Wednesday, January 24, 2007

Some Say It's OK for Girls to Go Wild

I'll be the first to admit that talking about young girls dressing like sluts makes me cringe/sick/what have you. I noticed an interesting trend in my diagnosis while working in the psych emergency department last year: I labeled every girl with absolutely any exposed cleavage a likely borderline personality disorder-in-training. My attendings (well, the ones who were women, at least) thought I was jumping the gun a bit, but I couldn't get past that. Not in that one month, at least.

But I've learned enough about adolescent development (or at least, the best substantiated theories thereof) to admit that these people know what they're talking about, and my I-see-your-boobs-so-you're-unstable instinct isn't a valuable or accurate one.

While young women may express their sexuality more overtly than they have in the past, for the most part, their behavior isn't cause for alarm. It's a necessary step in growing up.

Looking Sexy Doesn't Equate With Sexual Activity

Looks can be deceiving. A girl who puts a seductive picture of herself on the Internet for all to see may shudder at the thought of striking the same pose in front of her peers.

"There's a difference between posting a picture of yourself in virtual space, like Myspace or YouTube or Friendster, and posing in provocative clothing in public," said John Broughton, Columbia University professor of psychology and education.

Similarly, sexy clothes do not beget sexual activity.

Jaana Juvonen, who studies the development of middle and high school students at UCLA, said that because girls hit puberty earlier now than they did decades ago, they're tempted to mimic the appearance of their older peers. That doesn't mean they're engaging in acts that ought to be beyond their years.

"Many girls might look very differently from how they act," she said. "We should not judge them based on what they look like.
Now, if my daughter reads this in twenty years and says, "see, Dad, you thought it was okay back when you were a kid," I'll deny it all. Or I'll take her to the mall and buy her some nice, flattering sweaters. No V-neck's allowed. Not until she's 18.


Anonymous said...

You're an ass.

People don't "train" to get borderline personality disorder. There are various schools of thought -- some think it involves a genetic component, or some tendency to be extremely sensitive.

Others suggest it may be related to a traumatic event that occurs in early childhood -- an episode related to a separation from the mother at a critical time in development.

Still others think it may be related to a traumatic event in a way that is somehow similar to PTSD.

And another theory posits that it is somehow a combination of all of the above and/or other factors.

No one suggests that wearing suggestive clothing, posting suggestive pictures online and/or "training" creates the diagnosis of borderline personality disorder.

You are in training to be a doctor? Really? They let you into medical school with an inability to reason?

Let me point out one final fact. It is inappropriate to diagnose any young woman -- probably under the age of 20-22 with borderline personality disorder (pretty much with any personality disorder) because the criteria for having such a disorder involves it having a longstanding and persistent characteristics.

Should you take time to look up the symptoms/characteristics of borderline personality disorder, you will see that many describe exactly those that also define "teenager," including mood swings, unstable interpersonal relationships, unstable sense of self, impulsivity, difficulty controlling anger. What makes it a personality disorder is the persistence of it BEYOND young adulthood.

If there is any one thing a person with borderline personality disorder needs, it is a medical establishment that validates his or her needs with kindness and a sense of compassion instead of a shaking of the head and inappropriate jokes. Next time you encounter a person who is out of control with anger, rage, fear and hurt, please consider that maybe there is a REASON this person feels this way. Maybe there is a WAY you can make this person feel better. Maybe the first thing you can say is "I can see you are really scared. I can see you are really angry. I would be scared and angry if I were in your situation, too."

That would be significantly more appropriate than oogling her cleavage.

Garrett said...

Thanks. That's the best response I've ever gotten on my blog. And I mean it. I'm glad you're passionate about your borderline personality disorder. Nice blog, as well.

M4 said...

By the way, the very diagnosis of "borderline personality disorder" is at least a little bit controversial.

I was at some sort of psychiatry rounds with Dr. McInnis when some poor soul had the unfortune to utter the word "borderline". Dr. M became very agitated, and passionately disclosed his own bias regarding this entity, namely its nonexistence.

So go figure.

Anonymous said...

Now you're a patronizing ass.

I am passionate about "my" disorder, but I'm more passionate about its myths and epic proportions.

I like to think mine is very much in proportion. You could use a little passion here @ And I mean that in the nicest possible way!

Garrett said...

McInnis is a researcher in the genetics of bipolar disorder, and an incredibly accomplished one at that. It's not an uncommon feeling among the more biologically oriented researchers in psychiatry that personality disorders aren't real entities. I think Jibson referred to them as "really bad habits" that people don't unlearn. Of course, that doesn't explain why Cluster B disorders respond so poorly to CBT, IPT, and MI. As you can find in the profile of our more spirited commenter, BPD kept DBT in business, since it isn't particularly favored for any other disorder, although I think we have at least one active protocol for DBT for ODD in adolescent boys.

Some of the newer neuroimaging research does in fact support at least some biological basis of Cluster B disorders, but fMRI doesn't really get at the chicken-or-the-egg issue. I would tend to think that most PDs will eventually fuse into what we know about biologically based temperament. But of course I would say that, because I'm a bit of a developmentalist.

Anonymous said...

Don't know Jibson, but maybe he's an ass too. :)

"Really bad habits"? If that were true, then any form of behavioral therapy should work equally as well, right? But time and again, CBT doesn't work as well at reducing self harm or improving quality of life as the more emotionally centered DBT.

He's not just an ass, or a patronizing ass, but a judgmental and inaccurate one.

I can agree that after a time, emotional reactions of anyone become "habits." We smile when we receive a dozen roses. We cringe when we see a dead pet on the road. We cheer when our teams win.

