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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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MS - 211

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Hi Dr. Mark,
I posted a question on line about 24 hours ago and the status is shown as 'locked'. The ref no is MS-201. What does this mean? And how can I see the answer?

Regards
Alex
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.
Alex, neither you nor I can have access to it. I don't know why it was locked. I assumed you asked for it to be locked.


So, the best we can do now is start over: please go ahead and ask me your question and we'll go from there. Be as detailed as you think will be useful, okay?


Dr. Mark
Customer: replied 1 year ago.
Hi, 

I broke up with my x girl friend about a month ago (Dubai). I explained that the reasons were that she lied so I could not trust her and that we had a different perspective on a number of things. I had been with her for about a year and 3 months and was pretty much living at my place for about 9 months (although she still had her own place). Since that breakup moment, i have experienced the following:

1) 1 hour after the breakup she claimed to have taken many tablets to attempt suicide. She said that she couldn't live without me. She called saying she wanted to spend the last hours of her life with me. I wasnt sure if she actually took tablets but I called the ambulance just in case and went to the hospital. It was a dramatic experience. I believe the whole stint was an attempt to get me back. From then on she moved out to stay with her aunt and since I have been worried about her well being. I couldn't cut off communication completely due to my concern. I wouldn't initiate communication, she would. (she's31years old).

2) 4-5 days after the break up later she requested to see me and she begged to have me back. Literally begged repeatedly. I also repeated a number of times that this could not happen and if I told her that there was a chance I would be lying. After the 12th time (roughly) of begging she said 'just for the sake of saying so i wont go crazy just tell me that there may be teven a slightest chance'. As the conversation was worn I replied, 'ok, just for the sake of saying it, whatever..' I was also worried about her suicidal tendencies.

3) about 10 days after the break up she requested to see me and said it was very important. We met up she claimed to be two weeks pregnant with a tubal (fallopian tube) pregnancy. We had used protection in our relation ship so it was hard to beleive. 
She also said that a tubal pregnancy is risky and she can die from it, but with medical means she can have the baby. She said with or without me she wanted to have the baby. 
She was observing my reaction and I mentioned it didn't make sense at all and that I'd like to see the Gyneachologist. in suspicion I said 'I'm not saying anything till I see a doctor' and then scheduled a time for this. We parted and she then went back to her aunt's place announcing the pregnancy to her aunt, she also called her mom (living abroad) and told her friends about this 'pregnancy'. She was very excited as I could see from her messages later  that evening. I realised she misunderstood me completely when i said 'I'm not saying anything till i see the doctor' thinking after seeing the doctor, we may get back together as i may want to have the baby with her. In order not to clarify my intentions, my reply to her series of messages was, 'IF you are pregnant, i don't think you should have the baby'.
She was upset the next day. I checked with justanswer.com and overall the medical story did not make sense. 

Before the scheduled appointment with the Gyneachologist, she said 'since you don't want the baby, i will induce an abortion'. In Dubai abortions are illegal, so she did some reseach and drank tea made from laurel leaves to induce an abortion on her own. Laurel leaves and their berries were used in ancient times to induce abortions. But they were taken in large amounts. The same night she claimed she took the laurel leaf tea she dramatized that the abortion was taking place and she was bleeding a lot. It all did not make sense and it was obvious she was lying. One lie after the other. Finally we went to her Gyneachologist who was paid to lie too and said, 'indeed the baby was lost'. There were inconsistencies in the story. A lot of lies, even to her friends and family!

4) I spoke with one of her close  girl friends today and we both realized that over the past, she has made a number of lies to both of us. Her friend told me that her friends in University nicknamed her 'liar'. She continues to sent me obsessive messages saying how much she loves me and wants to be with me etc...

Overall, it looks like some obsessive behavior. She also spontaneously dropped into my house about three times since we broke up. She obviously lies a lot. Suicidal tendency; maybe, it could be but could be a lie as well. She is extremely jealous as well. At one point when we met up after the breakup and I mentioned one of our friend's names (female), she lost control and pushed me and groped my neck at the same time.

I didn't expect all this before breaking up!!!

Today her close girlfriend and I agreed that she is ill/not well. I want to help her to be well. 

Overall, what do you think is wrong with her? 
What do you recommend I do to help her?

Thanks

Expert:  Dr. Mark replied 1 year ago.

Alex, I remember your question now. I remember my answer as well.

