Who actually has HPD? (janey, scarlett1939, miss meow? …)

Scarlett1939,

No need for apologies, post any time, take as long as you like. I personally very much appreciate all the thought and effort you put into it. Thank you very much! Yes, indeed, it helps me personally cross that “chasm,” and try to better climb into the “mind” of an HPD, to really feel what some of this actually feels like from inside. Great stuff!

I hear you on the high cost of therapy. I’ll do a whole separate post on that.

Scarlett1939 wrote:I have not been diagnosed.

Scarlett, I very much hear you on this – in here there is no need for labels, and absolutely no stigma. Undoubtedly, if you were totally 100% out of control / off the charts with HPD, you probably would not have been able to pull yourself out of it the way you have, using virtually only your sheer mental will power, digging for answers, and I’m sure, what was difficult at times, self-directed efforts. Your progress is clearly evident in your writings. Others reading your success story should keep in mind there are huge variations in the severity of HPD. Traits and mild disorders (combined with desire to change, willpower, and intense personal effort, over time) can get after it. The more severe the disorder however, the more the person may need highly specialized and extremely talented professional help to get after it.

Of particular note – and this is information I have directly from a lecture given by Dr. Kernberg (a well renown expert in PD – now in his 70s or 80s, and still at it!) – the more severe the comorbid Antisocial Personality Disorder (ASP) traits are, the harder it will be to successfully treat the PD. If even the “pro’s-pro” can’t seem to “fix up” those who present with severe ASP features, a “do it yourself” approach given those obstacles will likely have a similar very high failure rate.

However, if someone has at least some feelings and genuine empathy in their intimate relations, something to attach to; if there is “some light” getting into the end of the tunnel from somewhere, the prognosis using only self-directed help is so much brighter!

Scarlett1939 wrote:I went to a "very good" Dr. once and pretty much laid everything out on the line of
what I do
feelings I have when I do them

The fact you saw a Dr. and could actually reflect back on yourself puts you miles ahead. This seems to be what most people with HPD need to do as their very first step – look back at yourself and reflect:

• what have I done/felt, that in hindsight, without blaming myself now, was not the way I would like to be, who I really am, or how I want to feel in the future?
• after much reflection and internal analysis, what were the specific, identified, labeled / verbalized feelings attached to those behaviors?
• What triggered those behaviors and those feelings?

When we are talking feelings, we are really talking about states of mind (Thank you Mardi Horowitz!) and in particular how those “states” change. Feelings are evoked from somewhere, meaning they flow from someplace and they “travel some distance” before they eventually pop through consciousness, with all that consuming at least a brief interval of time.

If you are ever seriously injured you know that even the experience of intense pain comes after (sometimes even a few full moments after) the physical event takes place. It’s natural to just “feel” the feeling, when you feel it. It takes supreme effort to capture the specifics of what actually preceded the feeling, the stuff that may have actually triggered the release of the specific emotion.

Think of your working memory as a fixed cup, able to hold a tiny amount of past, all the present, and even a few assorted hypothetical futures (various scenarios you might enact in the near future), all inside it, all at once, all accessible. However, as time moves forward, that cup has to eject the past to make room for more "current" and new hypothetical futures that it must hold. Think of it as always pumping in a chemical enzyme that fairly rapidly eats away the “trivial” past. The challenge here is to 1. Recognize immediately when you are having a certain feeling (having pre-identified them, and named them, and rehearsed a bit, so you know exactly the “shape” of what you are looking for, and become highly proficient at spotting them immediately); then immediately attending to that entire internal “cup”. You must respond extremely quickly before that pumped in enzyme eats away the what came just before. This implies knowing in advance your feeling states (know what you are searching for, name them if possible) and then hyper-monitoring yourself a bit. Admittedly hyper/meta-monitoring takes some effort away from ordinary consciousness – its part of yourself detached and looking at / monitoring /reflecting on the rest of yourself going through and experiencing the present. Since this takes effort and prevents you from fully “living in the moment”, don’t over do it all the time, or overly stress over it. Treat yourself well psychically! Cut yourself some slack.