What happens (I think) (and I may be an ass, too) is that these highly emotionally sensitive little girls get hurt (to whatever degree -- from being ignored to being tortured; there must be a tipping point and a maddeningly different tipping point for each individual). The response to hurt is to blame themselves, to become overly eager to please, to become so dependent on external validation that internal validation becomes irrelevant (and absent). This creates a cycle where the girl is probably needy and maybe whiny, or maybe just silent and not seeking what she needs. At any rate, she continues to not get it, and more, and more. And as she develops other relationships outside the family, she can't trust those either. Nothing is real, nothing feels permanent enough, there is a frantic feeling that if this friend leaves I will be all alone and being alone is the worst thing ever.

This translates into romantic relationships later, where men get crushed by the absolute need of these little-girls-cum-women who cling and cry and test the stated love and commitment constantly and push the men away, then pull them back, and scream 'you don't love me' when he resents the push and pull. What happens next is inevitable -- he leaves, completing a cycle that's inevitable -- she knew he would leave because she's so unlovable.

Involve her as a mother and the stakes are higher, though I am proud to say that my three children are delightfully healthy and grounded people with compassion and common sense and character traits that don't mimic mine. For whatever reason, I have not felt it necessary to take my rage out on my children, and that is the one area in my life where I don't feel like a fake or a failure. I guess that's because the love of my children really does feel unconditional and forever, and I appreciate that so much and trust it so much that I don't need to test it.

I don't think it's accurate to say that BPD keeps DBT "in business." It's accurate to say that Marsha Linehan developed, tested, iterated and now teaches a protocol that works to reduce suicide rates, rates of hospitalization and to increase the quality of life among those diagnosed with the disorder. The way you phrase it can arguably be seen as some scheme to keep the diagnosis alive to enrich therapists. (Wouldn't that be against your own interests?)

Look, clearly there is a disorder, problem, proclivity, tendency or some other word for some people (it seems primarily women) to be more emotionally sensitive than others. To dysregulate more easily than others. To have episodes of rage more intense and longer than others.

I agree with you that there is a biological component. That seems obvious even anecdotally since there are shared character traits among those with this dx.

However, for this disorder to be "reduced" to a biological cause would dangerously overlook the incidence of traumatic episodes in the early lives of those suffering from it. I'm not arguing that correlation equals causation, but the statistically marked correlation must not be ignored.

Another factor is that the symptoms and reactions exhibited by those with this dx are remarkably similar to those diagnosed with PTSD. In the case of PTSD, the cause and effect of the disorder are often more closely time-linked. In the case of veterans, the subject matter of nightmares and hellish war scenes is clearly married.

However, if the traumatic episodes happened before the age a child is able to retain memory, the effects could be there while the memory is not. This would make PTSD treatments somewhat ineffective, but would explain by DBT is effective. (As the first is focused on de-sensitization while the second is focused on acceptance of that we can't know, skills to cope with distress, ways to distract from stress, ways to become less emotionally sensitive in general or, at the very least, to understand that there is an emotional sensitivity and to attempt to see around those filters.

I think the answer to the question of why this "personality disorder" doesn't act like the others is because, well, maybe it isn't. Few agree its name is a great one. Angry Momma Syndrome would be better, or maybe Hates Oneself And Therefore Can't Feel Love Syndrome.

Do you think "personality" and "temperament" are the same thing? Then this is an angry temperament disorder.

Yes, the results of the self hate become anger, and the results of the anger become the self fulfilling prophecy of abandonment. Or, in a tragically high number of cases, the self hate becomes self harm and suicide.

DBT addresses the anger part with its behavioral aspects. It addresses the self-hate part with its understanding of dialectics. It's not as important to understand why I hate myself as to accept that I do and to try to develop a different relationship with myself that focuses on my competence instead of my failures.

Look: Does it matter why a person in your emergency room is screaming and biting and kicking and threatening to kill herself? She is absolutely a pain in the ass. She also knows she's a pain in the ass, and wishes to god she could stop but every single word anyone says, every single gesture is misinterpreted as being invalidating. Even as it's happening and she knows it isn't so, she believes with every fiber that everyone wants her to die. Not just leave, but die. She wants it, too, right then.

Shoving her into a 72-hour hold may be society's way of 'protecting' her, but it really isn't the way to 'treat' her. What she really needs is time and attention, and who gets that on a psych ward? She needs someone to hold her and tell her she's OK. Not that she's going to be OK, but that she is, fundamentally, OK and deserves to live just because she is. Just because she is. Even if she's acting like a 3 year old. Because in many, many regards, she may well be one.

Michael said...

do you REALLY want to do psych? holy cow.

Garrett said...

Yeah, I wanna do psych. There are too many personality disorders in surgery. *Rimshot!*

Just Me said...

Hmmm. He may want to, I'm not sure he's strong enough for it.

Not constitutionally strong enough, if you know what I mean. If dealing with emotions is scary, or if the proper response always seems to be humor and/or putdowns, please consider podiatry.

Or at least not child psychiatry ... try and fix them after they're screwed up ... we don't need anyone else fucking with 'em when they're little ...

(You may learn that people with BPD are also, well, relentless. Exceptionally smart as a whole. Facile with words, too. We may be emotionally sensitive, but not dumb. In fact, statistically a good many psychologists/psychiatrists and [who knew] parole agents have this PD. Good luck!)

Anonymous said...

Hahahahaha oh god, the "third person" rationalizing, the nasty Electra complex, the ego defense, the pretentious pseudointelligence, the splitting "asses" from presumable "non-asses," god this is fantastic

Lol she called Jibson an ass

Cluster Bs always make my day