I have been working in therapy via Skype with a young man, also not in the US, with a very similar situation: when he told her he wanted to break up, she told him she had been raped, that she had been to the hospital and police; this was with a man that he knew. He confronted the man who denied knowing anything about this and the families became involved. And eventually it became clear that she was lying because no police, he checked with the hospital, etc. And there were even more incidents!

And he became emotionally distraught and very shaky in himself from all of this. And so we have been working on her continual need for and creation of drama; her overpowering fear of abandonment; her desperation. All these things led us to work on how to get his footing back in his own life and to move forward after having been so involved with someone with Borderline Personality Disorder (BPD).

I can't tell you if your former girlfriend has BPD just from what you've written; but it is clear that she has a number of features that are very similar. So I'll put in the diagnostic criteria for BPD at the end of the posting to give you more information. And even if the criteria don't fit her behavior in all a full way, the point is important for you:

You need to make sure NOT to think about how to help her. That is not within your abilities. She needs professional help to become well. And you need to focus on yourself and on your moving forward in your life toward healthy relationships. That is most important. You have to not allow yourself to be emotionally blackmailed by her into continuing having a relationship. That is a frequent BPD behavior. And you must not fall for that as it will keep you in that emotional turmoil state that is not healthy.


Randi Kreger wrote a book with Paul Mason you will find in the library though it's very popular and may be checked out. So you may want to buy it online. It is called Stop Walking on Eggshells. Her is the American Amazon page for it:

http://www.amazon.com/Stop-Walking-Eggshells-Borderline-Personality/dp/1572246901/ref=sr_1_1?s=books&ie=UTF8&qid=1284441698&sr=1-1



She also has a wonderful online group called the Oz Online Community for Family Members. You need to really get to know her resources because they'll help you. She's a very nice person, too.

Because, again, I have a very strong suspicion that she was not just a stable, normal, loving, easy natured, likable, easygoing woman before you two became involved with each other. I suspect she was difficult to live with and that you often felt like you were walking on eggshells with her. If I am correct, I want to point you to go to Randi Kreger's website and get her book of that same title and especially go to the link on the left for support groups and see if you connect with some of the information you read there. Because I think it will help you put her behavior into perspective even if she doesn't have BPD fully.

http://www.bpdcentral.com

Here is the BPD description. It's long; I apologize: I didn't edit it. It's from the BPDtoday website:

Borderline Personality Disorder DSM IV Criteria

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3. identity disturbance: markedly and persistently unstable self-image or sense of self.

4. 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.

5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6. 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).

7. chronic feelings of emptiness

8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9. transient, stress-related paranoid ideation or severe dissociative symptoms

The DSM IV goes on to say:

The essential feature of Borderline Personality Disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts.

Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.

Individuals with Borderline Personality Disorder have a pattern of unstable and intense relationships (Criterion 2). They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not "there" enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will "be there" in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver who nurturing qualities had been idealized or whose rejection or abandonment is expected.

There may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self (Criterion 3). There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with this disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

Individuals with this disorder display impulsivity in at least two areas that are potentially self-damaging (Criterion 4). They may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly. Individuals with Borderline Personality Disorder display recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (Criterion 5). Completed suicide occurs in 8%-10% of such individuals, and self-mutilative acts (e.g., cutting or burning) and suicide threats and attempts are very common. Recurrent suicidality is often the reason that these individuals present for help. These self-destructive acts are usually precipitated by threats of separation or rejection or by expectations that they assume increased responsibility. Self-mutilation may occur during dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating the individual’s sense of being evil.

Individuals with Borderline Personality Disorder may display affective instability that is 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) (Criterion 6). The basic dysphoric mood of those with Borderline Personality Disorder is often disrupted by periods of anger, panic, or despair and is rarely relieved by periods of well-being or satisfaction. These episodes may reflect the individual’s extreme reactivity troubled by chronic feelings of emptiness (Criterion 7). Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger (Criterion 8). They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil. During periods of extreme stress, transient paranoid ideation or dissociative symptoms (e.g., depersonalization) may occur (Criterion 9), but these are generally of insufficient severity or duration to warrant an additional diagnosis. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours. The real or perceived return of the caregiver’s nurturance may result in a remission of symptoms.

Associated Features and Disorders

Individuals with Borderline Personality Disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last). Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, and hypnotic phenomena) during times of stress. Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships. Premature death from suicide may occur in individuals with this disorder, especially in those with co-occurring Mood Disorders or Substance-Related Disorders. Physical handicaps may result from self-inflicted abuse behaviors or failed suicide attempts. Recurrent job losses, interrupted education, and broken marriages are common. Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with Borderline Personality Disorder.

Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 1 year ago.
Dr Mark,Borderline Personality Disorder is exactly what I assumed she may have! I was researching the web for disorders last night and this one was a closer fit than others. I want to help her somehow, I can see that her behavior has pushed away a number of her friends and even some family and she doesnt have someone to really help her. When I say help her, I mean getting her to a Psychiatrist. Would you agree with me? If so, what is the best way to get her to commit to seeing a psychiatrist? Also would my direct involvement in this misguide her to imagine that I potentially am still interested to be with her?How do you think I should approach this?Also, how do I keep a distance or deal with this? I don't want her to become suicidal again.Thanks
Expert:  Dr. Mark replied 1 year ago.
Let me answer each of your questions individually:

  • When I say help her, I mean getting her to a Psychiatrist. Would you agree with me?
No. First of all, BPD sufferers go from one therapist to another until THEY are ready to go. And when they are ready to go, they don't need help to find a doctor. Until then, they use going to a doctor as a way to keep you in their orbit. She will seek ways to need your presence in sessions or your support in order for the treatment to be effective. She doesn't need you to show her how to find a doctor if she's looking for one.

  • Also would my direct involvement in this misguide her to imagine that I potentially am still interested to be with her?

Exactly. You clearly understand this dynamic within yourself. But she knows that the romantic "knight in shining armor" part of you is what she needs to rely on. And so she will use any gesture on your part as something that now obligates you to her.


  • How do you think I should approach this?


You accept that she's an adult who has made her choices and now she will move forward in her life. Period.


  • Also, how do I keep a distance or deal with this? I don't want her to become suicidal again.


You are not responsible for her health and her life. She is an adult. She has responsibility for her desire to live. Now a secret: Borderlines are very good at manipulating you once they've hooked you into their orbit by making their lives YOUR responsibility, not theirs. You can only win your life back in such a circumstance when you reject that unhealthy dynamic. You keep distance by not returning calls, not responding to texts or emails, etc. You say goodbye and you mean it.


You might need to then get therapy help for yourself to get over the emotional wounds to yourself like I told you of before. Because they are real. But if you keep giving in, you will keep enlarging those wounds and making your own recovery more difficult.


I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 1 year ago.
Should I not arrange (through her girlfriend) that a psychiatrist sees her to verify that she indeed has Borderline Personality Disorder ?

Based on info received from a close girlfriend of hers just now, the current situation is as follows:

1. She is barely sleeping
2. She has left her aunts place and is sleeping in her car on the beach.
(She let go of her apartment a couple of months ago)
3. Today she tattooed my name on her leg (large,below the knee)
4. She is barely eating or drinking and has lost ALOT of weight and does not look well.
5. She is not performing at work.
6. She is driving very recklessly. She crossed 2 red lights when driving with her girlfriend
7. She is losing her friends with her behaviour and this makes her feel more 'abandoned' which is a driver of BDP from what I read.
8. Her strange behaviour is getting worse day by day

My main worry is something bad happening to her. And if something bad does happen to her whether it is suicide or a bad car accident etc, it would be on my conscious forever. I understand your recommendation to not answer calls etc, and I do intend to stay away, but should I not first confirm that she has BPD?

Her girlfriend has agreed to find a place to stay with her to help her out. Wouldn't it be good for her to be aware of how to deal with this?

I appreciate all your answers so far...

Thanks
Expert:  Dr. Mark replied 1 year ago.
No, you don't arrange a psychiatrist's appointment for any reason for her. Remember your important insight?


You yourself recognized that she might use any action you take as a sign that she can still get you to stay with her if she manipulates you enough. I pointed out to you that she will read ANY sign you make, no matter how small, as a message from you that you love her and you want to be with her. You've seen this before.


So, as I said above: you cannot help her. She is not incapable of getting help if she wants help. She is very capable. Your taking her to a psychiatrist is not what is holding her back from becoming better. You are only going to give her the signal that you still care about her and that she should do whatever she can to get you back.


I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX


Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5089
Experience: Dr. Mark is a PhD in psychology in private practice
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