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Hello, friends! This is another question and answer episode. Next week will be an interview with the amazing Dr. Andrea Letamendi all about comic books, pop culture, and mental health.
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I was sexually assaulted over a year and a half ago, and sometimes things will cause me to have flashbacks. It’s really frustrating. Is this normal, and what can I do to help stop them? I am seeing a professional counselor, but I still don’t understand why I can’t just move on with my life.
First off I’m sorry that you had to go through a sexual assault and I’m glad that you survived it. I know that things suck right now but there IS a chance that things will not always be that way. You described having flashbacks which are a common symptom in post-traumatic stress disorder. Basically, most of our memories are stored in a way that makes them like a movie that you are watching. It’s a memory of something that happened in the past. You can see it and sort of put yourself back in those shoes, but it’s clearly in the past.
A flashback is different. When you have a flashback, your body feels like it is going through the event again. Whether it’s an exact memory or a general vibe related to what happened, it feels real, present and threatening. You can be thrown into a full fight or flight reaction. It can be agitating, sad, and exhausting. I’m sure you wish that you could “just be over it already”.
As to whether this is normal – I think its important to not think in those terms. Being sexually assaulted is not normal. As humans, we don’t have the best adaptations to endure that kind of thing, so the whole situation is inherently difficult to recover from. Some people begin feeling traumatic symptoms immediately after a trauma and for others there is a delayed reaction. For some people, they are able to work through it relatively quickly and for others, it becomes integrated into their life forever. For this second group, that is typically when they are unaware that they have PTSD and do not get any help for it. With proper treatment, the rates of recovery are actually pretty good for PTSD.
So, I’m proud of you for taking the leap and getting help for it. I’m not sure what you and your counselor are working on or how long you have been seeing them, but I will say that for you to be experiencing significant triggers that cause you flashbacks 1.5 years later is totally reasonable.
You asked why you can’t just move on with your life. That’s because those memories are still present and threatening like I talked about. With time and work, you can move store those memories differently. Our memories are live. They aren’t static. Every time you remember something, you store it in a different way with new cues. It’s actually what makes humans have pretty bad recall of events. Studies have shown time and time again that eye witness testimonies are terrible for this reason. However, you can exploit that quirk of human memory to mold and shape the traumatic memory into something that is less threatening. This involves recalling the event or aspects of it and getting exposure to the feelings that come along with that in a slow, safe, and gradual way. If you therapist does not specifically focus on trauma, I’d encourage you to find one. Someone that does trauma focused CBT or EMDR would be a good fit for your situation.
Overall, I want you to have some patience with yourself. Realize that you are trying to do what you can to make things better. Try to avoid avoidance where you can. It’s easy to start avoiding the world and things that could potentially be triggering for you. Caution is okay, but ideally you want to build up some coping strategies for dealing with anxiety in general so that you can feel more confident in going about your life.
If your counselor is not working on breathing strategies, cognitive techniques for reducing anxiety, and helping you work toward exposing yourself to your traumatic triggers in a way that helps you build confidence, you may want to consider speaking with them about this or switching.
So I’ve been to many different therapists/psychologists/psychiatrists over the years and never really stuck with any of them. Every time I️ go to someone new I️ am thrown a new diagnosis which is very difficult for me to grasp. At first I️ was unofficially diagnosed with borderline with bipolar tendencies. Throughout the years I️ have been leaning more towards the borderline diagnosis. My last therapist told me he thought I️ wasn’t either, just had major depression which caused the mood swings and irrational thoughts. I️ just went to a new therapist yesterday and she says she seriously doubts I’m anything but bipolar 2. I️ really struggle with my identity as it is so my question is how do I️ deal with all these mixed diagnoses and how can I️ cope with having the diagnosis??
Side note: I️ may start medication for the first time (mental health related) and I’m really worried all of my mixed diagnoses will affect this.
Well first off, kudos to you for doing your best and continuing to get help. Whatever your particular issues are, it’s clear that they are tricky and really intrude into your life.
Diagnoses like borderline personality disorder and bipolar can be pretty hard to differentially diagnose (meaning tell the difference between them). It sucks because we don’t have something like a blood test to tell us which one it is.
To me, one of the major points that would indicate that you do have borderline personality disorder is how you are in relationships. Typically someone with BPD will have a sort of “boom and bust” pattern in relationships where they sort of alternate between idolizing someone and giving everything they have to them and then feeling betrayed and hurt by them and feeling like they are the worst ever. You can definitely have mood swings as well, but they tend to be quicker than they are in bipolar where you have somewhat prolonged periods of mania and depression.
Of course you CAN have both. I saw someone this year that was told by a previous psychologist that a borderline diagnosis means that they can’t have bipolar, which is bullshit. It’s actually pretty common that they co-exist. The way that I conceptualize it in my mind is that if someone has the emotional instability and that relationship pattern that I described and they also have extended periods of at least a week that look like manic phases where they are not sleeping, have an overabundance of energy or creativity, and make impulsive decisions, they might have both.
Basically BPD can cause micro fluctuations on a moment to moment to moment basis and bipolar is more likely to have macro fluctuations during prolonged manic phases and depressive phases. But again, it can be really difficult to pin down the best diagnosis because there are also things like rapid cycling bipolar.
The thing is, at a certain level the exact diagnosis doesn’t really matter. At this point, you have a pretty good profile of yourself and your symptoms. You know that there are elements that seem like BPD and that seem like bipolar. Formal diagnoses are just shorthand. They are not nearly as precise as medical diagnosis of something like lupus or a broken arm. What matters more is trying to facilitate yourself and word toward living a successful life in the context of your symptoms.