At the very first, leading edge of experiencing one of the “pre identified” feeling starting to ramp, capture as much of the entire working memory cup as you can immediately! Don’t try to filter and understand what’s important or not, aim to capture it all. Reflect/reverberate/rehearse/hyper attend to that cup so you in effect copy its highly fleeting contents into longer-term memory. Its guaranteed, that is going to cup will disappear! Once you have that snapshot copy however you can wait for a relaxed, non-emotional, state, and then set your full mind to the task of analyzing the immediate “pre feeling” (less emotional, more rational) information. Here, with the luxury of more time, you can deploy your immensely more powerful but much slower to “compute” frontal lobes to deeply probe to the depths of what actually triggered that feeling.

Use any technique that works for you to capture at least parts of that fleeting cup. If it helps, immediately jot down or ruminate on a few words or specific visuals that are “coupled” with that cup. Be sure to do this "indexing processing" immediately, which may help bring it all back up later. And by “later” I mean a few minutes later. With some practice, and knowing a bit about what you might be looking for, those few "index entries" you consciously attach may be sufficient for you recall the “whole” again, and then perhaps gain some real insight.

If you are erupting into a high emotional state for say 10-20 minutes or longer (and lets face it, strong emotions are released relatively rapidly, and don’t dissolve quickly,) you will have to do your best to revisit the delicate “lead in” period at some future time, perhaps hours later. Wait for a time when you can be very quiet, and then comfortably close your eyes and “reincarnate” the whole emo scene, this time watching very much in slow motion as it starts off, and see if you can discover the mystery “smoking gun”. Those few remembered words (or visuals / sensations) that you applied within moments of the occurrence (and perhaps a few minutes later wrote them down to later jog your memory) will greatly enable the hours later recall. When you do that later recall, be sure you are fully recovered back down to a “neutral/peaceful/protected” emotional state, then bring up the cup and set those frontal lobes loose searching for the “deeper” answers.

Scarlett1939 wrote:[I was ] hoping for him to say ok,
here is what you have,
here is what caused it, and
here is what we need to work on.

For work here in this forum we have to assume someone is presenting here with HPD or HPD like symptoms, enough to really bother them, or their mate, beyond a simple annoyance. Since the whole forum is broken down by disorder types we should probably try to limit discussions here to things specifically related to HPD. Having said that, we also recognize that most people with strong HPD symptoms will be comorbid with other personality disorder traits. On top of that, all people have at least several bad habits, plus most people are at times anxiety prone / have neurotic tendencies, experience occasional depression (not feeling good about themselves – at least on some level(s)), experience some dissociation (a fascinating area all in itself…), have some painful and only party resolved childhood issues, have current environment challenges, and perhaps have one or more unhealthy addictive behaviors. In any “get better from HPD treatment program" some of those issues may have to be addressed first - particularly any unhealthy addictions. All they do is undermine more rapid treatment of the underling HPD / early childhood issues.

Again, quoting the contents of a great Kernberg lecture: always treat unhealthy addictions first (sex, drugs, alcohol) – i.e. down regulate all the self-destructive behaviors as job number one. This is clearly the low hanging fruit – as soon as you get rid of it, a person will feel relief and start to improve. Self-analysis and personality improvement can’t take place in the shadows of someone actively self-injuring. There are well known, highly effective programs that work well for virtually all addictions. Clearing those out opens the doors to addressing the more fundamental disorders that may lie beneath. Think of digging down to the root. Anything self-destructive added later on top must be removed first.

Note: any serous self-destructive thoughts, behaviors, attempts etc. should be addressed by professionals.

Scarlett1939 wrote:BUT, I found this forum about a year a go when searching for my dad's diagnosis of SPD. I read through the different PDs and I thought OMG

I’m always impressed by the reactions people have from reading about PDs who experience a wonderful Eureka moment – “wow, My (or My mate’s) HPD behavior really isn’t all that unique!” There is a huge benefit right here and its easy to get. I am not alone! Humans hate to be ostracized. When they discover HPD is really just a set of patterns of behaviors it opens up hope that things might be improved. Come to find out what was previously thought to be totally bizarre / unique behavior was actually well known. The best part of that is the fresh hope for improvement is that its actually well justified! Much is known about treating HPD. Just as there are documented HPD problem patterns there are also some outstanding solution patterns too! Merely following the trail of known effective solution patterns produces good results for many people.

Why don’t more HPD actively participate on this forum? I believe there are multiple reasons.

