#comorbid: avoidant personality disorder

[chronicsymptomsyndrome]

I love earnestly and unironically calling conservative men bitches. I’m obsessed. Looking a wealthy white cishet christian man probably named John or Dave right in the face and saying “you’re being kinda bitchy, are your hormones acting up maybe?” really fucking makes my day

[whalesung]

• avpd/dpd baizhu icons - self indulgent

can be used with credit!

flag used

[hauntedselves]

(list taken from the DSM-5-TR)

[coldresolve]

How to Write a Schizoid Character

Schizoid Personality Disorder (SzPD) affects an estimated 1% of the population, similar to rates of autism, but is widely overlooked both in real life and in fiction - to the point where it is often colloquially labelled "the silent disorder". This is a somewhat comprehensive guide in how to write a character with SzPD, from someone who has it.

Quick research guide

I'm writing this guide with the underlying assumption that you've already done some cursory reading into the basics of SzPD. At this point, you need to understand two things: One is that this disorder is incredibly poorly researched, due to schizoids often not seeking treatment for the disorder itself (they sometimes seek treatment for comorbidities like depression or anxiety); and two, as a result of this, there is a lot of over-simplified misinformation out there about SzPD. This disorder often gets boiled down, even by mental health professionals, to the DSM-V or IDC-10 diagnostic criteria, which are criticised widely in the schizoid community for being incredibly superficial descriptions of overt SzPD. This is the kind of case where you need to seek out the SzPD specialists or the schizoids themselves for information about the disorder.

Akhtar's profile is a good overview. Psychologist Elinor Greenberg has a quora where she answers all sorts of questions about SzPD, and she typically hits the nail on the head. Other resources include Schizoid Angst, a youtube channel run by a man who has SzPD (this convo in particular is really good). If you're interested in a deep dive, I recommend reading The Divided Self by R.D. Laing for a deeper understanding of the inner workings of schizoids, as well as the relationship between SzPD and the rest of the schizophrenia spectrum.

Understand the "root" of SzPD

SzPD typically forms as the result abuse, neglect or abandonment in childhood. Schizoids have learned through trauma that emotional intimacy, vulnerability, and dependence on other people all have the potential to harm them badly, and as a result, they tend to avoid those things. In that sense, schizoids don't have a problem with other people, per se. Understanding this fact can help you write your schizoid character with more realism and nuance.

For example, it's a common misconception that all schizoids are averse to having sex. Many schizoids are, to be fair - but plenty of schizoids also frequently engage in hook-up culture, or form other sexual relationships. Physical intimacy can be entirely seperate from emotional intimacy, and thus pose no real risk to a person with SzPD. It's also possible for schizoids to form good relationships with other people, if those relationships are based on non-emotional grounds, such as recreational interests, work, religion, etc.

You can show this in your schizoid character by thinking about which of your other characters your schizoid might gravitate towards. In general, they will feel safest with characters who place few (or no) emotional demands on them, don't place high value on phatic gestures, don't pry into their emotional state or background, respect their need for independence and agency, and so on.

Overt or Covert?

Once you've researched the disorder a bit, you need to decide whether your schizoid character is overt or covert. The overt/covert split is about 50%/50%, so neither is more likely than the other.

Overt schizoids tend to be a lot more blunt about their indifference, visibly detached and aloof, and are typically way less likely to engage in social settings (or be in social settings at all). These are the characters who have blunt affect, ie. won't have much of an emotional reaction to their surroundings, even if it directly involves them (ex. getting praised/criticised). They may have odd speaking patterns, such as stilted or vague speech, and can sometimes come across as cold and uncaring. Overt schizoids are noticably reluctant to reveal what's going on in their internal world, so they might also come across as enigmatic, secretive, or mistrustful.

If your character is an overt schizoid, think about how their behavior and personality are percieved by other characters, what kind of reactions might arise. Think about how your schizoid character might navigate these reactions - after all, they're probably used to getting comments. How do they react if someone comments on how disinterested/moody they seem? Do they tell the person to fuck off? Do they raise an eyebrow, and that's that?

Covert schizoids, or "secret" schizoids, experience the exact same symptoms as overt SzPD, but they hide it behind what's called a false-self system. You can think of it as a form of compulsive masking. Apart from perhaps vaguely eccentric behavior, you typically won't be able to tell that a secret schizoid has SzPD unless you know what you're looking for. If your character is a secret schizoid, they will behave in a way that seems socially engaged and interested, maybe even extroverted, but they will be emotionally withdrawn and safe within an internal world.

