Alphabet Soup

MDD, GAD, SAD, OCPD, BPD, CBT, DBT…..Argh!! Sometimes when it comes to my mental health, I feel like I’m living in a bowl of alphabet soup. These letters are constantly floating around me and half the time I have no idea what is going on. Health professionals don’t always have the time to explain what these things mean. Sometimes I think they find it easier not to mention them at all and I’ll just get a referral slip with a bunch of letters on it. I know going on the internet to figure things out isn’t always the brightest idea, but I’m glad I starting reading blogs. I’ve learned so much about mental health and these letters are starting to feel less like alphabet soup and more like acronyms that have actual meaning.

When I was 21, I was persuaded to go to a youth clinic for depression. The general practitioner there, diagnosed me as having Major Depressive Disorder (MDD) with some Generalized Anxiety Disorder (GAD). That’s the diagnosis I’ve known for the last 8 years.

Not too long ago, I had an appointment with the local clinic to start up talk therapy again. At the beginning of my treatment, I thought there was just medication or talk therapy, but over the years I’ve learned that there are different types of talk therapy. Cognitive Behaviour Therapy (CBT) was what I was usually referred to. Anyway, this local clinic woman was offering therapy that was new to me (Dialectical Behaviour Therapy or DBT). She was kind, easy to talk to and didn’t seem to be in a hurry so, out of curiosity, I asked her what my formal diagnosis was. She said it was a primary diagnosis of major depressive disorder or MDD (old news) and a secondary diagnosis of Obsessive Compulsive Personality Disorder (OCPD) and Borderline Personality Disorder (BPD).

Wait, what?!

I had never heard of OCPD before. I am familiar with OCD or Obsessive Compulsive Disorder, but OCPD? She explained that OCPD is basically my need for approval and my being a perfectionist, beating myself up over everything. It’s a completely different condition from OCD. Ok, fine. That makes sense but, what about BPD? That doesn’t make sense. I don’t know much about BPD, but I do know they tend to get a bad reputation (clingy, unstable, impulsive, demanding, reactive, difficult relationships, etc..). This sounds like the polar opposite of me. Most of it is probably misunderstood, a stereotype created by so many referring to Glenn Close’s character in Fatal Attraction as an example of BPD. I was pretty sure that the emotionally reactive/unstable mood part was accurate though.

The woman I was with was nice, but she didn’t have the time to answer ALL my questions about this, so I turned to Google.

Here is the DSM IV diagnostic criteria for BPD. A diagnosis of BPD is determined by meeting five of more of these criteria.

• frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. Maybe. I think this is the reason I’m such a perfectionist. I worry people wont like me if I don’t do a good job at things. I always feel guilty that I’m not doing enough.
• a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This doesn’t sound like me at all.
• identity disturbance: markedly and persistently unstable self-image or sense of self. This could be true. I can’t seem to figure out what I want, what is important to me. I just aim for what I think everyone else wants or expects of me or I choose the hardest route so I can’t be accused of being lazy.
  
• impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. I am guilty of binge-eating, skin picking, isolation, over sleeping, ignoring emotions….
  
• recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Yea, ok.
• affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). My moods can change relatively quickly. An emotion will come on all of a sudden and I just wont understand it. For example, I’ll be fine in the morning and then, in the depths of despair in the afternoon. This is something I don’t show to people though. No one can tell that I’m dreading something and having a total panic attack on the inside unless I tell them. I think I taught myself to do this because people would feed off my reactions and make things worse for me.
  
• chronic feelings of emptiness. Yes.
• inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). I get very intense feelings of anger, but I am always in control. No displays of temper or fights…I’m more likely to wait until I get home and then just got to sleep for a day or turn on the TV and eat junk until I feel numb.
  
• transient, stress-related paranoid ideation or severe dissociative symptoms. I don’t think so…

Oh….

So, maybe I do fit the criteria…

Google also told me there were different types of BPD (High-functioning, Low-functioning, Extroverted, Introverted and Transparent). You can read more about these different types here. Based on this, an Introverted Borderline with High-functioning tendencies sounded a lot like me. I asked psych about this when I saw him last week and he agreed. Funny that he never shared this with me before. I guess he doesn’t like labels. No one fits perfectly into a cookie-cutter diagnosis when it comes to mental health.

The mystery of why my brain works the way it does is a little less mysterious.

No more alphabet soup….for now.