1. HPDs extract love and adoration from multiple intimate relationships, either sequentially, with some minor or major overlap, or in many cases, fully and broadly in parallel. However, since no single mate is ever ultimately perceived as good enough, nor trustworthy enough, enabling one with HPD to totally love and give themselves fully over to them (with blissful, absolute abandon,) all the mates are eventually adjudged flawed in some way, and all ultimately deemed fungible and expendable. It takes an HPD a long time, perhaps even a lifetime, to cumulate sufficient self-awareness to discover the horrible truth - that the intimate relationship troubles they continuously face is actually really coming from within.
2. Even on a fully anonymous basis, disclosing any personality issues on a public forum takes significant courage.
3. The main feature of HPD involves trouble with intimate relations, including: sexuality, infidelity, empathy for others, true lasting friendships, issues on the innate capacity to love, etc. Even attention loving exhibitionists might still find public exposure here very intimidating. However the anonymity very much helps.
4. As a HPD discovers the intense trail of pain left behind in the exhaust of their disorder it’s completely natural for them to want to move past that, and put that phase of their life totally behind them. Only the soulful can actually use that painful past as a concurrent, disciplinary guide for a better future that is also relatively guilt free.
5. For every HPD out there, there are likely 10 or more Non x-partners who suffered very significant pain from their relationship. It’s natural for many Nons to smolder for extremely long periods in their hurt. Their anger is both internally directed, for enduring such poor treatment at the hand of such an intimate partner (when part of them maybe even “knew something wasn’t right”), and externally directed, blindly seeking retribution from any and all people with HPD, to somehow level the scales of justice, and magically lift them back to neutral from the toll their HPD extracted from them. These Non’s can be highly abusive to HPDs who had nothing whatsoever to do with their personal suffering, are actually putting in a good effort now, fighting hard against the disorder. These Non’s end up doing to others what they most disliked experiencing themselves - inflicting pain.

Scarlett1939 wrote:I thought OMG... this is totally how I was and some of it I still do, although I do a lot of it inwardly with my thinking.

Scarlet, I can’t tell you how invaluable it is to hear your vivid descriptions of how you were, and exactly how you “do it inwardly with your thinking”. The inward thinking here is critical. It serves two good purposes. 1. It lets others with HPD traits and disorders identify with you. Again, they then feel, wow, I’m not alone here! 2. It demonstrates to people with HPD that yes, it is indeed possible to actually reflect inwardly and describe (bring words to) inner thinking and feelings. Having achieved #1 “close identification" with the situation it then lays down the gauntlet and challenges them to #2 – can you also tightly hook up to your thoughts and feelings in these specific areas and not let them just pop in and then evaporate from your mind?

Scarlett1939 wrote:Like I really do not believe I'm the most beautiful woman in the world. I honestly don't. I DO however know that I can hold my own in the looks department and based on past experiences I know what I'm capable of with my looks and my personality that seems to draw men in.

Using the quote above only as a thought starter, lets separate attractive capacity into two components. The first one being the uncontrollable area: your physical looks, based mostly on your genetics, how you grew up, health care, environmental support or pollution, nutrition as you grew up with, and all the other factors you have or had virtually zero control over.

Then let's look at the things any girl can do, especially if they focus hard and are highly motivated to incrementally increase their attractive capacity. These are the controllable areas. At the very basics there is great nutrition, ample rest, TLC, vigorous sweaty exercise, body sculpting and toning (e.g. Yoga and Pilates, etc.), very good periodic health care including skin care/dermatology, Bowtox and plastic surgery treatments, teeth whitening, orthodontics, etc. Of course there is the “top layer” including great makeup, hair care, tanning, manicures, pedicures, perfumes, facials etc. And, very stylish and highly attractive dress in whatever “trademark” personal style and colors that seems to work the best in garnering the most responsive opposite sex attention. Those cloths can also be shopped for with a special eye for close fit or be highly tailored to feature the best body parts, and the perfectly coordinated ornamental accessories can be added such as jewelry, shoes, handbags, etc.

Any girl can then attend to the exact fluid way they move, the tone they project with their voice, facial gestures, eye language and all other areas of body language. They can even use other projective techniques, think steamy, wonderful, alluring thoughts to themselves, allow themselves to ponder seductive possibilities, and somehow synchronize their targets to this "anticipatory" thinking, all non verbally. When it comes to charm they can perfect themselves to be off the charts.

