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Questions on medications for us caretakers - Buspirone?
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Topic: Questions on medications for us caretakers - Buspirone? (Read 450 times)
campbembpd
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What is your sexual orientation: Straight
Who in your life has "personality" issues: Romantic partner
Relationship status: married
Posts: 83
Questions on medications for us caretakers - Buspirone?
«
on:
January 03, 2025, 10:03:33 AM »
I had such good intentions a year ago that things were going to be different a year from then, where we are now. That I would be able to draw a line, make boundaries and I'd be strong. That either things would change or maybe our marriage would be done.
There were some good moments but for the most part I didn't hold many boundaries for long. I folded like I feel disappointed in myself. Like a scared little kid who won't rock the boat.
I am trying to focus on the positive things that have happened. I have definitely learned more. We had a period of almost a couple of months where things were good. My wife had given up THC and cut back on her drinking. It seemed to make a world of difference. It was like we could have actually have normal conversations and things didn't bother her as much. Even our daughter told her she was different.
It was the first time in years that I wasn't consumed with constant worry, stress and anxiety over what the next explosion would be over. I actually took time to do things for me - it was like my mind was free and my attention didn't need to be 100% dialed into a mentally ill partner. I read, I read a lot (I love to read but haven't in years, just haven't had the mental space to do that). I was doing meditation and just more self care. I was motivated and felt invigorated like I hadn't felt in years. But it was short lived maybe 6-8 weeks then things went back to how they were. I feel stupid, why would I think any different? She started drinking more and more until she was at the same level as before (avg 8 drinks a day).
The good news is she has not gone back to using marijuana for a couple of months. She says she wants to do dry January after our vacation (I'm starting tmw as well). She said she wanted to find a therapist to help her with her drinking but hasn't tried to find one after 2 she contacted said they didn't work with that. I'm not very optimistic - she's only gone 1 day without a drink in the last at least 6 months, maybe a year and that was only because she was very sick that day.
She did say during a couple of episodes over the past couple of months we need to go back to therapy. She gave up on therapy last year when I started working on codependency, she really didn't like that. She split our therapist and I eventually stopped seeing him myself. She started saying that therapy was going to end us. Sadly - me giving in after continued explosions that I was choosing him over her. I found a new therapist (still waiting to hear back). And I think it was time to switch anyway. This one says she specializes in BPD, regulating emotions and couples therapy. I still have to pitch it to my wife. I'm planning to start going regardless, whether it's this person or someone else. But I'm bracing for hell...
There were a few bad incidents that really hurt me recently. Actually put me into a state of anxiety and probably a mild depression. I've had a terrible time focusing on work or anything almost. My motivation is nil, I got sad and I started drinking more, eating worse and have put on some excess weight because of it over just the past 6 weeks. It's strange to say but feeling this was has made things kind of clear for me about the toll this is actually taking on me. That I've been under incredible stress for years and dealing with anxiety, like so many of you. I hate to blame anyone else for what I'm doing but I've struggled a lot with my weight over the past 7 years. Slowly going up and very hard to take off. I love to work out, I actually love to eat well and cook all our meals but this past few months has made me realize how much I'm using food to cope, and alcohol to a degree as well. I get anxious about something we need to talk about or an episode that just happened and turn to food and alcohol.
Medication question - I just saw my primary care doc and actually opened up about this. That I'm having a lot of anxiety, problems sleeping and that things are probably honestly going to get worse since I'm going back into therapy. I told him about my anxiety and he didn't think xanax or something similar would be good just because of the potential for abuse. That's the last thing I want too. So he recommended Buspirone. It's not an anti-depressant, it's a long term anxiety medication. So far my research seems it's pretty mild with not bad side effects and good reviews. Has anyone here had any experience with it? I need to be able to get strong and lose some of this anxiousness. I need to be able to work with a therapist and hold my boundaries, even if that means losing the relationship. It feels a little sick and ironic that I am at the point where I feel like
I
need medication. Also, second question in regards to this. If I start this med I don't have any intention on telling my uBPDw. I can't see that going anywhere good and would just cause a shame rage spiral (honey - I can't handle your psychotic episodes so I have to go on medication (is what she would hear)). But what's the right thing you think?