If your character is a covert schizoid, your other characters might not notice that anything is out of the ordinary with them at all - until they learn more about your character's lifestyle. Secret schizoids are not as used to being confronted about their odd behavior as overt schizoids are, and, depending on the character overall, might respond to these confrontations with awkwardness, defensiveness or confusion. Many secret schizoids are also unaware that they have SzPD, but are instead just vaguely aware that their behavior and preferences seem strange and different to other people.

Figure out the internals

An intricate internal fantasy life makes for a well-thought-out, sharply self-aware character. Schizoids spend most of their time in their own heads, so you need to have a good understanding of your character's internal world, fantasies and reflections, and how these things affect their behavior, priorities and decisions.

For many schizoids, their fantasy life is rooted in their own lives, either their past, present, or future - what-ifs, what-if-nots and could've-beens. They'll have internal "interactions" with other people they know, play out entire conversations and scenarios, and respond and react much more vividly than they tend to in real life. For other schizoids, their fantasies exist in a world entirely seperate to our own, with its own rules and structure, which they can explore to their own liking. For others yet, they think up fictional stories, sometimes inspired by real life, sometimes not.

Themes in the internal world often reflect the schizoid's own struggle with independence and intimacy. A lot of schizoids use their fantasies as a safe and sufficient way to feel "connected" to others. Others have violent, vengeful fantasies, which often juxtapose the indifferent demeanor - these fantasies tie in to the need for independence and emotional control, sometimes referred to as schizoid omnipotence.

Beyond the intricate fantasies, consider your character's moral beliefs. Schizoids tend toward idiosyncasy - we're in the "odd and eccentric" cluster for a reason. Akhtar described this quality as "occasionally strikingly amoral, at other times altruistically self-sacrificing." Take some time to figure out how this might express itself in your character, and how it is percieved by the characters around them.

Schizoids and relationships

You know how borderlines have their favorite person, and narcissists have their chosen person? A schizoid might just stumble upon someone who will become their interest person, or IP.

An IP is someone outside their immediate close family who the schizoid feels safe enough to be vulnerable with, are genuinely interested in, and who the schizoid forms an honest-to-god emotional connection to. This relationship can be either romantic or platonic in nature. If you choose to give your schizoid character an IP, make sure to emphasize how much this relationship stands out as uniquely meaningful to the schizoid - this is the one person they are even capable of having a genuine bond with, and that bond alone can keep them grounded against feelings of cosmic isolation. Your schizoid isn't likely to take this for granted.

An interesting tidbit of information is that schizoids paradoxically tend to gravitate towards relationships with highly extroverted, emotional people, to the point where the schizoid-hysteric relationships are an entire category of psychological research. Here's a really good snippet that describes how that dynamic tends to play out.

(Also keep in mind that just because a schizoid doesn't have an IP does not necessarily mean they are miserable. A lot of schizoids are capable of finding their own peace with whatever tools they have available.)

Another notable term for schizoid relationships is the controversial stock friend. A stock friend is a person who considers themself friends with the (typically covert) schizoid, and who thinks they have an emotional connection with them, but who the schizoid feels no emotional connection to, has no real interest in, and only interacts with out of convenience or happenstance. Is this immoral? Are schizoids leading people on, or are we justified in masking to avoid a constant stream of awkward confrontations, that have the potential to hurt other people's feelings? Who knows.

Splitting

You might have heard of idealization/devaluation-splitting as it pertains to borderline PD (bad/good) or narcissistic PD (worthy/unworthy). Splitting happens in SzPD as well, along the axis of safe/unsafe.

Schizoids will occasionally cut other people out of their lives, and this usually happens when they get overwhelmed with another person's attempts at emotional intimacy, or their boundaries have been deliberately or repeatedly crossed. They will often view the person as relentlessly prying, controlling, demanding, or dangerous, and will desperately seperate themself from that person as a way to avoid being consumed, or "smothered". At this point, if the other person doesn't let the schizoid get away, the schizoid might become overtly hostile. This is a fear response.

If you want to write a schizoid splitting, be aware that a split with a schizoid usually marks the end of the relationship altogether - especially if the relationship hasn't lasted for very long, and double especially if the person isn't the schizoid's IP. Once a schizoid has lost trust in someone, that trust is very, very difficult to build back up, even if both parties agree to try. Your schizoid character is going to be incredibly wary of the other person, and the relationship is probably never going to feel like it did before.

Beware of stereotypes

Every once in a while I'll encounter a story that features a character who has very obvious schizoid traits, and almost every single time, their arc leaves me disappointed and frustrated. Here are some tropes I would personally avoid writing for a schizoid character.

"He just needed love all along." Kill this trope, no exceptions. Strong emotional intimacy can erode or overpower a schizoid's sense of self, and usually leads to feelings of smothering, being trapped/crushed by the other, and losing autonomy and independence. A schizoid is capable of love on their own specific terms, but if it's on the terms of other people, they will strongly feel like it's something being forced on them against their will. They might still outwardly "accept it" as a form submission or compliance, but it will not be out of love. This trope gives me psychic damage.