With some interpersonal sensitivity most girls can carefully focus in on their targets and read them very carefully. They can “suck in” non-verbal emotional content and with practice and feedback, they can hone themselves to a remarkable degree of accuracy. If that weren’t subtle and complex enough they can adapt their “presentation” ultra rapidly iterating through thousands of possibilities while simultaneously sensing in real time, what’s working and what isn’t. They can make small and large “adjustments” so subtly and rapidly they go undetected by their male targets, virtually guaranteeing their ability to be positively attended to. As Scarlet says, there generally is no difficulty drawing men in.”

I’d like to think that HPDs have pretty much vastly superior capacities to please their man, way above the typical female. The trick here with HPD is not to stop after you have “won” him over - actually just keep going and see how far you can take it in pleasing him. Be creative, take it as a challenge. Even before you age, hit menopause, and experience diminished sexual functioning, loose your hourglass figure, firm/youthful breasts start to age, figure out 1000 different ways to seduce him and please him.

I’d guess most HPDs find things that “work” for them drawing in guys in their pre-teens and attempt to replay that static style over and over. Once you draw the attention of lots of men and pick one to settle down with, the "seduction" game changes. No more need to “draw multiple menin” you need to devote all your seductive charm to “drawing your (single chosen) man out”. Since his intimate emotional support needs change every 10 years or so this can be a very challenging, but exceptionally rewarding area. Move to a "total woman" challenge / self concept. Its still seduction so don’t loose any of your skills you learned to ply earlier, just adapt them to be more updated, more satisfyingly "on target", a bit more mature but still sparkling and playful, a bit more deep and sublime, and ever so much richer!

Scarlett1939 wrote:I try to be more careful now that I am a grown, married woman, than when I was in high school, and didn't know what drew them in.

I’m very curious exactly what you learned here, and perhaps more importantly, the knowledge you now have that you feel you lacked in high school? If you can share – how did you behave in high school and what were your romantic relationships like? What were the typical patterns? (Perhaps a few specific examples to illustrate?) What were you looking for / seeking / craving? Feelings, security/protection, love, hot pursuit, steamy romance, a wide assortment of high quality suitors competing for your favors? Prince charming?

Relationship wise, what was satisfying to you back then? Were you pretty satisfied at that time or left hanging in the air? What specifically about you or did you do back then to “draw them in”? Sounds like you were pretty successful at seduction? How did you make yourself attractive back then? What did you have to work at and what worked? It may have seemed all "natural" but what I'd most like to have you examine is how your spent your resources (time, effort, and to a much less extent money available to you...) to get your "pleasure"?

Now that you are a “grown married woman” sounds like you may have shifted how you want to behave? The wording “I try to be more careful” sounds like you still to this day have perhaps a few unfulfilled cravings? Have to exert continuous effort not to revert to pre-teen, and teen-like attention / validation behaviors? Being careful to get your needs met without getting caught or upsetting the status quo? Have you now extended who you want to protect from just yourself to your husband also? Want to spare him pain? What works for you / feels good for you now?

Scarlett1939 wrote:I just jumped in and was like hey I think I'm hpd, every body help fix me now. BUT after a few got offended and bashed me

I’m very sorry you got bashed on this Forum while seeking help to be a better person. It's fine for any participant to call "BS” or point out difference between words and actions, but a support form should self-police itself to be exactly that – support! There is no need take it to the point where someone feels “bashed”. And no need whatsoever for any “brutal” honesty.

Scarlett1939 wrote:I sort of stood my ground that I really want to be fixed this isn't just an attention seeking method for me

Since it’s nearly impossible to derive real human, “in-the-bed-next-to-you” love from any anonymous Internet support forum, I’m surprised to see people think that’s possible. This is a great place for solid information (as long as you filter opinion from solid research, one-shot anecdotes that can indicate anything vs. advice from people you can identify has having some expertise. It's also a fantastic place to tell your story and have others listen. And you can tell it over and over in different ways till the soothing aspects of that process sinks in and helps you understand it and move on. I’ve seen this work.

Scarlett1939 wrote:… I really want to be fixed

You mean you really are willing to put in the effort to learn, apply and then fix yourself.

Scarlett1939 wrote:A handful of people really helped me see the other side of what I had done to people.

Would love to know how people helped guide you into what I’m sure was a painful look back to what effect you had on other people. How did the helpful people here “take you there” and support you on that trip, without you feeling like you were getting “bashed”.