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Last Edit: January 03, 2025, 11:33:17 AM by kells76, Reason: correct a typo
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HurtAndTired
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Who in your life has "personality" issues: Romantic partner
Relationship status: High Conflict Marriage
Posts: 163
Re: Questions on medications for us caretakers - Buspirone?
«
Reply #1 on:
January 06, 2025, 09:57:19 AM »
Hi Camp,
I am on a daily low dose of diazepam (valium) at 2 mg to manage a pre-existing General Anxiety Disorder (GAD). At this dosage, it controls my panic attacks and does not lead to dependency (I have been at the same dose for many years). I wouldn't recommend trying to get a script for anti-anxiety meds from a General Practitioner though, as they lack the expertise needed to treat you. You need to see a psychiatrist or a psychiatric nurse practitioner. They will be able to more specifically and effectively address your needs.
About 16 months ago I radically changed my approach to dealing with my wife's BPD. I put strong boundaries in place and have held firm since. She, predictably, did not like me growing a spine and acted out against my boundaries. This is the dreaded "extinction burst" where behaviors get worse before they get better. However, it would be more accurate to say "extinction bursts" as I have been placing multiple boundaries and she has been testing them on and off since I put them in place. This increase in acting out has brought me incredible increases in the amount of anxiety that I am dealing with. As a person who already had an anxiety disorder, the additional stress of holding my boundaries firm and dealing with my wife's extinction bursts was just too much. I did not want to increase my diazepam dosage because as your doc said, it has the potential for abuse and dependency. So instead my psychiatric nurse practitioner recommended buspirone. It has been a game-changer for me.
Buspirone, on its own, would not be enough to manage my anxiety. I am taking 10 mg buspirone twice a day in addition to my 2 mg, twice-a-day diazepam, which is enough to keep my anxiety under control even with the additional stress of enforcing boundaries. A few things to expect. Buspirone makes me feel like I have had a strong cup of coffee about an hour after I take it, especially in the morning after I have already had my coffee. It can feel a little like a mild electrical current going through your brain. This only lasts for 15 to 30 minutes however and is not unpleasant.
Buspirone also does not mix well with alcohol. If you are going to drink on a given day, either do not take your buspirone that day or only have one or two drinks. Buspirone only stays in your system for a matter of hours, so you will be fine if you haven't had it that day. If you have more than just a few drinks, it will amplify the effects of the alcohol. I got the room spins and nearly got sick from having 5 beers over the course of 4 or 5 hours while watching a football game in the evening after having taken my morning dose of buspirone but skipping my evening dose.
I know it sucks having to take medication to mitigate the effects of our spouses' mental illness on us, but it is much better to be under a doctor's care than to go down the road of self-medicating. You are living through a large amount of ongoing trauma. It would affect anyone. This is merely a part of taking care of yourself so that you can care for your children. I specifically did not mention your wife, because she is an adult and should be taking care of herself. That is not your job, and trying to do so will only wear you down to a nub. Only she can choose to take care of herself...or not. That is not in your power to control.
HurtAndTired
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campbembpd
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What is your sexual orientation: Straight
Who in your life has "personality" issues: Romantic partner
Relationship status: married
Posts: 83
Re: Questions on medications for us caretakers - Buspirone?
«
Reply #2 on:
January 06, 2025, 11:44:30 AM »
Quote from: HurtAndTired on January 06, 2025, 09:57:19 AM
Hi Camp,
I am on a daily low dose of diazepam (valium) at 2 mg to manage a pre-existing General Anxiety Disorder (GAD). At this dosage, it controls my panic attacks and does not lead to dependency (I have been at the same dose for many years). I wouldn't recommend trying to get a script for anti-anxiety meds from a General Practitioner though, as they lack the expertise needed to treat you. You need to see a psychiatrist or a psychiatric nurse practitioner. They will be able to more specifically and effectively address your needs.
