Borderline Personality Disorder Dysphoria and Treatment

Q. How do I tell when what I am going through is Dysphoria?

I have emotional storms that are extremely painful, and seem to be a combinations of depression, some anger, fear and despair, all at once, along with racing thoughts I can’t follow; I just feel like being alive is a mistake when I get like that. My suicidal ideation is worse then. I also feel a lot of stress, I feel like something inside of me is about to snap… Is this *anything* like Dysphoria? Or is this just “feeling bad”?

These “episodes” vary in strength and quality, the emotion that dominate can change. There are times when I go into states that are more slow, depressive but not exactly. It’s like things slow down inside me; it takes me longer to respond to what happens around me, I feel a little disconnected from the rest of the world (just a little). this feeling is like floating around in a bubble, seeing everything but through a thin layer. And if someone insists on talking to me and I have to be responsive, I kind of “snap out of it” and after about a minute, it can go away… I didn’t notice how much my behavior/perception were affected by some of these episodes until one day, when I was taking the subway to somewhere while feeling disconnected (after a bad therapy session), someone tried to explain to me how to use the turnstile — I guess I looked a little disoriented and like I didn’t know what to do, because I was doing everything slower, and thinking about what to do next took more time… and this is just one kind of “episode.”

While there are those times when I slow down, other times I get incredibly tense. I remember having “attacks” of terrible distress when I was going through depression a few years ago, and they were so unbearable that they drove me to self-mutilate to get rid of the pain. They were different from the feeling of depression. The ones I have now are not as bad; so I am not sure if this is even Dysphoria. I often don’t even know what causes me to feel this way. It’s like a build-up of despair that just erupts all of the sudden; other times, it happens because I feel rejected, self-loathing, hated or guilty. Is this treatable?

One thing I should probably mention is that, unlike most BPDs, although I grew up in a very problematic family, I did not have a traumatic childhood and I was not abused.

I guess the disconnecting thing is when my feelings reach a state of overload. Another reaction I get when it’s too much is feeling nothing — being numb, functioning well but being “dead” inside. I must admit that there are times when I find it useful and count on it when I have to go through something painful; I don’t know how to “turn it on”, but somehow it happens. Sometimes the numbness turns into euphoria. I am completely confused about this.

Sometimes I take mild sedatives when I can’t stand the tension, but they rarely do anything. I just lay in a dark room or stare at the wall. Sometimes these feelings–esp. the stress– are triggered by things like someone saying they’ll come over and being late; not being able to get someone on the phone; expecting something that I know should happen — even if nothing goes wrong, the expectation alone makes me go crazy. I try to remind myself of the reality, that I am not being rejected, but it does not help at all. Once my mind starts this kind of a cycle it’s like it doesn’t know how to stop.

I’m in therapy, and it’s helped me control my anger and violent outbursts (for which I will feel guilty for the rest of my life, as I should), but we have not found a solution for this emotional vulnerability yet. Other than the “episodes” I was talking about, I generally suffer from tension (to the degree that I get extremely annoyed by sounds; I go ballistic when a neighbor plays his radio a little too loud, or the TV in the other room is on, while other people in the house get angry for a minute, then shrug it off), and, on the other hand, a complete lack of energy, concentration and interest in anything.

A. I’ve never seen a better description of dysphoria, dissociation, psychosis or the urge for self-mutilation.

These are all a form of seizures.

Dysphoria is anxiety, rage, depression and despair – and it gets progressively worse and worse. The pain from it is unbearable.

The reason you do the self-mutilation (painful stimuli) is that for whatever reason the dysphoria stops.

All these things are neurological and can be controlled by the right sequence and combination of medications. I usually start Prozac at 20mg daily and 1 week later tegretol mid day. In cases like yours the dysphoria resolves in 3-4 hours. Your meds then need to be adjusted and then you have to move on to a happy and successful life.

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