This sort of reminds me of some points in the 12 point programs and also confession in the Catholic church. Perhaps a painful realization, followed by contrition, then a new understanding, then a fresh start leaving the guilt behind?

Scarlett1939 wrote:I already felt bad and sorry for hurting people, but to actually read the stories of the other side,

First off, as I understand it, you stumbled on this board based on researching your father’s diagnosis of SPD. Dare I say from there you were sort of “seduced” in to the HPD area based on identification with some things here? (Like what specifically could you identify with, beyond the very “dry” dsm criteria for HPD? Still, it sounds like at some point, either before or after you came to this forum, you “started feeling bad and sorry for hurting people”. What was the sequence? And what triggered your various “conversion” moments where you thought, I need to go further with this?

For thought starters, (hopefully not leading you in any direction but your very own) what led up to your first realization, humm… something isn’t working here and perhaps it isn’t outside, bad luck, constantly choosing the wrong guys, etc? What first caused you to think, “gee I feel bad and sorry for hurting someone…” or somehow evoked in you “I should probably do something (take action) about this?” I believe your description here might reach others and help them come to a “conversion moment” of their own…

Scarlett1939 wrote:I really came to terms with it is a choice. WE CHOSE our actions. We can't go murder someone and get by with it because we are angry. Although the anger is what led us to the even, we CHOSE to murder. So same way with HPD, we have walls and feelings of distrust of others, and we FEEL like we are wronged even though we really aren't because NO ONE can admire us 24/7, so for us to turn around and hurt that person because we FEEL they hurt us.

Scarlet, your statement in bold is the most concise, most accurate, most insightful statement about HPD I’ve ever encountered. I’m going to repeat it one more time here because I think it so great, then take it part -by-part to see that its both a clear statement of the problem and a clear guide to a solution, all rolled into one. We have walls and feelings of distrust of others, and we FEEL like we are wronged even though we really aren't because NO ONE can admire us 24/7 so for us to turn around and hurt that person because we FEEL they hurt us.

Scarlett1939 wrote:walls and feelings of distrust of others

People in general, and especially the chosen mate are walled out, and the HPD herself is walled in. The wall is erected because its hard for HPDs to trust completely and make herself vulnerable at the core. (That didn’t work well in childhood!) Inside, he HPD waits for someone to bash through her wall, be perfect/worthy/the ultimate in trustworthy, and rescue her from her isolation and horrible loneliness. What she doesn’t realize is she is the one who erected the wall in the first place, and the knight in shining armor (a real man (who always has some flaws), in this real world, in the context of a real, occasionally “flawed” relationship) has no power whatsoever to smash down this magical wall she has erected. Only she can remove it.

Scarlett1939 wrote:NO ONE can admire us 24/7… so we FEEL like we are wronged even though we really aren't… [phrase order flipped.]

The mate actually “wrongs” the HPD in a very minor way, or just lets too much time pass without pumping in constant, non-stop, 24/7 worship and adoration. Oddly, these minor "wrongs" trigger an avalanche in on the HPD as total rejection, loathing, utter lack of worth etc. The “infraction” if you can even call it that, was however absolutely normal. This "miss-perception / hyper over reaction" is the core of the disorder.

That avalanche / deflation of self worth reconfirms the need for the wall - “wow, I’m really happy I walled myself off and am safe in here all alone. I’m never, ever going to let that wall down. You just can’t trust anyone! Here is yet another, perfect example of my disappointment when I do that." So the problem - over reaction / increased self preservation - is actually self reinforcing.

Also, simultaneously with the feeling of injury, there is need to lash back out and get even -sort of "I feel myself responding immediately and fully automatically, I'm hot, and must do something right now! This warrants extreem reaction or the damage to myself will continue and escalate! I may even die from this! It really, really doesn’t feel good and I need to take five-bell-alarm action immediately!" All of this is to get that interloper the hell away! I need to push him out from being intimate with me (where he can, and just did, damage me!) And I must get that self protective wall back up, and thicken it just as soon as possible!

Scarlett1939 wrote:so for us to turn around and hurt that person, because we FEEL they hurt us [is radically wrong!]

Mistake number one is that the HPD is actually hurt. From 20,000 feet up, in neutral reality, the situation can’t be classified as a willful desire to hurt the partner, or gross negligence in looking after the needs and desires of the partner. If you were to compare a very good, loyal, dedicated, loving human mate to a fully idealized, five year old vision of an absolute prince charming mate the trigger behavior lies outside the normal human mate yet within the reasonable domain of the internalized, idealized, prince charming mate. The expectation was not for a real, flesh-and-blood human. When the real world behavior falls short of prince charming, that is a huge issue.

