Self Awareness

I am starting to have some grave concerns that there is something fundamentally wrong with me. I have a long history of an eating disorder (30 years), a little bit of mild self harm, depression and dissociation issues. More recently I have started acknowledging that trauma is a part of my history and probable post traumatic stress a factor.

I have now recovered from the ED, have control of the depression and have greatly increased self awareness and as a result have identified the following problems:

• I struggle to have a cohesive sense of who I am and have quite extreme changes in who I am when with others. More than would be considered normal and it includes abilities. This despite much work on developing a sense of self. I often feel I don’t recognise myself at all. The level of my paradoxical reactions to just about everything is truly extreme and sometimes happens simultaneously which creates great internal conflict. Sometimes this even manifests in physical ways.
• Regardless of improving my paranoia about criticism and attack I am still intensely affected by perceived criticism or if I am not understood. I may not show it but it is a big problem.
• A seeming almost total inability to have a narrative of my life on a day to day level. It’s as if both my life and I are made up of pockets of time. All disconnected.

There are certain things I have thought preclude it but I am no longer sure:

• I do not rage at people. I am always in tight control of my anger and until a few years ago I thought I did not get angry. My anger is turned inwards. I may be impulsive in other areas of my life but I have both an intense need to avoid hurting others at all times and a need to appear rational. Both are more powerful than anything else.
• I am impulsive but only in some parts of my life. In others I am super controlled and use it to create a buffer between the world and my internal problems.
• I have huge problems with relationships but in some ways am able to give the appearance of not by keeping my self hidden and keeping things superficial.
• I am very private and had thought that those with BPD are normally open. I give the impression that I am open and am quite expressive and entertaining but in reality I am not.

Therapy literally feels intolerable to me. The interactions required seems to immediately send me into a downward spiral of paranoia and distress. In other words I would certainly not be the type of person people would think would have BPD. But I wonder if a lot of these problems can still be a factor but hidden. Or I wonder what else could explain these struggles. It seems to impair my life in so many ways and stop me from getting help that does not simultaneously damage me.

The interpersonal sensitivities and the and the seeming inability to have any sense of cohesion in my life is the foundation of most of my problems.

You have provided a long description of what you think is wrong but you did not provide any specific examples. For instance, you stated that you struggle to have a cohesive sense of self and have quite extreme changes in who you are with others but did not describe these changes. What do you consider extreme? What do you mean by the phrase cohesive sense of self? Without more information, it’s difficult for me to determine if you have correctly assessed your problems. People with depression tend to inaccurately judge their own abilities. They often incorrectly assume that something is wrong with them. That might be what is happening in your case.

You also mentioned that therapy feels intolerable. It makes you feel paranoid and distressed. What about it makes you feel this way? It shouldn’t cause that reaction. It is an inappropriate emotional reaction. Logic dictates that therapy is designed to benefit you. Some people are hypersensitive, to the point where even constructive criticism is perceived as being a personal attack, an attack on the very essence of who they are. Your hypersensitivity might be why you are reacting with such strong, negative emotion to therapy.

I would recommend therapy even if it feels intolerable. It might feel intolerable but in reality it’s not intolerable. You have successfully overcome many issues in your life and for that you should be proud but at this point professional help is required. Therapy might be difficult but it’s necessary to overcome the issues that are plaguing your life.

You asked whether or not you have borderline personality disorder. That’s not something I can answer based upon your short letter. An in-person therapist, after collecting an extensive psychosocial history, can determine if you have a diagnosable mental health disorder. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog