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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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My father was an alchololic and although I am adopted and drink little alcohol as my husband does, somehow I still married the emotional roller coaster. The guilt and pain I feel from him are the same as my father when he was alive and drinking. Making me feel worthless and that everything is my fault. Tell me that I make too much of things and not understanding my point on anything. A perfectionist on how I should do things but a lazy unmotivated person in general. Complains about everything he does not have (although I think our lives are good) but does nothing about it.. On the other hand it makes me feel bad and guilty and I want to try and fix everything. So I am constantly trying to make everything perfect and walk on eggshells so we do not fight because they are completely unproductive. I thought we had made progress with our last incident when he confessed to me and the kids that he has a problem and will get help. That was 3 weeks ago and we have incidents since and no talk or action toward getting help. I am on the verge of divorcing him, finally realizing it is not my fault but it has been 28 years of marriage and I am a fighter, because I know he loves me and it is a disorder not him. Any suggestions?


 he can be the most wonderful person full of humor.  Unfortunately this person is the same person that never wants to go anywhere or do anything.  He cares more about what everyone else thinks about him than what I think about him.  He says that how he acts is my fault-- my response was well I wish someone would of told me that I am responsible for not only my behavior but also for your behavior... 

Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

Hi! I believe I can be of help with this issue.


First, let me say I can imagine how distressing and worrisome this situation must be for you. You are seeing the same pattern of behavior now in your marriage that you saw as a child in your father. That you're aware of this pattern is very important as it clearly is helping you recognize that you cannot continue to take responsibility for his getting better or his problems (enabling).

Enabling is what you're battling in yourself right now: that he is denying he has problems and blaming has made you take responsibility for things and to feel guilty. And then he just gets more rage and blaming and the cycle continues. There are clearly underlying emotional disorder(s) he needs to work on and that need treatment. But that is not really possible until he is willing to deal with the alcohol abuse. So, the first thing is for you to become familiar with the term enabling. That's going to have to involve Al Anon which we'll discuss below but also I would like you to do a Google search on enabling and become familiar with it. Again, the key is for him to take responsibility for his own problems and his own getting better.

You are clearly a good-hearted person and you very much want to help him. You are already at the divorce thinking stage and I can understand if you choose to go that route. But let's see if these strategies can help you help him first. And so I want to now convey to you what you CAN do that does have a chance of helping. First, you must NOT accept the world from his disordered view of it where it's okay for a man to behave like this simply because he's very loving and a good man when not drunk and/or raging. This is not good enough. I treat adults in my office almost continually who grew up in alcoholic homes and they more often than not agree their alcoholic parent loved them and had many good traits. But they are in therapy because they suffered and they have ongoing problems from their childhoods. So, you must not accept his view that it is okay.

Only you can decide if the next step is to print out my answer and read it with him. You must decide if it is safe to do that. And if it is safe enough and you do show my answer to him I want him to consider this: I posed it to your wife that she needs to decide if it is SAFE to show you my answer. That is hopefully enough to make you pause and take time to consider what you are doing to your family. Reread my above sentence. It is not make believe.

So, you must help him and to do that you must get help yourself. First, you need to get yourself or you and your kids if they are old enough to Al Anon. That's the part of Alcoholics Anonymous that is for the family. Here's the meeting finder:

http://www.al-anon.alateen.org/meetings/meeting.html

Not all meetings are the same. So if you don't hit it off with one group, find out where there's a different meeting. But you need support for the next step:

He needs to get to AA right away. He may refuse, but still, you can offer to go to AA meetings with him (that's what the meetings for the alcoholic is called) at first. Same idea: not all meetings are the same. But, then, it's up to him. He needs to take responsibility and you need to let him take responsibility.

http://www.aa.org/lang/en/central_offices.cfm?origpage=373



Well, that was tough to read but I believe you are good-hearted enough to know that I am speaking honestly and openly from experience as a psychologist and that you need to hear this.

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. 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.


I am going to continue reading but from what I have read so far, i am under the impression that I have misled you to believe my husband is an alcoholic. He does not drink, maybe a few times a year. I was describing his behavior to be similar to what I encountered as a child of an alcoholic the emotional rollercoaster. Maybe I have jumped to conclusions if not please respond but I will continue now to read your answer.

Expert:  Dr. Mark replied 1 year ago.
I am so sorry! I reread your post and you're right: I wouldn't have been mislead if I would have read it more carefully...I apologize.


And that changes the picture very much, doesn't it. I have to tell you, I wanted to discuss the issues based on the important phrase you used "walking on eggshells" and the emotional rollercoaster. But I was distracted by thinking he was drinking like your father. So I'd like to pick up back there, okay?


Randi Kreger has an important website, though she uses it a lot to sell her books, and I'd like to link a page for you to look at and read and then get back to me if you think you're dealing with a similar situation in your husband. By the way, her first book was Stop Walking on Eggshells. Here's the link:


http://www.bpdcentral.com/help-for-families/familiar-fights/


I'll await your response.


Dr. Mark
Customer: replied 1 year ago.


This describes him exactly, almost scary.... Is this a chemical inbalance or simple therapy? Since we have discussed it he knows I have been doing research. With that being said, would it be appropriate to print out that page and hilight the obvious similarities and concerns and then hand it to him? He wrote me a letter a few weeks ago describing this feeling of hoplessness and how he cannot control and and how much he hates it as it escalates and comes out on the family. To me this was a huge step. But I think he thinks he can do it himself and I do not know how to approach that mindset.

Expert:  Dr. Mark replied 1 year ago.

First, let me say that you have to prepare yourself for the realities of personality disorders, if that's what is really present. You have a lot more research to do before you should be comfortable deciding. Yes, I was concerned and yes, it seems like a good possibility now. But, still, you need to learn more.

I'm going to paste in a narrative description of the psychiatric description for Borderline Personality Disorder (BPD). And when you spend more time on the BPD central site, you'll see that Randi Kreger has put a tab for Narcissistic Personality Disorder (NPD) there also. This disorder is often associated with BPD and sometimes people with BPD will have features of NPD.

Personality disorders are not chemical disorders. We don't know what causes them in the way we know what causes diabetes. We know that they form from infancy through childhood. And there are many factors that are involved. There is no evidence of genetic predisposition that has been shown to be promising. We know it to be so ingrained in the person that it is called a "personality" disorder, meaning it has worked its way into the person's personality.

That means these disorders are the most difficult to treat. Long term therapy, very long term therapy is the only way we have of actually treating these disorders. Today, the best treatment we have, in my opinion, is a combination of psychodynamic therapy with Dialectical Behavioral Therapy (DBT). DBT is wonderful for giving the person with BPD skills to use and a framework for managing overwhelming feelings, not blaming, not making people into saviors/enemies, etc. Psychodynamic therapy, though, is also important for helping to separate the past from the present, from not getting triggered so much from past feelings today. This is why you walk on eggshells: you might do something that is totally innocent and it triggers him and you can't figure out why. And it's because it's triggered something that relates totally to his past and not the present. He may not be fully aware of it either. Thus, the need for therapy.

To learn more about what DBT offers, start with the following website put together by people who aren't psychologists but who have gone through DBT themselves. Try as many of the self-help options they have. Mindfulness is particularly important for him and a good place to start there. Here's their web address:


http://www.dbtselfhelp.com/

Now, we started with you ready to leave. I don't know how much hope this holds out for you two. However, I hope that it holds out at least some hope. But it will mean a long haul. A long haul. The troubles won't end. However, with the resources and proper therapy, it can be more tolerable, and eventually managed and workable.

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

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

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.

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: 5108
Experience: Dr. Mark is a PhD in psychology in private practice
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