About 16 months ago I radically changed my approach to dealing with my wife's BPD. I put strong boundaries in place and have held firm since. She, predictably, did not like me growing a spine and acted out against my boundaries. This is the dreaded "extinction burst" where behaviors get worse before they get better. However, it would be more accurate to say "extinction bursts" as I have been placing multiple boundaries and she has been testing them on and off since I put them in place. This increase in acting out has brought me incredible increases in the amount of anxiety that I am dealing with. As a person who already had an anxiety disorder, the additional stress of holding my boundaries firm and dealing with my wife's extinction bursts was just too much. I did not want to increase my diazepam dosage because as your doc said, it has the potential for abuse and dependency. So instead my psychiatric nurse practitioner recommended buspirone. It has been a game-changer for me.
Buspirone, on its own, would not be enough to manage my anxiety. I am taking 10 mg buspirone twice a day in addition to my 2 mg, twice-a-day diazepam, which is enough to keep my anxiety under control even with the additional stress of enforcing boundaries. A few things to expect. Buspirone makes me feel like I have had a strong cup of coffee about an hour after I take it, especially in the morning after I have already had my coffee. It can feel a little like a mild electrical current going through your brain. This only lasts for 15 to 30 minutes however and is not unpleasant.
Buspirone also does not mix well with alcohol. If you are going to drink on a given day, either do not take your buspirone that day or only have one or two drinks. Buspirone only stays in your system for a matter of hours, so you will be fine if you haven't had it that day. If you have more than just a few drinks, it will amplify the effects of the alcohol. I got the room spins and nearly got sick from having 5 beers over the course of 4 or 5 hours while watching a football game in the evening after having taken my morning dose of buspirone but skipping my evening dose.
I know it sucks having to take medication to mitigate the effects of our spouses' mental illness on us, but it is much better to be under a doctor's care than to go down the road of self-medicating. You are living through a large amount of ongoing trauma. It would affect anyone. This is merely a part of taking care of yourself so that you can care for your children. I specifically did not mention your wife, because she is an adult and should be taking care of herself. That is not your job, and trying to do so will only wear you down to a nub. Only she can choose to take care of herself...or not. That is not in your power to control.
HurtAndTired
Thanks so much for the info and sharing your experience. Extinction bursts... It sounds like what I'm expecting... Right now things are bad enough and I know things will worse before they get better. They did before and I couldn't handle it when I tried this a year ago, I simply wasn't able to withstand the behaviors getting so much worse. So I'll see how the buspirone works, I started on the lowest does (7.5mg twice a day) but will increase in a couple weeks or so if needed but I understand it can take a while to get it dialed in and to really see the full effect. That coupled with a having a support of a therapist who really understands BPD is my plan.
You said you changed your approach 16 months ago. How are things today compared to then? Are the outbursts less often or less severe? Do you have a 'plan' of action for different scenarios when she does act out? How are you feeling now compared to then? Are you less anxious, or more able to talk with her about topics you could previously not? (i.e. I can't currently talk to my uBPDw about money, sex or certain topics unless I'm prepared for a bad dysregulation episode)
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HurtAndTired
Online
What is your sexual orientation: Straight
Who in your life has "personality" issues: Romantic partner
Relationship status: High Conflict Marriage
Posts: 163
Re: Questions on medications for us caretakers - Buspirone?
«
Reply #3 on:
January 06, 2025, 01:52:46 PM »
Things are better now, but they got much worse after I placed the boundaries in late August 2023. This was her going through her extinction bursts where she raged at me for not "acting normal" and capitulating to her demands the way I had for years. There have been times over the past 16 months that were absolute hell for me, but I knew I had to stay strong. Things are better in the aggregate, but there are still flare-ups. I am just better able to deal with them than I was. Having a good therapist was very helpful with that (she specializes in BPD as well).
I do have specific plans to deal with specific situations. For example, any physical violence whatsoever is an automatic call to the police. 100% of the time. Suicide threats are an automatic call to 988. 100% of the time. Divorce threats are met with "If you want a divorce, go ahead and file. From there on it will be our attorneys talking to each other, but I will not ever discuss divorce with you ever again." 100% of the time. Are you seeing a pattern? I have forced myself to be 100% consistent with my responses. It is NOT easy, but it gets easier.
About a month ago I found out that two friends from college had died. I was devastated, but my wife couldn't even tell me "I'm sorry for your loss." Instead, she mocked them (even though she didn't ever meet them). One died from complications from alcoholism (pretty ironic that my wife who drinks every day would mock someone for drinking themselves to death) and the other took her life because she was facing some serious legal issues (my wife said that suicide is a coward's way out).