"He sacrificed his life for others, which proves that he cared all along." This trope isn't necessarily bad, it just always leaves me with this impression that neurotypicals can only interpret caring when it happens in the extremes. And while it's true that schizoids can sometimes be altruistically self-sacrificing, it's kinda depressing to see schizoid-like characters die all the time. There are other ways you could show schizoid altruism that would also leave the door open for more closure for the character themself.

"He turned evil and violent." While this trope isn't quite as common as it is with other disorders, notably those from cluster B, it does still exist. So here's your friendly reminder that mentally ill and neurodivergent people are more likely to be the victims of violence than to be perpetrators, by far. I'm not saying you should never write a schizoid bad guy, you certainly can - I'm just telling you to be very careful about how you go about it, so you don't end up sending the wrong kind of message.

Conclusion

Schizoid characters are cool, and I wish there were more well-written canonically schizoid characters out there. But I'm also clearly biased, so what do I know

[bethanydelleman]

Trope exploration: Man, usually a war veteran, with PTSD drowns his sorrows in alcohol

I was rewatching one of my favourite shows and I was struck by the fact that the main male character had severe Posttraumatic stress disorder (PTSD)* and yet didn't drink because it seemed like a big trope subversion. This made me wonder about the real world comorbidity** of substance use disorder (SUD) and PTSD, so I could determine if this common association was a reflection of real life or a trope.

PTSD & SUD co-occur at a rate of about 30-55%

(many of these studies are in veterans, source, source, source)

However, this is SUD in general, which means it includes any abuse of a drug, including but not limited to alcohol. The highest rates of PTSD are in cocaine and opiate users. Also, and this is very interesting, the direction of causation is unknown (does the substance or the PTSD come first):

Although PTSD and SUDs appear to be strongly linked, little is known about the nature of their relationship. The most widely held explanation of their frequent co-occurrence is the self-medication hypothesis. This hypothesis is based primarily on clinical observation and posits that traumatized individuals attempt to use substances in order to dampen traumatic memories, or to avoid or “escape” from other painful symptoms of PTSD. A second hypothesis, the high-risk hypothesis, posits that individuals with SUDs, because of high-risk lifestyles, are likely to experience a trauma and are, therefore, more likely than the general population to develop PTSD. Finally, a third hypothesis, known as the susceptibility hypothesis, states that substance use increases an individual's susceptibility to developing PTSD following a trauma. (source)

It was also noted as important that most patients who suffered from PTSD had multiple traumatic events in their lives, beginning in childhood. Also, more men had SUD than women, which holds true in the general population as well.

I think one of the best representations in popular media of PTSD might be The Hunger Games. They have SUD/PTSD Haymitch and the Morphling (opioid abuse) victors, but Katniss and Peeta deal with their experience in other ways, as do the others that we see. Also, it's clear that most of the victors have repeated trauma: Katniss's father dying and nearly starving to death; Peeta's childhood abuse; and Haymitch being forced to have a front row seat to subsequent games.

Conclusion: at most, only about 50% of patients with PTSD abuse a drug of any kind, less of them abuse alcohol. So it would be both interesting and scientifically valid to see more characters with PTSD who are not constantly drinking. Men are more likely to have substance use disorders, so the trope is partially supported.***

*Comorbidity is when two disorders happen in the same person at the same time. There are many conditions that are likely to co-occur, like depression and generalized anxiety disorder or Type 2 diabetes and obesity.

**Symptoms of Posttraumatic Stress Disorder, taken from one of the sources above:

The characteristic symptoms of PTSD can be divided into three clusters: avoidant, intrusive, and arousal symptoms. Examples of intrusive symptoms include unwanted thoughts or flashbacks of the event. Avoidant symptoms include, for example, attempts to avoid any thoughts or stimuli that remind one of the event. These symptoms are particularly relevant to this review because substances of abuse are often used by individuals with PTSD in an attempt to avoid or escape memories. Arousal symptoms generally include exaggerated startle reflex, sleep disturbance, and irritability, and are generally associated with hyperactivity of the autonomic nervous system.

***I'm not saying that this trope is bad or that we shouldn't see any people with PTSD resorting to substance abuse in media. Instead, I'm saying that the amount of people with PTSD who use alcohol as a coping mechanism is lower than most people probably think, and it would be interesting to see other representations of PTSD as well. PTSD & SUD are most likely commonly paired together in media because it's an easily visible sign of internal suffering.

Also, varied displays of different disorders are important, in my opinion. We don't want someone thinking they don't have PTSD or that a loved one doesn't have PTSD because they don't also have a problem with alcohol.

