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Ocpd: Some Personal Comments


RonPrice

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There are other psychiatric disorders often confused with BPD and patients need to be aware of these others in the diagnostic dialogue with their doctor. Differential diagnoses to be considered include: ADHD, schizophrenia, obsessive-compulsive personality disorder; recurrent major depressive disorder and schizo-affective disorder. I have had all of these disorders except schizophrenia at one time or another in the last seven decades. Some were officially diagnosed by a psychiatrist and some were not. In one study of 60 patients with BPD, 23 (38%) fulfilled the diagnostic criteria for at least one personality disorder. Those personality disorders most commonly were: narcissistic, borderline, antisocial, avoidance disorder and obsessive-compulsive. In my case the obsessive-compulsive personality disorder(OCPD) has been the most dominant and especially after the age of 60. The presence of these disorders sometimes make BPD symptoms more intense and more difficult to treat and they appear to increase the risk of suicide. This account is about BPD and by a person with BPD and it only ventures into these several other psychiatric illnesses and personality disorders to a limited extent and only from time to time when it seems relevant.

A personality disorder is an enduring pattern of inner experience and behavior that: (a) deviates markedly from the expectation of the individual's culture, (B) is chronic, pervasive and inflexible, © affects two or more of the following areas: thoughts, emotions, interpersonal functioning and impulse control. To be considered a personality disorder the behaviour should also have an onset in adolescence or early adulthood, be stable over time and lead to distress or impairment. Because these disorders are chronic and pervasive, they can lead to serious impairments in daily life and functioning.

In a list of ten basic symptoms of obsessive-compulsive personality disorder(OCPD), I possessed six symptoms rated at 5 or above on a 10 point scale in January 2010. I will not list these symptoms of OCPD here since this narrative and analysis is a focus on BPD, but readers can easily google them if they are interested. To be diagnosed as having a personality disorder the pattern of behaviours must be stable across time and have an onset that can be traced back to adolescence or early adulthood. The pattern of behaviours for my OCPD has been highly diverse over the years as far back as my childhood but have become more dominant, as I say, in my late adulthood, the years after the age of sixty on a new medication regime of an anti-depressant and a mood stabilizer which I will discuss in more detail later in this story.

I was diagnosed with schizoaffective disorder in the summer of 1968 and after six months in four different hospitals I was eventually released. I have also been taking the anti-depressants luvox(fluvoxamine-2201) and then effexor(venlafaxine-2007) for depression. The side effects from these anti-depressants which I have manifested in the years 2001 to 2010 are: a sedative affect, fatigue and weight gain. Less common side effects that have been manifest in my day to day life include: belching, difficult or laboured breathing, some loss of touch with reality, neck pain, vertigo and withdrawal symptoms. The effexor has helped decrease the intensity of the lows which I had been experiencing for 20 years. The sense of relief from the intensity of depression was a source of positive energy, a wonderful injection of spirit and joy in my life.

Cyclothymia is a rapid-cycling form of bipolar affective disorder which creates alternating short periods of hypomania and depression, with periods of stability in between. Cyclothymia is often regarded as the poor cousin of BPD, but should not be underestimated as a very serious condition that needs long-term management and support by health care professionals. Suicidal thoughts and feelings, lack of interest in socialising or going out, the need for a very large amount of sleep, not wanting to get out of bed, difficulty in holding down a regular job. relationship issues and, after retirement, financial troubles, but it can be managed well to provide a decent standard of living for sufferers.

Over the last several decades I have suffered from an inexplicably varied cyclical pattern of highs and lows. They are difficult patterns to define, to understand and, therefore, to seek out and obtain diagnosis and treatment. Perhaps by the first decade of this third millennium I had what had come to be called Bipolar Disorder NOS, sometimes called sub-threshold BPD. I seemed to be suffering from bipolar spectrum symptoms, that is some manic and depressive symptoms, but in some ways my symptoms did not meet the criteria for one of the major subtypes of BPD. I could argue that I had the type of BPD known as: BPD NOS (Not Otherwise Specified). Despite not fully meeting one of the formal diagnostic categories, BPD NOS can still significantly impair and adversely affect the quality of life of the patient.

I have mentioned these two sub-types of BPD above since I seem to have some elements, characteristics, of these forms of BPD over the last several decades. But I have never been formally diagnosed as having either of these sub-types. By the 1980s the lows in my life had come to be manifested only before going to sleep. These lows seem both in retrospect and prospect to have been/be those depressive episodes in life that do not meet the full criteria for a diagnosis of major depression. These lows have included, though: suicidal thoughts and feelings, lack of interest in the social dimension of life and the desire for more sleep, among other symptoms.

By 1999 I also experienced the difficulty in remaining in FT employment with consequent financial troubles of just having on an old-age pension standing between my wife and I and the cold, cold world, as they say. There came in the train of these events relationship issues from 2000 to 2010, as I say. In some ways, of course, one cannot/should not complain since there are millions, indeed, billions of people now with relationship issues and who are far worse off financially than I am.

This statement was originally written in 2001 to assist others in assessing my suitability for: (a) employment, (B) for a disability pension of some kind and/or © public or private office in a casual work and/or volunteer capacity. This document is no longer needed for these reasons since I am fully retired from FT, PT and casual/volunteer work and am on two old age pensions. Although this document no longer serves the purpose of helping others to make the evaluations it did eight years ago in 2001 and make their decisions and their personal and organizational assessments of me informed ones; although there is no need for others to assess my capacity or incapacity to take on some task or responsibility, I have kept this original general statement, what was a first edition in 2001 and have extended it to what is now an 10th edition eight years later for other purposes. I tend to update the most recent edition, from the previous year, in the following year as: (i) new knowledge comes to hand, (ii) new experience is added to my BPD history and (iii) as I reflect on 66 years of my experience of BPD. I have included in appendix 5 an article from an online newspaper to place mental health in a wider, populist and, hopefully, helpful context for readers.

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I hope this has been of help for those who have OCPD....ron

sychologists, to

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