Thursday, 25 April 2013

Questions for DBT Criteria.

So, dinner finished and there is nothing on the TV I thought I would give this a shot.

First off he has given me a questionnaire. It's one of those with a statement and you have to answer true or false. Very black and white. This annoys me in a way. They say people with a diagnosis of BPD have a very black and white way of thinking. Yet this questionnaire which is determining whether or not someone has a PD only gives you the option of black and white answers.

I have answered it as truthfully as I can, but some of the questions get to me a little bit. For example;

"People think I am cold and detached".

I had to get some feedback from my friends on this. They said not. But sometimes I can become a bit detached if someone is giving me tough love and I don't like what I am hearing. But I am certainly not cold. I don't think I am cold and detached. But, I appreciate because I don't show my emotions (another of the questions) I may come across as cold and detached.

I had an appraisal once when I worked on the forensic PD unit. My line manager said it can come across as though I don't care. I said this was far from the truth. What it was is I didn't let me emotions and stress show as when in stressful situations I didn't think it was beneficial for anyone for me to be flapping with stress. There was one nurse in particular who used to get stressed out and flap and it was no good for anyone. The team would break down and also if patients picked up on the stress then this could affect the way in which they were.

I don't think I get any benefit from showing my negative emotions. What's the point. If someone has upset me or made me angry (I'll get on to this in a minute) I usually let it go and forget about it. I will do anything to avoid confronting people. I know this is not good, but it's what and who I am.

So, on to the more detailed answers in which they'll be asking me.

Emotional Dysregulation.

When was the last time you lost your temper? What did you do?

The last time I lost it was over that incident in the car park a few months ago. I don't tend to lose my temper very often. Yes, I get angry sometimes, but I try not to let it show. When I get angry I cry, and being as I don't like crying in front of other people I try not to get angry. I try not to let other people bother me. I suppose maybe I internalise it somehow and maybe this is one of the reasons for self-harm. It's not bad to get angry, anger is a normal emotion. But, I don't tend to get angry that often.

When was the last time you got into a fight/argument?

I'm not too sure. There was the car park incident where I did want to rip the woman out of her car as she made me angry. But other than that, none stand out to me that I can remember. And as for fighting, I don't think I have since I was about 11. And that was only because I was being bullied and nothing was being done so I was told to stand up for myself. So the lad who was doing the bullying got a couple of punches and we had a few fights. But saying that, with my ex I did used to hit him and throw things at him as he made me so angry at times. No one other than my Dad and my ex can make me feel like that so that I lose it. Oh, there was the incident with Fingers I suppose. But I was provoked, and that was proven.

My tolerance for people can lower when I am not doing so well. I know when I was on PICU I had a few issues with people. One guy I had a massive go at as he kept spitting on the carpet inside...yuck! There was also an issue with one guy who just seemed to have it in for me. He would say stupid, irrelevant, abusive things to me for no reason and so I used to get into arguments with him.

Affective Lability.

Do you get easily annoyed or irritated?

Not generally, but if I am tired or stressed or am not doing too well then I can do. Like at the moment I am not in a great place and downstairs are really getting to me with the noise and door slamming.

How do you respond to criticism?

I suppose it depends how personal it is or if I know I deserve it. If I deserve it, it doesn't get to me that much. But if it's unwarranted then it can make me feel hard done by. I try to take it on board so that next time I won't receive criticism.

How long does it take you to calm down when you feel annoyed or angry?

It depends really. If I can vent at someone it's quite quick. If I don't have anyone around then I tend to mull over it until I can vent and it takes a bit longer.

Are you a moody person? If so why would you describe yourself like that?

I don't think so. Yes, my moods change and the changes can be quite drastic i.e. from quite low to being high or anxious. But these usually last a few days at a time. My moods don't rapidly fluctuate.

Interpersonal Dysregulation.

Do you develop very strong opinions about people very quickly?

Not sure on this. I would say that generally my first impressions of someone are pretty accurate and I can tell whether or not I am going to like someone and then they give me a good reason to like or not like them. If that constitutes developing strong opinions about someone very quickly then ok, I suppose I do.

Then there's a few stupid questions that are asked which are just simple nos.

Behavioural Dysregulation.