[unwelcome-ozian]

TREATMENT BOOKS (a few suggestions, listed alphabetically)

Rebuilding Shattered Lives, Treating Complex PTSD and Dissociative Disorders, 2nd ed, (2011), by James Chu. A valuable book for beginners and experienced clinicians, this text offers practical advice on therapeutic techniques and treatment, with information about early attachments and their effects, neurobiology, crisis management and psychopharmacology

Shelter from the Storm: Processing the Traumatic Memories of DID/DDNOS Patients with the Fractionated Abreaction Technique, (2013) by Richard Kluft. Integrates elements from psychoanalysis, psychodynamic psychotherapy, hypnosis, behavioral therapy, cognitive therapy, and EMDR to support a practical, empathic, and compassionate approach to treatment, taking care to avoid retraumatisation

The Haunted Self – Structural Dissociation and the Treatment of Chronic Traumatisation, (2006), by Onno van der Hart, Ellert Nijenhuis & Kathy Steele. This key text draws attention to the substantial problems suffered by chronically traumatised individuals. It presents the theory of structural dissociation of the personality, a phase-oriented approach to treatment, and hope that recovery is achievable

Trauma Model Therapy: A Treatment Approach for Trauma Dissociation and Complex Comorbidity, (2009) by Colin Ross. A practical, well-structured manual, presenting theory, assessment and treatment strategies, techniques and interventions for severe dissociative disorders

Treating Complex Trauma and Dissociation – a practical guide to navigating therapeutic challenges, (2017) by Lynette Danylchuk & Kevin Connors. This highly readable book combines clinical experience and insight. It presents clear and practical information to support understanding and offers guidance for navigating a phased approach to treatment, handling foundational issues and potential challenges’ 2nd Edition due out July 2023, includes the latest research and treatment developments

Treating Trauma-Related Dissociation: A Practical, Integrative Approach, (2017), by Kathy Steele, Suzette Boon & Onno van der Hart. Written by leading experts, this comprehensive text extends the content of the skills training manual, (listed in the ‘Self-Help’ section). It offers a practical, thorough, and insightful approach to treatment based on the structural dissociation model

Treatment of Dissociative Identity Disorder: Techniques and Strategies for Stabilisation, (2018), by Colin Ross. Practical, concise and informative, especially useful for practitioners new to working with DID

Working with Voices and Dissociative Parts – A Trauma-informed approach, (2nd edn, 2019) by Dolores Mosquera. A comprehensive, elaborative, and inspirational workbook, that is truly integrative, structured and collaborative, and informative for both the novice and the senior practitioner

[15-lizards]

You need to tell us about Gregor's daughters

Tw: child abuse

Honestly I’ve never fleshed this idea out further than “wouldn’t it be supremely fucked up if Gregor, constant danger to all women, had daughters from his previous before they mysteriously died” but I should

It would just be so both cosmically unfair and horrific that the one who’s responsible for so many horrific fates of women in the series has daughters of his own

And ofc the daughters would have to be So mentally fractured bc what is ASOIAF if not about the horrible cycles that can occur between parent and child over the generations. It’s all ab the cycles babey!

Daughter 1 the comorbidity queen would fully have some sort of antisocial AND borderline personality disorder. Toooo much like Sandor for anyone’s comfort. She’s aggressive and paranoid and constantly in fight or flight mode, takes everything as a slight or insult, which is all just a production of her extreme anxiety. Growing up as an eldest daughter in such horror leads to constant dissociation and feelings of emptiness. However she’s probably super defensive of her younger sister, though that relationship is ofc also unhealthy. Her sister is her only lifeline and is basically her morality pet, so she’s incredibly defensive and protective of her, even to her sisters detriment at times.

Daughter 2 is selectively mute with dependency issues. More traditional signs of extreme anxiety. Like her sister, she’s in a constant fight or flight mode, but her go to method of survival is usually avoidance. She makes no disturbances, is always hidden away somewhere. Completely avoidant of most other people and lives in her own mind as a safety response. But completely dependent on her elder sister to the point where she can’t do anything without her. And thinks of the elder as more of a mother figure than anything else

Um yeah so I never shoehorned them into the plot that much other than to be a kind of foil to Sansa and Arya’s decent upbringing and morality pet for Sandor but here you go ✨

[alexandraisyes]

question about ASPD!

so i heard there’s a stereotype that people with ASPD like attention and act out to get it

ofc that’s a stereotype so idk if it’s true

but the reason i’m mentioning it is cuz, i have a friend that is diagnosed with ASPD (they showed me your blog actually), and they have this mortifying fear of being perceived-ish(?)

it’s like- pretty bad?

i used to think they had severe social anxiety-

it’s the sort of thing where they’d rather be nothing more than a background character people would forget exist, in their own little bubble with the very few people they hang out with pop in every now and then

so like-

this example contradicts the stereotype, so i though i’d ask your POV(?) thoughts(?) on it

Heya! Attention seeking is not a part of ASPD at all, and someone who has that trait while also having ASPD probably has a comorbid disorder! Cluster B disorders can mishmash, I actually talked about it on my thread so hold on.

There's actually a whole list of ways the different disorders can combine by more or less being a weird mix and mash of two different disorders in the cluster B spectrum (For some reason narcopath is the only ship name disorder). Also most of these are the common use name for the specific combos rather than clinical ones bc the clinical ones kinda suck and cause controversy - Narcopath (Sometimes referred to as Malignant Narcissism): Anti-social + Narcissistic - Covert Narcissism: Borderline + Narcissistic - Dramatic Narcissism: Histrionic + Narcissistic - Dramatic-Emotional Disorder: Histrionic + Borderline - Dynamic Histrionic: Histrionic + Anti-social - Covert Antisocial: Anti-social + Borderline

I also talked about this specific stereotype the other day. It's less of a stereotype and more of a mix-up with NPD. The two disorders get mixed up a lot by the public.

People with ASPD tend to accidentally attract a lot of attention, from my experience and what I've noticed from others. We have a tendency for adrenaline-seeking behavior, which could put us in the spotlight. We're also very much surface-level people-people, if you know what I mean. Anyone we meet could be a potential ally, so we keep everyone on our good side as much as possible. That doesn't mean we're seeking attention, it just means we're a magnet for interaction because people love charisma.

I also have horrible social anxiety, and I'm a really paranoid person. I'm literally the kind of person that will cross the street to avoid a stranger, and my throat tightens up when I pass by someone while walking next to a road because I'm worried they're going to shove me into traffic. Paranoia just comes with the territory, most of the time, and I make it clear when I'm not willing to socialize. People tend to leave me alone because I am a walking "fuck off". The thought of being perceived is horrifying actually, and I try not to think about how large my fanbase is because that's also horrifying.

I'm just doing my own thing with my select group of people I interact with on a daily basis, and then a larger bubble of people I interact with less often. I don't have any desire to expand the smaller bubble, but I'm not against gaining more acquaintances should the opportunity present itself. But over all, I think people are tedious and they're all ticking time bombs because empathy makes you irrational.

[starfishinthedistance]

Why do so many people like...have such an aversion to admitting they might have OCD? Like someone will be talking about OCD symptoms and people will be like "oh I do that but it's because of my autism!" or "oh yeah that's totally me except ADHD lol"

Like...guys I've got news for you.

ASD and ADHD do not cause obsessions or compulsions. They might cause symptoms that look similar (like dependence on routine in ASD or mental hyperactivity in ADHD), but aren't obsessions or compulsions like what's seen in OCD. If you see OCD people describing their inner thought processes and you relate, you can't chalk it up to ASD or ADHD. However ASD and ADHD are highly comorbid with OCD (about 30% for both autism and ADHD), so chances are you just also have OCD. But an autistic or ADHD person without comorbid OCD is not going to have obsessions or compulsions (again, they might have symptoms that resemble them from an outside perspective, but they aren't going to relate to OCD people describing their OCD).

The only other neurodivergencies that can cause obsessions and compulsions are Tourette's and sometimes personality disorders if we're being technical with our definitions (that could be a whole other post because it's complicated).

Like yes there's overlap between neurodivergencies, but they don't cause identical symptoms, and when you look at the internal processing they're easy to tell apart. If you have the exact same internal processing as someone with OCD, chances are you have OCD. There's probably something to be said about recent OCD demonization leading to this aversion, but that can be saved for another time.

Untreated OCD can be really deadly, you aren't going to be able to get better with OCD if you think it's just your autism or ADHD, that's why this is important.

Bottom line is: research whether certain symptoms appear in a disorder before attributing those things to that disorder to avoid misinfo. Because good God this shit has caused a lot of that.

[darkmaga-returns]

The 1st peer-reviewed nationwide study showing vaxxed vs. unvaxxed long-term health outcomes. This is the TRUTH. Do read & PLEASE share.

Joy Lucette Garner

Jan 01, 2024

BEHOLD the “public health benefits” of the vaccine programs in America:

If you’re an American over the age of 18 who’s never been vaccinated (with anything, ever) your risk of even one chronic condition is less than 6%. If you’ve also avoided the “vitamin” K-shot injection (typically given at birth) AND your mother was not vaccinated during the pregnancy, your risk of one condition after the age of 18 drops down to 4.49%. The few conditions found in the unvaccinated were generally mild, i.e., one 84 year-old (who was otherwise perfectly healthy) reported early signs of cataract development. Similarly, non-life-threatening, and non debilitating issues were the only issues found in the unvaccinated population. No cancers, diabetes, arthritis, or heart disease were reported in the entirely unvaccinated adults. Based upon the random sample size, this means that the more serious conditions are below 0.09% in the entirely unvaccinated adult population.

