Throwaway05
6d ago
Mild symptoms complicate both diagnosis and treatment - much of what DBT is designed to help is for moderate functioning people (can be great) and low functioning people (where it isn't likely to).
Your diagnosis could be wrong, but I'd guess what's happening is that you are well enough, and the underlying biological reality of a borderline brain gets in the way sometimes.
However also possible you are what you are and don't meet criteria for anything.
Throwaway05
6d ago
Yeah don't date one, but you gotta keep in mind that if you are seeing them (at this phase in your training) it's either so bad they are on an inpatient psych unit or in the ED, or they are in the hospital for other reasons and they are such a pain in the ass that the diagnosis makes itself clear.
In training you'll get the skills to pick up more mild cases in the community, and presumably also see more mild cases in therapy clinic.
This also is true for things like depression and anxiety (early in training you'll only see total shit shows, but more mild cases exist they just don't need you).
This is also, also true for things like hypertensive emergency vs. generally outpatient family medicine seeing mostly controlled shit.
Throwaway05
6d ago
Borderline is better conceptualized as more like depression or anxiety than schizophrenia when it comes to severity. Many people with depression or depressive thought process never present for care, nor do they need it. Some of these people kill themselves.
The same is true with Borderline. At state hospitals in the U.S. you often see a mix of psychosis and severe borderlines who won't stop hurting themselves. It can be very bad. You also have borderlines where the symptoms are so rare or mild that you'd have to have a long relationship with a therapist to catch it.
Don't underestimate how "harmless" it can be.
When it comes to treatment it is treatable. Certain kinds of therapy work (chiefly DBT). Patients accumulate coping skills and calm down just by aging. Medications don't work great but can be helpful for symptomatic management.
Throwaway05
6d ago
Dawg I haven't changed my goal posts at all you just jumped down my throat reaallllll harrrrrdddd.
Throwaway05
7d ago
I am supportive of hypnosis as a modality but it has limited utility and that utility is further hampered by susceptibility to hypnosis seemingly being more of an innate trait. Some people it works for and they want it to work for and you can do some great things with it but for the majority it is useless.
However overstating its value in the way you seem to do patterns matches to ....a lack of scientific rigor, and I'm saying this as someone who came into the conversation correction someone to let them know hypnosis is actually a thing.
Throwaway05
7d ago
Since you are asking this question I'm sure there is a paper from 50 years ago with terrible research methods that suggests this is a thing, but that doesn't make it not absolute nonsense.
To more directly answer your question, I predict the literature that is the body of scientific knowledge suggests that this is not a thing and does not take it credibly. The existence of crank papers to the contrary does not mitigate this.
Especially since it is now known that many strange papers at the time represented intelligence work.
Throwaway05
7d ago
Funnily enough, no AVM found on multiple kinds of imaging, including an MR angiogram. No kidney disease either. As far as anyone could tell, it was just bad luck.
Fuck.
Also OB/GYN is traumagenic. Complicates the psychiatric formulation.
On a more serious note it's worth thinking about the way autism has become a catch all for poor socialization, that isn't to say that these people don't have some form of autism spectrum, just that it's worth being a bit more cautious with it since it's becoming an over diagnosed thing (at least in the U.S., thanks TikTok!).
Throwaway05
7d ago
Lots of weird shit causes orgasms, and IIRC people have used hypnosis as a replacement for anesthesia. Dissociation is powerful.
If you are saying hypnosis can make your boobs grow then I'm going to call you a crank unless you have some damn good evidence.
Throwaway05
7d ago
I mean it's entirely possible it's more potent than described by medical literature. It's also entirely possible that people who buy into it are more likely to have out of character or excessive manifestations.
Throwaway05
7d ago
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Never, ever, EVER, sleep with someone you can diagnose with BPD easily. You're welcome. cries
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Excuse me what the fuck with that head bleed.
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Social media autism.
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All these people are probably borderline.
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Once you have training to look for mental illness you'll see it everywhere, especially on the apps.
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Tell them Tylenol is the absolutely worst way to die and to use Melatonin instead.
Throwaway05
8d ago
If you are willing to explore changing medications (may not be safe depending on your situation) some of the medications in that class are more weight neutral than others.
Additionally depending on the pathology an alternate medication class might be available, especially if you haven't really revisited it in the years since you started (some things will require that type of med though).
Medicaid may cover a dietician which is better than nothing.
Your primary care may have some routine health suggestions (again a statin, some preventative care etc) or maybe even something like Ozempic.
