition, I often do feel like I’m going crazy. I could’ve been fine hours or even minutes before, but in such a severe emotional state, all there is, is depression, anxiety or paranoia.

6. Everything will start to annoy you. Even you will start to annoy you. My sensory overreactivity gets a lot worse when I’m in a mood episode. So does my general irritabilty. Unfortunately, irritability in BPD is commonly seen as a behavior problem rather than a mood problem./P>

7. Everyday tasks will feel overwhelming. As I said, most people with BPD experience chronic, low-grade depression. For this reason, everyday tasks feeling overwhelming is not just a symptomom of a severe mood episode for me. It could also be related to autism in my case. However, it is true that, when in a severe mood episode, I find everyday tasks even mroe overwhelming than usual. It is important to keep some level of activity even when in an episode.

8. It’s nearly impossible to tell when it’s “just your BPD talking”. With BPD being a chronic mental health condition, we often get used to our irrational beliefs. They however do become worse when in a dysregulated state. At the same time, it is extremely hard to see beyond this mood to our (still distorted) everyday sense of reality.

9. Moods will wreak havoc on your sleep schedule. When depressed, people often experience disrupted sleep. They may sleep more during the day and less at night. On the other hand, borderlines can have periods of hyperactivity similar to bipolar (hypo)mania, when they seem to need less sleep. Sleeping pills may have opposite effects in BPD, causing agitaton and even aggression.

10. Sometimes, you will not feel anything at all. Feeling nothign at all may be a sign of depression, but it is also common in BPD (“chronic feelings of emptiness” is one of the criteria). I personally don’t feel empty or numb that often, but when I do, it’s often the “calm before the storm” and I run an increased risk of falling into a dysregulated mood episode.

11. Your dreams get weird. Both changing moods and the medications many borderlines take can cause you to start having weird, intense or scary dreams. I felt a wave of recognition when I read this in the article I linked to. When I was admitted to the psychiatric hospital in 2007, the psychiatrist asked whether I had scary dreams. I said “No”, but I did say I had these really weird, intense dreams. They quieted for a while and then came back when I went on an anitpsychotic. PTSD is also common among those with BPD, and one of the symptoms of this is recurrent nightmares about the trauma you endured.

12. Your mood will seem totally “logical”. As I said, it is hard when in a severe mood state to look beyond this state. Your mood will also make you feel like it’s the most normal, or even the only state to be in. Some research shows that depressed people lack healthy but unrealistic optimism. Therefore, your thoughts may seem or even be close to reality, but they aren’t helpful.

13. You won’t be able to think clearly about your future. When I was in my worst mood epsiode, even looking a day ahead seemed impossible. I not only had no hope, but no image of even the short-term future whatsoever.

14. Mood episodes distort your view of the past, too. When I am in a severe mood episode, I can not only not see that it will ever get better, but I exaggerate how long I’ve been in this state. This doesn’t happen consciously or with a purpose, but it’s impossible to look not only beyond this state, but also to the past before this state started.

15. BPD makes you feel like you’re alone. You’re not. I often feel like no-one has similar experiences to mine. Of course, it is true that no-one is in my head so no-one has the same expeirneces, but many people do have similar experiences. You are not alone with BPD.

Suicidal People Need Support, Not Judgment

Through my feed reader, I follow a fair amount of mental health blogs. I don’t follow any of the mainstream media and I don’t watch or read the news frequently. I did hear of Robin Williams’ suicide through the mianstream news, but anything more in depth has come to me through blogs.

I see a lot of discussiono n suicide and its reasons. “Reason” is really the wrong word, as Bill Brenner of The OCD Diaries points out that suicide isn’t a rational act. Brenner writes about the differences between long-term depression leading to suicide and a “spur of the moment” suicide when someone kills themself after a disaster, such as the 1929 economic meltdown..