Do you ever feel that your behaviour has caused you difficulties or have you ever been told your behaviour is a problem?

Well, I suppose the self-harming behaviour is a problem and yes I have been told that this is a problem. I also am quite avoidant and will do anything to avoid confrontation. I suppose this could be a problem.

Cognitive Dysregulation.

Another load of questions that are a straight forward no. Except from...

Do you think that others will use what you tell them against you?

Kind of. I don't want my family and friends to know details about my mental health problems in case this changes the way in which they behave towards me. My Mum has done this in the past and has become verbally hostile towards me over what she knows my troubles have been. This question is in the middle of a few questions that are looking at paranoia, but I don't think it's paranoid thinking I am showing here. Not on this anyway. I know I do get quite bad paranoia over things. But none of the questions get at that. My paranoia is that I am being watched, that there are cameras in my flat watching me and that when I see a police car or ambulance that they are coming for me to get me because of the things that have been witnessed by the cameras.

Dissociative responses, flashbacks, sense of unreality etc.

Again, a few straight forward nos here. Again the questions don't really apply to me. That's not to say I have never dissociated, I think sometimes when I cut I do. It used to be that hours would go by while I had been cutting and I hadn't been there. But that has changed now. It seems as though what I get from the cutting has changed.

How do you cope when experiencing extreme distress?

The self harming urges and suicidal urges increase. I may self harm more regularly and even make attempts at my life. I either don't sleep very much, or sleep too much. When I am under immense stress I usually sleep too much. I know when I was at uni and had assignments due in that were really tough I would sleep around 12 hours a night. At the moment I am getting by on about 4-5. I got to bed at about 3ish and wake around 7.30ish. I don't know what's going on at the moment with my sleep. I don't seem to be getting that tired or needing the sleep. Maybe it's a bit of mania as my thoughts are racing as well. But I still feel really low, full of both type of urges. But at least I am too scared to act on them.

There were loads more questions on the thing but they are straight forward no answers.

I must say I am a bit worried about the assessment. The psychologist keeps saying how remarkable my last one was in January 2012 as I came across as nothing at all and having no personality. A mist is how he referred to it today. Also, it could just be a huge waste of both of their time. It's two people doing it, him and a nurse I kind of know. I really like the nurse as well. I think I may be at a bit of a disadvantage in a way with my psychologist doing the assessment. I have a feeling I will answer and he will contradict me or say what I am saying isn't right. I have been seeing him now since January 2012 and he knows me really well. What I mean is I may have my own opinion on how I am but he may have observed differently and that is going to be hard. Does that make sense.

Also, we talked about the practicalities of it again. I don't know what's going to happen come September whether or not I will have Wednesday mornings off uni and if I don't I won't be able to continue the course. He said to me today that he had also been thinking about it and he doesn't think I will get much benefit from only doing it a couple of months. He's got a point. I am not too sure either.

To be honest, I am not sure if I am going to do it. I don't really see the point. Not for such a short period of time. I am not going to know until July time when I am in uni. This DBT course starts in May. So do I start it and then stop and not have any benefit from it, would it be a waste of time? But then my CPN basically said today unless I do it I probably won't be going back to uni anyway as it's a proven treatment for people with BPD and PD traits and it could turn my life around. She said things are unlikely to change without it.



Anonymous said...

I hated DBT when I did it as an inpatient but I think your CPN has a good point - if you want to continue at Uni and get a health related job in the future to get past occupational health you are going to need to prove that you have undertaken the recommended treatment. Unfair but that is the way the NHS etc work. We used to say DBT stood for Doing Bulls**t Therapy!

Golden Psych said...

What was it about it that you didn't like?

I am not even sure if I can do it at the moment. There are only 8 spaces on the course and being as though I am not sure if I can commit I am not sure if I will be offered a place.

Anonymous said...

I found it all very superficial - did nothing to address my very deep seated 'issues' - have found attachment based psychotherapy much more useful. I didn't get on with CBT either - to me they seem very similar and I ended up being told and believing that the reason I wasn't improving was because I didn't want to - not that the therapy was not meeting my needs. Lots of people do find DBT useful if you can get into it but I never could get past the issues arising from my childhood which were never addressed.