Throwaway05
8d ago
This is a common side effect of that class of medications, you should discuss this with your primary care doctor and psychiatrist, they may recommend medication changes, dietary counseling, ancillary medications like statins etc.
Throwaway05
9d ago
Some of that was deleted (or I otherwise can't see). Missed the previous discussion in the weird psychopathology thread line.
I invite you to read the wikipedia page, which links to some actually studies on the matter (ex: https://onlinelibrary.wiley.com/doi/10.1111/apt.13706)
Basically the most evidence based approach to hypnosis concludes that it seems to function similar to mindfulness meditation, biofeedback, and other similar modalities where someone hacks their cognitive state and level of arousal, which is often easier to do with assistance from an external resource then by a person on their own.
Obviously this implies a limited level of clinical utility but it can help with psychosomatic adjacent pathology and any time "mind over matter" is more directly relevant.
I was fortunate enough to experience some training in this during my medical education and while I personally was not hypnotized I witnessed some of my colleagues experiencing it....and it was ultimately very unexciting and contrary to media portrayal (which is as this usually goes).
It seems most reputable people who do this emphasize the limitations and the fact that it can't really make you do stuff you don't want to do already.
Throwaway05
9d ago
Hypnosis is actually not fake, it just doesn't work the way people think it does. It's used in modern (Western) medicine it just doesn't really work well and the real version isn't mega useful so you don't hear about it a lot.
Throwaway05
16d ago
I mentioned this before, but I again recommend you read "Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process" by Nancy McWilliams.
Easy to grab a copy on the high seas, you'll find it will expand your view of human behavior outside just the DSM (see: neurosis) and it's written in basic enough English that anyone clinical will get a lot out of it. Hell, I've tossed it at some of my big business family members to help them understand toxic behaviors in finance.
Previously I would have hit you with "no you'll have these patients in every field and it is going to help." Now I am very pleased to hit you with "bruh it's your field, get a bit ahead of it."
Throwaway05
16d ago
Dr. House doesn't really exist, the equivalent in real life is something like a specialty tumor board at a premier research institution, which is a group of knowledgeable specialists "discussing" the specific approach to a known problem (and rarely trying to figure out what the problem is or arguing over what it is).
Your situation is different in that you know what the problem is, and it's a basic diagnosis, but you can't seem to get it treated. It's not unreasonable to be like "okay what's up we need more options, more heroic measures."
However, my suspicion is that you need to go back to basics.
Basically - you need therapy. Medication may not help in the way you want it to help.
This doesn't mean you should give up on medications, you can always try more/different SSRIs etc. to find something that hits for you, but at a basic level you have to keep in mind that some things are more responsive to medication than others and this includes in psychiatry.
The classic example non-psychiatric example is insomnia (well some consider this psych). We have meds. We have a lot of meds. We have really expensive meds. We have really dangerous meds you should never use but people demand anyway and have really bad outcomes. What works for insomnia? Behavioral modification and therapy. Works (maybe an exaggeration, maybe not, I'd have to review the data) orders of magnitude better than meds.
In psych - for people with certain types of depression (terminal cancer? live in an active war zone and your family all got blown up?) medications aren't going to work for a lot of people. Therapy is generally going to do more.
Back to anxiety.
Anxiety often requires higher doses of medications (sometimes to the point where the side effects outweigh the value), but best practice is essentially to have medications lighten the load enough for therapy to be useful and helpful.
You don't need a genius psychiatrist, you need an excellent therapist (can be a psychiatrist), which is not the same thing and is something you can absolutely pay for if you wish in most metro areas (and a cheap, serviceable therapist may do). It is possible that a slightly more clever psychiatrist would throw something on that would solve the problem but that should be a secondary goal.
Now I don't know what your relationship with therapy is but you might be skeptical about it and might be asking why that would suddenly be a thing you would need now later in life after medication worked for so long. Additionally, if you are posting here you are probably intelligent, high resource, and rational - and thinking because of all that therapy shouldn't be needed. Unfortunately that's not how this work.
For example: a lot of anxiety related behaviors and experiences are basically just good old Pavlov fucking with your nervous system. Don't matter if you are mucho smart, if the bell goes off you'll salivate.
I wonder if a process like that happened here - you went off the med and expected something to happen or something happened, you felt like the safety net was gone, you had experiences, they rapidly reinforced themselves now you are in an anxiety spiral..... one you'll be able to get out of with time and space maybe, but faster and more effectively with some skills training, CBT, whatever - all with medication as a supportive factor. The meds are often a crutch, and therapy skills can be more definitive treatment (one of the reasons why you may want to avoid meds for anxiety).