I myself have experienced a mixture of the two when I’ve been suicidal. In 2007, I had the worst suicidal ideation I’ve ever had three months into living independently. My crisis appears like a “spur of the moment” crisis, and in a way, it was. I wasn’t diagnosable with depression at the time, or ever for that matter. I was labeled with adjustment disorder for lack of a better diagnosis.

This is probably too what the people killing themselves in 1929, that Brenner refers to, could’ve been diagnosed with. Adjustment disorder refers to a maladaptive response to an identifiable stressor, where the response (depressive mood, anxiety, disturbance of conduct, etc.) is grossly out of proportion to the stressor and/or causes significant distress or impairment in functioning. The condition can only be diagnosed if other mental health conditions, such as clinical depression, have been ruled out, but it is a mental disorder nonetheless.

Another condition which can come with apparent “spur of the moment” suicide is my current diagnosis, borderline personality disorder. Unlike adjustment disorder, this is considered a severe and usually lifelong mental illness, yet people with this condition who attempt suicide, especially if they don’t succeed, are even more often seen as selfish or manipulative. People with BPD are seen as attempting suicide over the tiniest thing, yet their suffering is severe and chronic, like the suffering of people diagnosed with clinical depression.

In none of the above cases, suicide is a rational act. People with BPD are overwhelemd by intense emotional turmoil. People with adjustment disorder cannot see a life beyond the stressor affecting them at the time. People with clinical depression, the ones who are given the most sympathy when suicidal, are, of course, overcome with depression and hopelessness. These are different emotions and thought processes overcoming different people, but the bottom line remains the same: suicide is not a rational act.

I remember during my suicidal crisis in 2007 being told that I was selfish. In a way, I was, but not out of malice. I was unable to think of other people due to being consumed with intense emotion. Being told I was selfish only worsened my depressed mood.

Remember, people who are suicidal, are in pain. They need support, not judgment. They don’t choose to burden you with the consequences of their death – and yes, I was actually told that. Guilt trips, if they do anything, make the suicidality worse. What someone needs in an urgently suicidal state, is to be kept safe and to be loved. They may understand your point of view once they’ve climbed out of the depths of their suffering. If a person is at the stage of comtemplating suicide, supportive talking can help. If they’re acutely suicidal, all you can do is call emergency services and make sure they’re kept safe and sit by them until they hopefully get out of this state. It’s as sad as that.

I Am Astrid’s Functioning Label

Back in 2008, Bev over at Square 8 wrote a post entitled I Am Joe’s Functioning Label. The post struck a chord with me right the first time I read it, and, over the years, it has become more relevant. For those who don’t want to hop over to read the post, it’s about what the label “high-functioning” is perceived to say about an autistic person, and how this impacts the way autistics are treated.

For clartiy’s sake: I am not saying that people with an intellectual disability have it easy. The cuts to care and the accompanying independence doctrine affect them too. What I do mean is that it is often easier to understand why a person with an intellectual disability needs care than if you have a high IQ.

It is often presumed that a person who can do a cognitively challenging task like operate a computer, can also do more basic tasks like brush their teeth. In reality, these skills have nothing to do with each other. Another assumption is that people who know how to perform a task and/or why it’s necessary, can also perform that task. I remember even years before Bev’s post reading on Autistics.org about a woman who was getting ulcers beecause social services presumed that if she knew about hygiene, she must be albe to wash herself.

There are many more assumptions about people labeled high-functioning. Here are a few that are affecting my life.

  1. Because of my functioning label, I am presumed to be safe in traffic. Since starting to learn a tiny route around the building, I am not only allowed to leave the ward alone without any purpose, but am expected to leave the ward if I’m angry.

  2. Because of my functioning label, I am presumed to be able to take care of my personal hygiene without reminders or help. This is in a way somehting I don’t want to change, because the reason I’m not able to perform some skills of personal care is because of sensory issues.

  3. Because of my functioning label, I am presumed to know how to solve problems myself even when anxious or overloaded (my fuctioning label dictates that overload is just an excuse to avoid demands). I am presumed to be able to make my needs known in very specific terms.