However, vaccine-exposed Americans over the age of 18 carry a 60% risk of at least one chronic condition, with a 48% risk of heart disease, over 10% risk of diabetes, 18% risk of arthritis, and myriad other life-shortening and/or debilitating diseases, including MANY brain and neurological disorders. 42% of vaccine-exposed American adults are suffering from more than 1 condition, i.e., multiple conditions. And 12% of American adults are suffering from 5 or more conditions. The more chronic conditions (comorbidities) a person is suffering from, the more likely they are to DIE from ordinary (otherwise innocuous) “infections.” And clearly, the more health conditions one is suffering, the earlier they will likely arrive at their grave.

[szpd-polls]

Are you comorbid with any of the following common differential diagnoses? 1. Autism 2. Schizophrenia or other psychotic disorders, such as delusional disorder 3. Avoidant Personality Disorder 4. Narcissistic Personality Disorder 5. Obsessive-Compulsive Personality Disorder 6. Schizotypal Personality Disorder 7. Two or more

Common differential diagnoses based on information from wikipedia.

Common differential diagnoses based on information from wikipedia.

[box-dwelling]

Ok so as someone with bpd that sometimes projects it too much. I have been avoiding making this post lest I being doing that, but I finally caved and after a brief look at the diagnostic criteria again. Astarion is one of the best representations of a person with BPD I've ever seen.

Note is that cpstd is also a valid interpretation. Its not mutually exclusive, and as someone with both that and bpd, they can often both be very comorbid and inherently linked.

You only need 5 of the diagnostic criteria to fit the diagnosis, and to my read, he has 7 well evidenced in the text. Chronic feeling of emptiness and suicidal or self harming behaviour being the only ones I can't off the top of my head see instances of him experiencing. They might be there, and reads of him might incorporate them, I was just very much limiting myself to stuff I can immediately think of examples evidencing

So yeah, it makes sense it wouldn't be stated in game because of the settinf but he really really fits the criteria and I am choosing to call him representation because he is genuinely one of the most loving empathetic portrayals of this disorder I have ever seen.

Also, for people unaware, yes, these are also trauma responses. Bpd is generally understood to, at least to some extent, be caused by trauma and especially abuse. Again, this is not mutually exclusive with a read of cptsd. The two often go hand in hand.

[ed-recovery-affirmations]

Can being overweight be healthy?

This is a complicated question, anon. My go-to question is: over what weight? We know now that the BMI scale is largely inaccurate and does not take into account height differences, muscle training, breast size and other factors. I also know that many people have different ideals of what's a normal or "ideal" size.

I'm not a doctor. I do know personally know many people whose natural weight - as in no dieting, but no overfeeding - set them as being considered fat. I also know that a lot of those people ended up feeling shame for this, and spent lots of time putting themselves through restriction, various crash diets, and a traumatic level of hatred toward the bodies they lived in. Many of them did lose weight doing this, but at great cost to other aspects of their health, such as their hearts, gallbladders, brains, stomachs, and GI tracts. Would it have been healthier to leave well enough alone and stay fatter? I think so.

But I also think that health can be really complicated and a lot of people end up having to make choices as to what aspect of health they must prioritize. So, for example: say you need a medication that has a side effect of weight gain. Do you accept the weight gain, or do you deny yourself medication that you might need? Say that you used to be a runner, but then you got a permanent knee injury and gained weight from being less active than usual. Do you prioritize treating your knee, or do you keep running on your injury to maintain the same weight? Or do you give up something else, like restricting a favorite food, for no other reason than because you feel you must retain that body shape at any cost? Say you have recently given birth to a baby, and the pregnancy caused you to gain weight. You want to breastfeed, but you're struggling to produce enough milk when you diet. Do you focus on the diet? Or do you focus on your journey with your new baby? Now say you are diagnosed with an invisible disability. Your doctor advises you against heavy exercise because it would be dangerous, but your natural weight is bigger. Do you choose to exercise anyway and risk the consequences of further disabling your body? Or do you think that you should have to restrict your food intake simply because you have a disability? Now what if you also have a comorbid diagnosis that impacts your GI tract, limiting what you can eat already? (Yes, some people are in the situation of having multiple disabilities.)

Do you think that people with these conditions should have to disclose all of their personal health history in order to be accepted for being fat?

(How many people disclose these personal things, do you think, and are not believed anyway?)