So I stayed in the guest room for the next three weeks because I couldn't lay in bed next to someone who was so lacking in empathy for my loss. We were at a standoff. I couldn't back down because if she was so lacking in empathy over the death of my friends, how could I count on her to be there for me if I lost one of my elderly parents? She couldn't back down because she was stubborn and delusional. It was extremely uncomfortable. She tried to give me the "silent treatment" but I was neutral/positive in my interactions with her. If she brought up my staying in the guest room, I would just say that I would be there until she could apologize for showing me no sympathy at all. This is a core value to me and I had to make a stand on it to be true to who I am as a person.
Had this been before I grew a spine, I would have been groveling to her and apologizing for her atrocious behavior just to make things "normal" again within a week. By now, however, I was comfortable enough with her temper tantrums to not have them affect me...as much. After three weeks of her not wanting to apologize and splitting on me several times, she went out in a nearby city with my SS26 for his birthday. She wanted me to come with them. I had no desire to go out drinking with a bunch of 20-somethings in the middle of the winter, and was not going to leave S3 with my elderly parents to look after overnight. I politely offered to take them out to dinner, but was soundly rejected and screamed at. The divorce threats came out, the long list of everything I had ever done to "wrong her," she really threw the kitchen sink at me. It hurt, but I didn't let it show. Instead I enjoyed my night in with S3.
The next morning she came back home at 11:30 AM with no phone and without SS26. She had rented an expensive hotel room for them but SS26 stayed out partying with his friends and never came back to the hotel. She had her phone stolen. She was hung over. She needed my help, which I gave her. Four hours later I have reported her phone stolen, took her to the store to let her get a new iPhone, and then worked with Apple support to get her data from the old phone transferred to the new one. After this was all over, she said "thank you." To which I said "You're welcome, but of course I helped you, I'm your husband. That's what spouses do for each other. I just wish that I could count on you to be there for me the way I was just here for you." She finally gave me a sincere apology for how she had acted. I never would have gotten that had I not dealt with my discomfort and held my ground. Things are now "normal"...until the next split.
I guess what I am saying is that there is no magic recipe. You do have to come up with a list of "if she does X, then I will do Y" for problematic behaviors and stick with it 100%, but mostly it is just learning to live with the discomfort of her being upset. You said you couldn't imagine the hell that would follow if you hung up on your wife and put the phone on silent. Let me ask you a question. Don't you already get that level of hell without hanging up on her? You, my friend, have already been through hell on a regular basis. You trying to regulate her won't save you, or you'd be saved already. She's gonna go nuts and scream at you anyway, so why not do something like hang up or walk away rather than get drawn into a long argument that devastates you? It's really hard for her to argue with you if you choose to leave verbally abusive "conversations" (another boundary of mine). Believe me, it gets easier. Boundaries WILL eventually hold, but only if you hold them.
See your therapist and don't ever give your wife the power to stop you from doing so. Get your meds that you need to deal with your anxiety, and then get ready to be strong. The only way out is through. You have to place boundaries for your own safety and sanity, and for your childrens' sake. The power is yours. It has been all along. She's just convinced you that you don't have it, but that is a lie born of fear. Her fear of you. Her fear of a strong you. Her fear that a strong you would leave her. If she gets used to you being strong and sees that you still aren't leaving, things will get better. She will just understand that there are limits to what you will put up with and specific consequences for crossing your boundaries.
If you want more specific advice or have questions, feel free to send me a private message. I am pulling for you man!
HurtAndTired
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campbembpd
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Who in your life has "personality" issues: Romantic partner
Relationship status: married
Posts: 83
Re: Questions on medications for us caretakers - Buspirone?
«
Reply #4 on:
January 06, 2025, 03:21:13 PM »
Quote from: HurtAndTired on January 06, 2025, 01:52:46 PM
Things are better now, but they got much worse after I placed the boundaries in late August 2023. This was her going through her extinction bursts where she raged at me for not "acting normal" and capitulating to her demands the way I had for years. There have been times over the past 16 months that were absolute hell for me, but I knew I had to stay strong. Things are better in the aggregate, but there are still flare-ups. I am just better able to deal with them than I was. Having a good therapist was very helpful with that (she specializes in BPD as well).
I do have specific plans to deal with specific situations. For example, any physical violence whatsoever is an automatic call to the police. 100% of the time. Suicide threats are an automatic call to 988. 100% of the time. Divorce threats are met with "If you want a divorce, go ahead and file. From there on it will be our attorneys talking to each other, but I will not ever discuss divorce with you ever again." 100% of the time. Are you seeing a pattern? I have forced myself to be 100% consistent with my responses. It is NOT easy, but it gets easier.
About a month ago I found out that two friends from college had died. I was devastated, but my wife couldn't even tell me "I'm sorry for your loss." Instead, she mocked them (even though she didn't ever meet them). One died from complications from alcoholism (pretty ironic that my wife who drinks every day would mock someone for drinking themselves to death) and the other took her life because she was facing some serious legal issues (my wife said that suicide is a coward's way out).
So I stayed in the guest room for the next three weeks because I couldn't lay in bed next to someone who was so lacking in empathy for my loss. We were at a standoff. I couldn't back down because if she was so lacking in empathy over the death of my friends, how could I count on her to be there for me if I lost one of my elderly parents? She couldn't back down because she was stubborn and delusional. It was extremely uncomfortable. She tried to give me the "silent treatment" but I was neutral/positive in my interactions with her. If she brought up my staying in the guest room, I would just say that I would be there until she could apologize for showing me no sympathy at all. This is a core value to me and I had to make a stand on it to be true to who I am as a person.
Had this been before I grew a spine, I would have been groveling to her and apologizing for her atrocious behavior just to make things "normal" again within a week. By now, however, I was comfortable enough with her temper tantrums to not have them affect me...as much. After three weeks of her not wanting to apologize and splitting on me several times, she went out in a nearby city with my SS26 for his birthday. She wanted me to come with them. I had no desire to go out drinking with a bunch of 20-somethings in the middle of the winter, and was not going to leave S3 with my elderly parents to look after overnight. I politely offered to take them out to dinner, but was soundly rejected and screamed at. The divorce threats came out, the long list of everything I had ever done to "wrong her," she really threw the kitchen sink at me. It hurt, but I didn't let it show. Instead I enjoyed my night in with S3.
The next morning she came back home at 11:30 AM with no phone and without SS26. She had rented an expensive hotel room for them but SS26 stayed out partying with his friends and never came back to the hotel. She had her phone stolen. She was hung over. She needed my help, which I gave her. Four hours later I have reported her phone stolen, took her to the store to let her get a new iPhone, and then worked with Apple support to get her data from the old phone transferred to the new one. After this was all over, she said "thank you." To which I said "You're welcome, but of course I helped you, I'm your husband. That's what spouses do for each other. I just wish that I could count on you to be there for me the way I was just here for you." She finally gave me a sincere apology for how she had acted. I never would have gotten that had I not dealt with my discomfort and held my ground. Things are now "normal"...until the next split.
I guess what I am saying is that there is no magic recipe. You do have to come up with a list of "if she does X, then I will do Y" for problematic behaviors and stick with it 100%, but mostly it is just learning to live with the discomfort of her being upset. You said you couldn't imagine the hell that would follow if you hung up on your wife and put the phone on silent. Let me ask you a question. Don't you already get that level of hell without hanging up on her? You, my friend, have already been through hell on a regular basis. You trying to regulate her won't save you, or you'd be saved already. She's gonna go nuts and scream at you anyway, so why not do something like hang up or walk away rather than get drawn into a long argument that devastates you? It's really hard for her to argue with you if you choose to leave verbally abusive "conversations" (another boundary of mine). Believe me, it gets easier. Boundaries WILL eventually hold, but only if you hold them.
See your therapist and don't ever give your wife the power to stop you from doing so. Get your meds that you need to deal with your anxiety, and then get ready to be strong. The only way out is through. You have to place boundaries for your own safety and sanity, and for your childrens' sake. The power is yours. It has been all along. She's just convinced you that you don't have it, but that is a lie born of fear. Her fear of you. Her fear of a strong you. Her fear that a strong you would leave her. If she gets used to you being strong and sees that you still aren't leaving, things will get better. She will just understand that there are limits to what you will put up with and specific consequences for crossing your boundaries.