Mistake number two starts a with a hanging judge attitude and a very speedy trial. That kangaroo court is over immediately and it's swiftly on to sentencing. Here it’s remarkably like the Queen of Hearts in Alice In Wonderland “the Queen turned crimson with fury, and, after glaring at her for a moment like a wild beast, screamed `Off with her head! Off--'. Its like Scarlet spoke of “We can't go murder someone and get by with it because we are angry”

Scarlett1939 wrote:It is all about choices.
I do know that I can make good choices and I am SO much better off than I was when I was a teen. I was a different breed of woman

Would love to know what the before and after "breed of women" each stand for, with considerable specificity/elaboration. I was before like this…. After I realize I I’m like this….

Scarlett1939 wrote:as a young girl I didn't know what to do with all the attention I got from boys and men. Now I know my boundaries.

Sounds almost like an addiction? Sort of hooked on the rapt male attention you could generate with somewhat provocative behavior patterns? That reinforced by the immediate “high” you might have gotten from that, without really understanding all that it was actually provoking?

Are you saying that back then you might have wanted to be “sexy but not sexual? “ Flaunt your fresh teen sex appeal but never actually give vent to your sexual desires? Not actually respond to any sexual desire feelings in yourself, but wear cloths that transmit the playful, glittering image that you were a real ‘hottie’ or even a total ‘slut’? Attract all male attention you could garner, but somehow also fend off the resulting sexual advances?

Or, are you saying in hindsight it would have been better to have dressed down, been ultra conservative, less stylish, perhaps even a bit prudish in order to down regulate the excessive attention from boys and men. In retrospect you feel now (that back then) you just couldn’t properly handle the "entire" response you were generating?

Scarlett1939 wrote:Now I know my boundaries.
I SET the boundaries.
I am not a victim and refuse to be.

Isn’t it great that when you make healthy choices (set your own boundaries and self-regulate) that you stop being a victim?

When you unplug from getting “drunk” on the temporary high of evoking all that attention from boys and men (admittedly a great "narcotic" when young, and in the immediate term) then you become free to actually enjoy the true you, and real, richer intimacy with a single dedicated mate? Or am I all wet here?

Scarlett1939 wrote:I just keep doing what I gotta do, as a wife, a mother, and as a woman.

Sounds like a women who is going to be quite happy all her life, to ripe old age. And have everyone close to her cherish her forever!

Scarlett1939 wrote:So hope this helps you.

Yes it has, and perhaps others too! Thanks very much for your post!

Need for lower cost treatments of HPD

Lets face it; most people with a PD will need 2x per week therapy for 1-2 years to see results. That’s 100-200 hours of professional time! At $75-$250 her hour, the tab comes to $7,500 to a whopping $50k just to try to treat it in that setting. Since success is never guaranteed, the final cost per “cure” must always also include those who don’t get anything out of it, drop out and regress, etc. So, a very high cost per “cure”.

Psychiatric coverage on most healthcare insurance is spotty to say the least. On the one hand state insurance rules that mandate what must be covered have improved somewhat over the last couple of decades. Still, most insurance coverage for psychotherapy is spotty at best. There are several reasons for lack of progress in getting things covered.