If you live with these conditions, and are making the best decisions you can for your own health in every given moment, do you think that it's a healthy choice to accept a co-occurring hatred for your own body at that given time? Do you think it's always the healthiest thing to pursue thinness?

Life is not simple. Managing one's body needs will not always come down to a series of simple choices. It's always going to be a balancing act where each individual needs the liberty to choose what THEY are going to prioritize to live well. And it won't be easy for everyone else to tell, at a glance, what those carefully-selected choices looked like for that individual.

I'm someone who is not fat, but who does have a chronic health disorder. Am I more healthy than a fat person who does not have the same disorder?

All you can do, anon, is focus on the choices that are right for you. That might mean giving up restricting if your body feels better when you don't, even if that comes with significant weight gain, just as an example. It might mean you've spent so much time hating your body that preserving your mental health means avoiding dieting or diet culture. I can't tell you what the right choices are for you as an individual; I can only tell you to listen to your body's cues and use the information you have available to you in order to set your balance of choices as close to "correct" as you possibly can. Nobody else could understand your process for this, nor could you understand theirs if you don't live their life. And that means nobody else gets to judge you, or your body, at a glance. Loving it properly means taking care of it to the very best of your ability, and yes, sometimes that might mean letting it be naturally fat. And I think there'd be a lot fewer EDs in the world if we weren't always so afraid of that.

I hope this helps!

[eroticwound]

The Parentification of the Berzatto Siblings: Mikey’s Mental State

Let’s take a look at Donna’s mental state, as a way of understanding Mikey’s. Donna is dealing with mental illness. She most likely has a personality disorder (Borderline would be my guess) that might be comorbid with a mood disorder (Bipolar or Intermittent Explosive Disorder), and is using alcohol to self-medicate.

Donna’s alcoholism doesn’t exist in a vacuum. Because of her mental illness and the stressors of being a single mom, she is self-medicating with alcohol, meaning she is using it to numb herself out. Between 50 and 70% of people with BPD have substance abuse issues, and 41% of those with Bipolar disorder self-medicate.

This is the state of the Barzatto Family Home: the unstable woman at the center, who can be fun and funny, but is incredibly volatile. She is influencing and modeling behavior for all of the Bear Sibs. So looking back at Michael, as the oldest son, the burden of Donna’s moods and the state of his siblings (and any guests that happen to be around) is firmly on him. And he is empathetic enough to get others out of their funk and charming enough to keep things positive and running (relatively) smoothly. But all the anxiety of this situation—the parentification, which forces a child to disregard their own emotions and well-being in favor of their parent—gets severely internalized, and then masked by his ability to be loud and funny.

Mikey is avoidant above all else. In that first interaction in Fishes, between him and Nat, he literally says, “with [Mom], not handling it is the best way to handle it.” And this approach of his pops up again and again, whether he’s avoiding Carmy (by not picking up the phone or engaging in difficult conversations, or literally, when he leaves the pantry after Carm gives him the present), avoiding handling Donna, or avoiding dealing with his own mental health. This is in no way helped by the fact Mikey is most likely dealing with some form of chemical imbalance, whether it’s depression or bipolar disorder like Donna.

Add to all this the self-medicating behavior Donna models for him, and it’s a fairly clear line from internalizing and masking his pain, to substance abuse; alcohol and pain medication and whatever else he was using are just more intense ways of avoiding his pain. They are quite literally the only ways he’s managing his distress.

In fact, so much of Mikey’s behavior is modeled off of Donna:

The first person to throw a utensil in Fishes is not Michael, it’s actually Donna. She throws one at Steve while Mikey and Richie are giving Carm a tough time about Claire.

Mikey hits himself after Carm gives him the gift, and Donna hits herself at the dinner table.

If Donna hadn’t driven her car through the wall, the scene Mikey makes at the dinner table might’ve been the big story from that Christmas.

And then of course there’s the traumatic tirade Donna goes on about killing herself. That seems like a fairly common threat in the Berzatto household. And it makes me wonder if the gun Michael used to kill himself was his father’s, the one that Donna threatened to use.

And this is a real issue with Parentification: it becomes normalized and perpetuated. These roles and behaviors become integrated into a child’s personality, and alters ideas of what normal and healthy relationships look like. You can see this in how Michael treats Carmen. It was normalized for Mikey to handle Donna in the kitchen. It never occurs to him that baby Carm shouldn’t be around that. But it is normalized *and* unavoidable, so Michael let’s him take on that responsibility. Even the way he talks to Carm, calling him moody, a saltine—these are intended to get Carmen out of his head, but they are also cruel and tell Carm that his emotions are too much, that his emotions can’t compete with Donna’s. After all, Donna and Mikey work together as a parental unit.