  4. Because of my functioning label, I am thought to be able to perform practical skills like making a bed or pouring coffee myself. Ironically, the motor deficits which cause me to be unable to perform these tass, were originally thought to be especially common in Asperger’s Syndrome.

  5. Because of my functioning label, I apparently don’t need a lot of structure. This means I am presumed to be able ot schedule activities without help.

  6. If I get overloaded, my functioning label dictates that it was my own choice and I’m depriving other people of the right to make noise.

  7. If I have a meltdown because my routine is interrupted, again, my functioning label dictates that I’m just spoiled and trying to always get my way.

  8. Because of my functioning label, I am presumed not to engage in aggressive or self-injurious behavior. If I do, it’s obviously because of BPD-related attention-seeking.

Yes, I see that a lot of these assumptions are not just based on my functioning label, but also on my co-occurring diagnosis of BPD. Before I had this diagnosis, not only was I not presumed to be unwilling to act normally, but my autism was presumed not to be as mild as it is now. Hence, an additional diagnosis makes it seem as though I’m less severely affected. Isn’t that ironic? By the way, if instead of Asperger’s and BPD, my diagnosis had been multiple complex developmental disorder (McDD), which is characterized by practically the same symptoms, I would likely have been seen as quite severely autistic.

The BPD Behavior Double Bind

Attention-seeking, manipulation. Many borderline personality disorder patients are accused of these, and I struggle as I come to terms with the fact that, indeed, a lot of my behavior at least comes across like this. For example, a few weeks ago, my crisis prevention plan was changed to the effect that staff no longer need to make me come back if I run off. It’s up to me to decide whether to run off and, if I do, what to do about it. After trying to communicate my discomfort with this change and being told off with references to choices and responsibility a few times, I ran off and wandered for about an hour until the staff eventually decided to find me.

I can see in a way how this can be interpreted as manipulative. The staff also said I have tremendous power when deciding to run off, because there is no way the staff can responsibly not take care of me eventually.

To my defense, I find myself in situations many times where I communicate in a normal way that I need support and am not being heard because other patiets, with different diagnoses, are acting out more. For example, today I asked the staff to take me on a walk because I was feeling irritable. They couldn’t, because there are several patients in a psychotic break right now. I rationally understand that my needs need to go on the back burner when people are in more severe conditions, but at the same time, this feels like a double bind. If I act out, I’m attention-seeking, manipulating and it’s my responsibility, but if I ask for support in a normal way, I’m obviously not sick enough to need it. In this situation, how am I supposed to show that I’m genuinely not coping?

Always Greener on the Other Side

Another jouranling prompt. This one was meant for kids, and it asks what we mean when we say “The grass is always greener on the other side of the fence”. This saying speaks to me and makes me feel quite uncomfortable, because I can definitely relate.

I remember that, when I go to a new place, like anew ward or institution or supported housing or whatever, I’m always optimistic that this will be suitable for me, but I’m very soon disappointed. For example, when I first got to this institution, I felt truly like I’d landed in a cozy place, or as close to it as an institution can get. Within days, however, I heard the staff reprimand the clients for not doing their chores and I was upset at the phrasing: “You guys are the most independent group, the more independent one on this unit.” A few days later, I was further disappointed when my staff insisted I do chores I cannot do. Pretty soon, I wished I’d stayed in the big city institution, and I still wish for that at times.

I have always felt like this. When I came into blindness rheabilitation in 2005, I saw it as a wonderful opportunity to learn sklls and aadjust to my blindness. By the middle of the four-month rehabilitation program, I felt I was lagging horribly behind and hadn’t learned most of the skills I’d wanted to. Same when I came into independence training, the psychiatric institution and every ward I’ve been at since except this one, where I was quickly realizing that it wouldn’t be helping me much.