If you want more specific advice or have questions, feel free to send me a private message. I am pulling for you man!
HurtAndTired
Thank you!! This is really incredibly helpful actually. I feel like that is exactly what I need. She does X and I do Y and stick with it. all the time.
It's eerie how similar the stories here are, even the words that are said. When I previously set boundaries and she was bursting a frequent phrase of hers was/is "you're not the husband you used to be". And I know that will happen again as you so eloquently put it when I no longer capitulate to her demands how I used to.
You're 100% right. It's hell anyway. I just have to determine what my formula is X=Y and stay strong and consistent.
The other thing is I feel I have to really be at the point where I'm okay if she does go through with divorce. I don't want it but I am not going to be held hostage by the threats either.
Although I know this journey for us is our own as we only have power over ourselves - has your wife ever received treatment, thinks there is any issue with her behaviors or has she been diagnosed?
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kells76
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Posts: 3958
Re: Questions on medications for us caretakers - Buspirone?
«
Reply #5 on:
January 06, 2025, 05:32:15 PM »
This stood out to me:
Quote from: campbembpd on January 06, 2025, 03:21:13 PM
When I previously set boundaries and she was bursting a frequent phrase of hers was/is "
you're not the husband you used to be
". And I know that will happen again as you so eloquently put it when I no longer capitulate to her demands how I used to.
She's
right
though, isn't she? I mean -- she may experience the difference as distressing and unwanted, while you experience the difference as empowering and healthy -- but she's correct, you aren't who you used to be.
I wonder if that could be a validation target?
"Yeah, you're right, babe... I feel different, too."
Of course, not every moment is a validation moment (if there's screaming, if she's totally launched into dysregulation, those aren't moments for the validation approach). I just wonder if she accidentally gave you an opportunity to connect with her.
Yeah, you are different, and it's uncomfortable for both of you. Common ground.
...
Quote from: HurtAndTired on January 06, 2025, 01:52:46 PM
there is no magic recipe. You do have to come up with a list of "if she does X, then I will do Y" for problematic behaviors and stick with it 100%, but mostly it is just learning to live with the discomfort of her being upset.
Good reminder about how if/when we capitulate, that's not a "them" problem, that's an "us" problem, especially in the areas of our own feelings and our own consistency. Can we work on our own:
distress tolerance skills
and
education about "giving in", intermittent reinforcement, and true boundaries
:
Excerpt
Defending Boundaries
Even when we live our values responsibly, we can still encounter boundary busting.
When this happens, we should first challenge ourselves. Counter-intuitive, I know. <1> Did we make choices that were inconsistent with our independent core values? If so, which was wrong, the value or the choice? Do we need to change one? <2>
Have we been consistent in our actions and effective in our communications? Or have we been sending a mixed message?
Do we need to dedicate the time and effort to clean this up (this takes time)?
We also need to look at all the options(s) we have to available to us to help us navigate back and stay true to our value. I use the plural form of option because just saying "no" and taking timeout is not enough. Yes, it helps greatly in the moment, but if we are in a value hostile environment, we need to look at all the ways we can address that.
*Having values empowers us and motivates others.
I listen to the points of view of others and take them seriously
I treat everybody with respect
I am always supportive of family and friends
I am totally honest in all my dealings with others
... .and I expect that same.
*Defending boundaries (without values) tends to be shallow, reactive, and confrontational
I will not tolerate you getting in my face (stated aggressively)
If you do things I don't like, I will respond by doing things that are equally distressing to you
You weren't there when I needed you, so I wasn't there when you need me
Etc.
...
campbembpd, I've definitely been on psych meds before, too (though a long time ago). It makes a lot of sense to use them the way you'd use crutches as you heal from a broken foot but also need to get around town. The crutches aren't forever -- they're for this moment or chapter, when you need support
and
you have some responsibilities you need to accomplish.