You see it especially in the first Mikey-Carmy-Donna Kitchen scene in Fishes, where Donna and Mikey gang up on Carmy together, getting Carm to say he’s happy to be home and loves them. This is a lie to smooth things over on Carmen’s end, but if being around Donna is bad for Carm, it’s bad for all of them. Living at home has got to be triggering, and you can tell throughout Fishes just how done Michael is with it.

Michael’s adulthood is so sad. We know that he had a trail of failed business ventures, money problems, and even had to move back in with Donna. He doesn’t seem to have a girlfriend, and is stuck telling the same old stories from his youth, because the best he can do is mask his dysfunction and entertain everyone. All of this is a self-perpetuating cycle, his avoidance making sure he cannot ask for the help he needs, and his relative functionality ensuring no one pushes the issue.

My next post will breakdown some of the key Mikey scenes in Fishes.

[antisocialsharky]

hi, i have a couple questions about ASPD

my psychologist has implied that he thinks i have ASPD and wants to look into it further, do you suggest getting an official diagnosis or avoiding a diagnosis? are there any specific treatments that they would have me do?

Hi!

Thats another case, where I have to say "it depends". I would personally pretty much always suggest getting an official diagnosis, but I am also relatively privileged at this point, so I don't have to worry much when it comes to the topic of seeing a professional. I have seen other people say, that they wouldn't do it, since theres some "risks" (however you may define that term), such as:

• the people who have access to your file, can deny you treatment based on that (psychs who consider ppl with PDs treatment resistant, gender affirming care being denied cus "how can u know ur trans if ur personality is disordered", etc.)

• this isnt a thing in my country afaik, but allegedly is in other ppls countries => if a judge somehow knows of your diagnosis, that can be used to influence cases against you, get you a harsher sentence, etc.

• in some countries, you will not be allowed to be in the military if a diagnosis is on record and some jobs like police, pilots, working with children, etc. have also been named as difficult by ppl - allegedly (tho it depends on how open the access to documents is or whether you talk about it openly)

+ You just always have to ask yourself "is it safe & will I be taken seriously if I try to get an assessment?" => which is sometimes down to a good professional who does it. in your case your professional came up with it on their own, which is pretty much a good sign I think? so if you rly want my concrete opinion, I'd tell you to go for it.

Now the treatment is also highly individual! It rly depends on your symptoms, the severity, whether or not you have comorbidities, what you are prepared and ready to do, etc. Common stuff is:

• trauma therapy (since its usually at least partially trauma based)

• behavioral therapy (symptom management & reduction)

• specific therapies (like stuff I listed in the last ask - mainly with the goal of emotional regulation or development of prosocial skills)

• medication (usually also for emotional regulation so one is less likely to be impulsive/aggressive/etc.)

• theres also one therapy type we call "schema" therapy in my country, which (if I remember correctly) centers your environment and all the dynamics around you and how those influence you and how you're wrapped up in them? thats also been suggested to me as a treatment option for ASPD (tho I may be remembering the specifics of the therapy wrong, so yk look it up yourself xD)

[eternal-echoes]

“Below are a nearly a dozen different factors that can sometimes influence a person's sense of sexual identity. Rather than saying any of these things "cause gender dysphoria," it is more accurate to say that they could contribute to a person feeling dysphoric about his or her body. Some individuals might find that some of the factors resonate deeply with them, while others might not relate to any of them. The goal isn't to provide an exhaustive list, but to encourage individuals who experience gender dysphoria to listen with compassionate curiosity to their own story.

Rapid-onset gender dysphoria

Another significant trait shared by these young women was that 62 percent of them "had one or more diagnoses of a psychiatric disorder or neurodevelopmental disability preceding the onset of gender dysphoria."(64) The three most common were major depressive disorder, specific phobia, and adjustment disorder. A significant number had experienced trauma, struggled to handle negative emotions, and often felt overwhelmed by strong emotions while going to great lengths to avoid feeling them. Many parents also reported that their children had high expectations that transitioning would solve problems in various areas of life. Many were unwilling to work on basic mental health issues before obtaining gender reassignment treatments.

Before coming out as trans, many were high academic achievers. However, following the announcement of their trans identity, their parental relationships deteriorated, their grades dropped, their range of interests in life narrowed, and their mental well-being worsened.(65)”

-Jason Evert, Male, Female, or Other: A Catholic Guide to Understanding Gender

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Work cited:

64) Littman, "Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria," 13; A. Meybodi et al., "Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria," Psychiatric Journal (2014), 1-5.

65) Cf. Littman, "Parent Reports of Adolescents and Young Adults Perceived to Show Signs of a Rapid Onset of Gender Dysphoria," 22.

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For more recommended resources on gender dysphoria, click here.