Whether you call it BPD or bipolar, your issues are sticky and will rear their head at different points in your life even with treatment. And regardless of your diagnosis, the medication approach will likely involve similar components and may take a little trial and error no matter what. My best guess is that they will want you to start a traditional antidepressant and also something called a “mood stabilizer” these come in different forms, so I don’t want to go into too much detail.
The only risk with your unclear diagnoses is to put you on just an SSRI antidepressant without a mood stabilizer. If you do have bipolar, that could cause you to become more agitated or throw you into a manic phase. However, this is not my area of specialty. That’s why psychiatrists are around. They know a lot more about the best medication approaches.
My advice to you would be to try to step away from the relentless pursuit for a diagnosis for a bit and focus more on trying to understand and describe your patterns. Patterns in your relationships, patterns in your internal thoughts, patterns in the way that you interact with the world. Journaling would be a great tool here.
When you understand your patterns more, you can focus on addressing those regardless of the formal title. With either BPD or borderline, planning and setting yourself up for success is super important regardless of medication or counseling. You are going to have fluctuations and moments of clarity. You want to try to use those moments of clarity to plan for those times when you know you won’t be thinking as rationally.
Just a few tips. I want to say that I think you are doing a good job and the fact that you are so self-aware and concerned about this is a positive. I can tell you are really trying to figure this out, so I am confident that you will be able to make some progress.
Resource: Borderline Personality Disorder
The Recovery Village – If you’re looking for further information on BPD, this is a good resource provided by The Recovery Village which you may find helpful.
My question today is about relationships. How do I manage a new relationship when I’m struggling to suppress my borderline tendencies? I’ve known this person a little over a few months now and it’s the longest relationship I’ve had but I feel like I’ve been stifling my “true self” the entire time. In many ways he doesn’t really know me. Just the version of myself I present to him.
Also, we haven’t had sex and I think he’s growing impatient waiting around for this to happen. Should i just give him what he wants To placate? Sex for me is a lot to handle due to past childhood sexual abuse but I want to be fair to his needs as a man. I’d like to keep him happy but not having sex is making him feel like I don’t really like him. Why do men need so much sex? Maybe that’s too broad of a question but it feels like sex is the only way to get a man to really like you.
So there are many questions in here. I might not answer all of them, but I wanted to address a few points. First off – no you should not give sex to placate someone. You are allowed to have sex or not the way that you want. You can certainly give it as a gift or use it as a tool if that is something that you desire, but you should not feel coerced or pressured into giving it when you don’t want to.
To your question of why do men need so much sex? They don’t. They think they do. Evolutionarily, they are going to be inclined to always be scanning and searching for opportunities to have sex, but that doesn’t mean that they need it. Sex is good and healthy and it is a need for many people, but as humans with big frontal lobes, there are many different factors that we consider and weigh against the biological drive for sex.
There is definitely an underlying issue in the relationship that you described, which is that it sounds like communication is not happening. When there is a lack of open communication, that leaves space for guess work. Guess work can be dangerous, especially with our tendency to make up stories in our heads about what someone else is thinking or what they want. Does he know that you’ve been abused? You certainly don’t have to disclose that if you want to keep that information to yourself, but it could help provide some context.
You could also just be clear about your boundaries and what you do/do not want. You could say “I’m not ready to have sex yet and I’m not sure if I will be for a while. I’m not going to go into all the reasons why, but it isn’t because I don’t like you enough.” Saying something like that makes it totally clear where you are at. You can’t really argue or misinterpret that. If he makes up a story in his head that you aren’t telling the truth, that’s on him.
You’re allowed to want to have sex and you’re allowed to not want to have sex. If that’s something that he can’t deal with, that’s something that you guys should talk about. Maybe you don’t need to be in the relationship, maybe you don’t need to monogamous, maybe there is a compromise where his needs and your boundaries are both respected. There are a lot of different possibilities, but leaving things in the realm of subtext and guesswork will make it really difficult to move forward.
I just want to reiterate that you aren’t doing anything wrong. I’m not sure if he has actually expressed to you that he feels like you don’t like him and is getting impatient because you won’t have sex with him or if that is just your expectation given when you feel like you have learned about men. You could be totally right, but I just want to encourage you to try to find out rather than making guesses and assumptions.
The other important thing is to consider what you want our of this relationship. Are you trying to make this something that lasts? Are you trying to have a long-term relationship or is this just fun right now. Shoot, it could even just be a practice relationship to try different ways of being with someone. That is important to keep in mind. If your objective is to make this a long-lasting, enduring relationship, you need to be mindful of the foundation and expectations that you are building.
I’m not sure if you are currently seeing someone for therapy, but I would suggest it. Either that or making sure that you have trustworthy friends or family members that you can talk to.
You situation is somewhat common and it’s tricky. Where you have a history of abuse and borderline personality traits. It’s hard to tell whether that voice in your head screaming to leave is the logical part that is just being cautious and recognizing the potential for abuse again or if its the borderline part of your brain simply flip-flopping again and trying to make you run away. That’s why having someone outside of the situation can help. They can focus more on the facts rather than the way it feels and give you their perspective. So this is a lot of stuff for you to think about. The one thing I’ll be firm on is that you don’t need to feel like you are being pressured into sex. You don’t NEED to do anything when it comes to your body. That’s your choice.
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I'm always taking questions for the podcast, so contact me at robert@duffthepsych.com if you have something you want me to talk about.
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