When I was on them, I was seeing a PMHNP (psychiatric mental health nurse practitioner) who did both prescribing/dosing and also talk therapy. It was a good combo, I wonder if your PCP can refer you -- if not to a PMHNP, to someone similar, who won't just give you the Rx and say "see you in 6 months".
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HurtAndTired
Online
What is your sexual orientation: Straight
Who in your life has "personality" issues: Romantic partner
Relationship status: High Conflict Marriage
Posts: 163
Re: Questions on medications for us caretakers - Buspirone?
«
Reply #6 on:
January 07, 2025, 09:44:37 AM »
Hey Camp,
I just want to echo what Kells said is pure gold advice. I also wanted to respond to your specific questions about my situation.
My wife has been diagnosed. She was diagnosed several years ago during couples therapy by an LMHC as having "Emotional Dysregulation Disorder." I did not realize until later that this is an alternative name for BPD. It's more of a euphemistic way to give the diagnosis so that patients don't freak out over the stigma of "BPD" and so that insurance companies are more likely to pay for treatment. My wife blew off the diagnosis and insisted that there was nothing wrong with her.
She has never gotten therapy for her BPD. However, she is now willing to admit that she has "anger issues" and frequent nightmares about her childhood abuse. She admits that she loses her temper easily and has finally accepted that she needs to take antidepressants to deal with her depression. While this represents some progress in being able to acknowledge that there is a problem, it is so far not enough for her to accept that she needs therapy. Her antidepressants were prescribed by a GP rather than a psychiatrist or PMHNP.
The antidepressants have taken the rage down a notch, but she still self-medicates with alcohol on nearly a daily basis. It's hard to know how much or how frequently she drinks because she has gotten very sneaky with putting mixed drinks in an insulated tumbler cup, hiding bottles, etc. Still, I check the bottles that I do know about and watch the levels steadily drop and the bottles get regularly replaced. The alcohol counteracts much of the benefits of the antidepressants and the few times that she has really raged on me (when the eyes go black) over the past 16 months have been when she was visibly intoxicated.
I have no control over whether or not she eventually gets treatment. However, I AM steadily planting the seed that she would benefit from therapy. I talk about how much therapy has helped me. I talk about how it could help her get over having terrible nightmares and reliving painful memories from the past when she talks about those things happening. When she talks about having "anger issues" I mention that therapy could help with that. I hope that the seed-planting bears fruit over time, but it is out of my power to do more than plant seeds.
I hear what you are saying about needing to be at the point where you are ok if she goes through with a divorce threat, but the reality is that you have no control over that either. If she makes up her mind that she is going to divorce you, she will. Nothing you do will stop her from that. It's not in your power. Let that idea go and it will free you. The truth is that most of the time that pwBPD make these threats it is to exert control.
When I had reached my limit of letting my wife's divorce threats have power over me, I called her bluff. My response is always something along the lines of "I don't want a divorce, but if you want one you will have to get a lawyer and file. I will then get my own lawyer and we will only communicate through our attorneys. I will only ever talk to you about divorce through a lawyer."
She hardly ever makes divorce threats anymore, and when she does I just give her a version of my standard response, and that shuts her down fast. The reason it works is because I am not bluffing. I am being 100% authentic. I will not file...at least not until our S3 is old enough to testify that I am not abusive (I recommend that you read the book Splitting by Bill Eddy and Randi Kreger to know what a BPD divorce looks like and how ugly they can get). However, if she does choose to file, there is nothing I can do to stop her. All I can do is get myself prepared for what to do if she does go through with it. To that end, I am getting my financial ducks in a row and have been documenting the abuse, the drinking, and all of the other problematic behavior (digital journal, watch that secretly records video and audio, etc.), and have already contacted a divorce lawyer that specializes in BPD divorces to put myself in the best position possible should she file.
Hope for the best, plan for the worst. Plant helpful seeds when possible to try to improve behaviors and get your wife into treatment, but realize that planting the seed is the limit of your power to affect any change. Let go of the idea that you have control over anything but yourself, but take 100% of control back of yourself. Don't let her control you anymore at all. Get her out of your electronics. Stop trying to appease. Appeasement is a symptom of still believing that you can control how she behaves. Let that all go and it will free you.
HurtAndTired
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