I read in a paper a few months ago that this thing where “the honeymoon is over” and people start out okay but end up worse after a while, is common in people with borderline personality disorder. I remember in 2007, when I’d only been in the hospital for a few weeks, being told by another patient, who happens to have BPD too, that I need to work on myself, not on changing my environment every so often. I realize this at some level, but at another level, I think: “What do you think I was in training and treatment for all these years? To change the environment? No!” Yet maybe I still look to others to change me, not to myself.

Love Survives Mental Illness

Over at Bipolar Mom Life, there’s a great post for Valentine’s day on love surviving mental illness. This is a very powerful story. Unlike in my case, the author had not become mentally ill yet when she got married. Then again, with mental illness being unpredictable, it isn’t like my husband knew what to exppect when we started dating or even when we got married in 2011. IN fact, I didn’t know what to expect. Until roughly a year ago, we were expecting to go live together within the foreseeable future. We still hope to one day live together, of course.

Love does not always survive mental illness. In fact, love does not always survive the test of time, with around 40 percent of marriages failing in general. Then again, according to an article in BP magazine, 90 percent of marriages in which one partner has bipolar disorder, end in divorce. I bet that with borderline personality disorder, this percentage is at least as high.

There are several obstacles to a successful marriage for someone with BPD. There are of course those characteristics that are inherent in the disorder – higher risk of infidelity, aggression, idealizing and devaluing, etc. There are also problems that are not necessarily inherent in the condition, but which are more likely to occur due to the dynamics of partners not only being partners, but also having the patient or carer role. I cannot go into detail about this, but I want to warn mentally ill people who are in a relationship that their partner is their partner first, may be their carer second, and is not their therapist.

Gender and Autism Stereotypes: Problems for Autistic Girls

Yesterday, I bought Parenting Girls on the Autism Spectrum by Eileen Riley-Hall. I’ve only read bits and pieces of it yet, but what struck a chord with me are the problems faced by both passive and aggressive autistic girls due to gender stereotypes and stereotypes about what autism should be.

First, most girls on the autism spectrum are passive. This can easily lead to them being ignored in a classroom or even at home. I notice this on my ward, too, because I’m fairly withdrawn. Because of this, my needs are not always met, as there are many patients who act out to get what they need. In the book, Riley-Hall talks about a girl in her daughter’s nursery who was so shy that she could easily be isolated if not for her attentive teacher. Passive autistic girls, according to Riley-Hall, need as much one-on-one attention as possible. This seems coutnerintuitive, because they aren’t causing any trouble or being a danger to themselves or others. Then again, they too need to learn to relate to others. It is sad in this respect that isolation is no longer a ground for care in the Netherlands. Apparently, you need to be aggressive to be seen. Please note that, in DSM-IV, passive autism is seen as more severe than the active-but-odd type.

Yet aggressive autistic girls are also often mistreated. According to Riley-Hall, gender stereotypes dictate that less aggression should be expected and tolerated from girls than from boys. Consequently, if an autistic girl acts out, she’s punished more harshly than a boy. Riley-Hall does not say this, but it is my expereince that aggression in women and girls is also interpreted differently than in males. For example, many more women are diagnosed with borderline personality disorder rather than for example ADHD. Fortunately, researchers and clinicians are becoming more and more aware of gender differences in the symptoms of psychiatric and neurodevelopmental disorders.

What Does Mild Autism Mean?

Yesterday, I had a discussion with a nurse, who said that I am very mildly autistic, if I’m autistic at all (which she can’t comment on of course). This got me thinking, because I know that in some respects, I’m not stereotypically autistic, but then again, that’s not the same as not being significatly affected by autism, is it? I am for this reason posting an updated version of a post I wrote several years ago about what mild autism is. I wrote a list of common assumptions similar to the one on high-functioning vs. low-functioning autism, and am going to add some more.