1. $50k times the number of people with a personality disorder is simply a cost the entire U.S. economy can’t afford. Bottom line, it just can’t afford that, period! The current system can only afford in the $50k area if you can demonstrate prevention of a nearly certain death or absolute long-term disability.
2. Most insurance companies take the position (which is currently convenient to them) that PDs are parts of personality that are fixed for life and are therefore incurable.
3. It’s known pricy to even try to treat a PD. Positive outcome data for treatment of PD are nowhere as good as other, more traditional medical areas. Money flows to quickest, lowest risk, demonstrated returns. And it dries up quickly after the very basics are covered.
4. It’s currently nearly impossible (i.e. very expensive) for an insurance company to do case management on PDs. Let’s face it, an insurance company that can’t monitor and contain its policy payouts is quickly out of business. Well-established protocols, procedures and controls, and available staff who are “ready, willing and able” go to work the psych area are just not available at reasonable costs. What is needed for good insurance control is ample, rock sold experience data, including all detailed costs. Then insurance protocols can be established. There needs to be a bright-line diagnosis (has / does not have) that is very reliable and specific. Then, from there, the treatment options need to be extremely well understood (wide professional agreement) including the local cost to purchase them. Bottom line, a staff level insurance case worker (reasonably paid, not a clinical expert with tons of expensive schooling and experience) must be able to shop competitively for psych services, “value” them, manage a ton of cases simultaneously, get good outcomes most all the time, and bring treatment cost of each “stack of cases” in all at the right price. Remember too, that caseworker’s entire cost (salary, benefits, perks, etc) will be added to the treatment cost of the stack of patients they manage. If the stack were too thin, the cost per patient just for case management would be prohibitive.
5. As a rule of thumb take all the treatment payouts, plus all the costs of claims administration and that only adds up to 50% of the total insurance premium that must be paid. 25% goes to sales, marketing and general administration, and 25% goes to providers of capital for the insurance company as compensation for the risk they take. A $50k treatment cost for a single case of PD is really $120k in premiums that must be charged. That would break down as: $50k to the provider, $10k (20%) for the case worker (including benefits) to “purchase / manage those services effectively”, $60k for the insurance company’s general administration, sales and marketing operations, and $60k for the shareholders crazy enough to pony up the capital on the hope the firm will run everything efficiently, not have adverse payouts and go out of business, return that capital to back to them, and earn a reasonable return that induces an investor not to just deposit the funds in a nice, safe CD. )
6. Garbage in garbage out. Without a precise clinical diagnosis (wide professional agreement) the tradition insurance system totally falls apart. This is a chicken and egg problem – as a tradition, refuse to pay for psychiatric services. Result - no precise diagnostic data. With that void of accurate input, the system can’t determine with any degree of accuracy what other incremental health care costs are associated with individuals with specific PD diagnosis are going forward.
7. Say we had everyone that has health insurance go through a compressive psychiatric work up including full history, a comprehensive battery of psychological tests, interviews by 2-3 highly qualified and fully independent psychiatrists (with sufficient office visits to develop total trust, solid rapport, etc.) If each of the independent psych experts didn’t fully agree (including precise disorders and severity ratings of each, etc.) the “case” would then go to a panel of the best experts in that specific area - who would then be charged with determining the exact situation and, if necessary, immediately “fixing” the diagnostic categories and diagnostic procedures. That supervisory group would then be responsible for installing that new, updated knowledge back into the professional system, so future workups would be much more “harmonious” (and not require extra “custom” attention). With solid input data like that we could tie an early PD diagnosis (say when the person was in their 20’s to 30’s) to the incremental healthcare costs incurred by that individual over the next 5-10-20 years. That precision, along with treatment (vs. no treatment) costs, timeframes and results (i.e. less future payouts for other healthcare costs) would be powerful enough to “calculate” and prove that professional PD treatment “up front” would be very cost effective and pay handsome dividends for a life time (and even into subsequent generations…) Unfortunately, the cost for all that “up front work” is huge and bottom line, the system is way too financially impaired to even really care about it. Sad but true.
8. Well documented, (n>20), published in highly respected, refereed journals, prior success rates (diagnosed PD to party or fully cured) have been pretty dismal. However new research by very astute and respected beginning to rack up the irrefutable evidence that dramatic improvements may be achieved. Its still early in terms of getting funding however the clinical results being reported are quite impressive.

Following on that last point, here are some recently documented results of solid PD treatment
(see http://jppr.psychiatryonline.hrg/cgi/reprint/9/1/1.pdf)

1. Prior to therapy, the patients were absent from work an average of 4.7 months per year; [OK, this is clearly not a group of people with mild cases of PD….] following the therapy, the average had declined to 1.37 months per year.
2. The number of self-harm episodes after the therapy was one-fourth the level of the pre-treatment rates.
3. The number of visits to medical professionals dropped to one-seventh of the pre-treatment rates after the psychotherapy.
4. The average time spent as an inpatient decreased by half.
5. The number of hospital admissions decreased by 59% after the therapy.