Keep in mind that other conditions often work very differently.
It may also be reasonable to see your PCP to rule out any medical problems (not that they are likely) and assuage any health anxiety.
Throwaway05
25d ago
Fuck. I need to get a drivers license already.
Yes.
Also do keep in mind that the USMLE is a total horror show, my suspicion is that the switch to pass/fail for Step 1 probably puts "not entirely committed" people in a bind because it's harder to tell if they are excelling at the level they will need for still scored Step 2/Step 3.
Throwaway05
25d ago
Hell yeah man. As we say in the states: P=MD.
You can always catch up on whatever you feels is lacking once you have freedom to move, the hardest part is getting to the spot you just got to.
Scotland seems beautiful anyway.
Throwaway05
1mo ago
Assuming not a joke - relativistic kill vehicles.
Throwaway05
1mo ago
Unfortunately, as someone pointed out downthread, "monetizing their skills" these days increasingly means going into tech or pharma, rather than actually, y'know, treating patients.
This is a really important point in my mind, you can argue that doctors aren't the smartest people in the world but by the time you get into late training you've demonstrated that you are among the hardest working (24-36 hour shifts, 80+ hour weeks for some specialties) and best at stupid box checking.
Throwaway05
1mo ago
People fuck this up constantly. Educated people. Smart people. People believe in antibiotic stewardship until they have a cold and demand antibiotics "just in case." People take medications and are told "no really tell me if you start supplements or something really bad could happen" and then something really bad happens. People are told "don't eat before your expensive, time sensitive, maybe life saving surgery" and then they eat. Sometimes they die because they eat and we can't do surgery.
See front page of meddit today for a discussion on colonoscopies.
People can't be trusted to do a good job of this, and that includes health care professionals (including doctors). Thus the waves of verification.
Throwaway05
1mo ago
That's all stuff which is much amenable to discussion and debate (even if we disagree) but these are unrelated to my problem with your post which was the gross factual inaccuracies.
It's several orders of magnitude more common for a doctor to start making 250K a year at age 32 with a half million dollars in debt than it is for a doctor to be making over 750k a year, which nearly zero are doing through clinical duties alone.
Your comment, much as I loathe to use this term, is misinformation.
"What is the right amount of money for a doctor to make" is a reasonable question but it's functionally entirely unrelated to healthcare costs in America.
Throwaway05
1mo ago
Do keep in mind that the UK does its own thing and doesn't map well to the process in the U.S. (or other western countries).
At an extreme example if you want to be an electrophysiologist in the U.S. you'll be doing a minimum of 16-18 years of training after high school, with many looking at 22 years. During 8 of those years you will be working 60-80 hours a week with some programs closer to 100 hours a week. Even if the years are the same you are doing twice* as much work during each year (is that sane? No. But it is).
All the while you are dealing with an average student loan debt of around 250k, with that number not counting interest or all the rich kids (who are admittedly a fair chunk) with zero debt.
If you want anybody in the U.S. at all to do that you need to offer them a pretty big carrot. And you do want them to do that - we've seen the outcome disparity between U.S. MDs and other populations (most notably of late, midlevels).
AND.
Lower quality doctors (or doctor replacement) increase overall healthcare cost due to increased unnecessary testing. Very well documented at this point.
You need to change the regulatory and malpractice environment first if you want any of this to work, which nobody seems to be interested in doing, and if you did things would cost less without coming for MD salaries at all.
*these days 1.5 times the work is much more common and realistic but that's still a fuck huge disparity.
Throwaway05
1mo ago
Most European countries have 6 years of combined med school and undergrad (see: Germany) vs. 4 years of undergrad + 4 years of med school in the U.S. these days 1-2 gap years is also common, with 3-5 being uncommon but not rare (for things like PHD, MPH, MBA).
The amount of debt is important because it is relevant to the level of pushback you get for changes, and the fact that if you cut salaries by half and allow limitless importing of doctors then you will have pretty much zero people applying to med school in the U.S. overnight (and that would be the rational response). People still interested will do PA/NP school instead.
Do also keep in mind the quality difference which is real but is frequently not acknowledged.
It's also worth keeping mind that mental illness almost always impairs insight - your ability to understand and read your mental state may be hampered (not that the average person is truly good at this, but it can be more important in someone who struggles).
Many borderline patients hear the diagnosis and its description and go "thank god, that's me! it all makes sense now." Many go "no that's bullshit I AM TOTALLY FINE LALLAALAL................."
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