  • Mild autism means Asperger’s Syndrome. This is a common assumption among auitsm advocates trying to discredit people with an Asperger’s diagnosis. Indeed, it is true that people with Asperger’s diagnoses in DSM-IV-TR must not have significant impairments in cognitive or language abilities, but having an IQ above 70 and being able to speak, says little about real-life functioning.I know that adaptive functioning cannot have been impaired in early development either. In this case, I was misdiagnosed with Asperger’s, but then again maybe my adaptive functioning impairments were presumed to be due to blindness. The DSM-IV-TR expanded text uses other differentiation criteria, like “active but odd” vs. “passive” social behavior. Again, I am passive, as are most women on the autism spectrum.
  • Mild autism means the person has an IQ above 70 (or 85, in some cases). This doesn’t say anything about one’s autism, but about the presence or absence of comorbid intellectual disability. Why would the severity of one disorder be defined solely by the existence of another disorder?
  • Mild autism means the person meets fewer criteria. Relatively speaking, then, again, Asperger’s can be considered to be milder than autistic disorder, because for an Asperger’s diagnosis, you need to meet only three criteria (out of eight), whereas you need six (out of twelve) for an autism diagnosis. I could be considered to have moderate Asperger’s, because I meet five criteria (as I walk myself through the DSM-IV-TR right now, I forgot how many I met during my diagnostic interview). However, most people with an Asperger’s diagnosis will in fact meet some criteria from the “communication” set that isn’t included with their diagnosis, but less obviously than those with an autistic disorder label (I for one have periods when I use a lot of repetitive language, but am generally judged to have normal communication). Also, some people experience more trouble due to one area of impairment (eg. repetitive behaviors) than another, and may therefore meet fewer criteria but still be equally severely impaired. And, of course, I’m not even speaking about those autism symptoms that haven’t made it into the DSM-IV, like sensory processing differences, executive dysfunction, etc. I for one find these particularly impairing.
  • Mild autism means few behavioral problems, like aggression or self-injury. Even though this is often assumed to be a logical determiner of severity, these problems aren’t anywhere in the DSM-IV-TR or DSM-5 as far as I know. I got this one thrown at my by my therapist and social worker. They don’t realize that I’m heavily medicated and that, besides, my aggression/self-injurious behavior is considered a symptom of my borderline personality disorder.
  • Mild autism means the person can live independently, keep a job, etc. This may in fact be the most accurate determiner of functioning, and it has made it into the DSM-IV-TR as one’s axis V GAF (global assessment of functioning) score. The problem with this very raw guess about one’s ability to function in daily life, is that of course someone may function alright in one area and not function at all in another. For example, I am at this point unemployable for reasons related to my autism (of course I am unemployable for reasons related to my lack of education, too, but that is not the point) and cannot live independently, but I can be in a romantic relationship.
  • Mild autism smeans needing little structure: this has made it into DSM-5 as the repetitive behavior severity determiner. I got this thrown at me yesterday by the nurse saying I didn’t need ltos of structure. This may be so, in that I do not attend day activities nine-to-five, but this is mostly because I have such severe sensory and cognitive overload issues that I cannot function in a group for any extended period of time. I also avoid needing support a lot by for example staying in bed all day.

  • Mild auism means being able to hold a conversation. This is in DSM-5 as the social communicative impairments determiner of severity. I can hold an okay one-on-one conversation, but then again, I’m passive, not active-but-odd.

I do realize that I’m not severely autistic by many of these determinants. This, a gain, however, does not mean needing little support. In fact, on a busy ward like mine, it is required that you actively ask for support when yo need it. That is particularly hard for me, so I’m told I a pretty self-reliant. This inability to ask for support has led to a few pretty awkward situations lately. For example, yesterday night, I couldn’t sleep, but when going to the night staff, I was met with: “So what can I do for yu?” Well, I didn’t know, so I went back to my room and was up all night. When, a few hours later, I was feeling very much on edge, I self-harmed to calm myself because I knew that I didn’t know what else to do and I knew the staff wasn’t going to help me anyway. I haven’t told the staff about my self-harm, because I reckon they’ll chalk it up to BPD-related attention-seeking if I do.