Didn’t intend to be so lengthy but really wanted to make the point that self-help, mutual support groups, reading, personal reflection, support from friends/family/generous and oftentimes highly experienced, thoughtful and practical Non’s, church/spiritual groups, and community based Internet help are all likely to be the only sources most people with HPD can access. That’s why anyone with HPD or HPD traits that has experience making any progress, and is willing to share what they did, and how that worked for them, should be very cherished by all. It’s both illuminating and inspiring to others. Very valuable stuff! Remember, your thoughtful contribution here can very much be leveraged, over a long useful life, to a very wide, international audience.

Wisdom,

I am sorry I haven't been able to log on to read your posts. You have absolutely gave me a lot to take in, reflect on, and really give answers back. I can't do it all at once but I will do my best. That was some really moving things you pointed out to me. Some of it I might not have thought before but a lot of it was spot on with what I've done and do.

I've read every self help book I ever got my hands on plus with internet read anything and everything. I even googled once "why can't I be happy" or what will make me happy. TRULY happy.

I am however on my blackberry right now instead of my laptop it is past midnight where I am and it is difficult to read and sort through and type all what I want to say.

BUT everything you reflected on IS helpful to me and others. It really did so much more for me than my "therapy". I mean the guy(dr) is some sort of marriage guru and I'm pouring my guts out of what I do and not sure why I do it and he basically would ask me "and how does that make you feel?". I wanted to smack him and say I'm really paying you for an hour at $200???

So your posts are so much better than therapy. "Talking" about my problems to someone who isn't giving me feedback or suggestions or never even gave a diagnosis or anything plus charging me was a total waste. He wasn't the first one I saw either but he was the last.

I know what is right and wrong no matter what I feel I need or want. I don't always follow that but I do try.

This has helped me tonight to read this and reflect. Was actually feeling a little anxiety and couldn't sleep even though I'm exhausted. Husband out of town kids in the bed. Laid down and I just feel a slight anxiety. I am at a time in my life I want to complete. All what I want to do and slowly getting there. But it is a process. And with 3 kids it might take a while.

The biggest difference between me as a "wild and carefree" teen is that I know how to "harness" my. Abilities. I still know that if I choose to, with only eye contact, can send off signals that would draw men in. Some may think it is what I "want" to believe but I know what I'm capable of. I know what I could do if I ever should choose to do it. I try to be modest and dress conservative I am not flashy or don't dress provocatively, I don't wear much jewelry hate shopping and don't buy much shoes or handbags etc add appeal to myself.

I wear a good mineral makeup with only mascera and lipgloss. I had skin problems after babies so that is one thing I will always do is to buy good makeup for my skin if I'm going to wear it. Let me tell you acne for an hpd is like taking an elephant out into the middle of the ocean dropping it in and say now ur sinking slowly, swim back to shore if you can. It is horrible. And I don't have low self esteem. I'm very confident even with acne, but at its worse I wanted to quit my job and not go out or to work. Of course my husband assured me I was still beautiful to him blah blah blah, but I looked in the mirror and new what I saw. Still
had to press on and go to work and continue to search how to get over the acne. That is a story for later of searching for natural things to heal myself. I believe we have it in us to make ourselves better from mental (most normal cases) to phusical with things and wisdome of what God gave us naturally.


But aside from what my physical appearance may be, I know the looks I get when I go places or walk into a room or place of people. Some men are more obvious about it and some play it off but I know when I'm being stared at or watched or sometimes even followed or approach. I posted some about this before that even when I'm not looking or paying attention I can look up and some man will Be looking at me. Or they might come up to ask me something in general and try to linger. I thought I was doing nothing to attract this attention. Tattered, who has probably helped me thin the most on this forum, thus far, pointed out to me that perhaps I send off an underlying signal to "look at me". This happens even not at my best or n sweats or hair pulled back or whatever. So it isn't just that I would be "expecting attention.

BUT I think I have really figured out something about myself. I really think I've done it for so long that I didn't really realize it. I think I'm always ready to be "admired" that I hold my carriage or my head or my etes ina way such as to say, ok I'm posed so admire me now. Now imagine like on the red carpet, everything is posed calculated nothing by accident tummylies sucked in everything in place. Not really looking at one person but looking thru them or basically ignoring at the same time recognizing that they are looking at you. I really think I'm always ready to be "on display" for all the world to see even if they aren't looking. I realized this when someone asked me why I hate my picture to be taken. And I said because if ur caught off guard that is a permanent reminder that you look bad or too fat too thin or just not perfect and u can't erase it. So I only take pics if I'm completely ready for them. Occasionally hubby or kids sneak one now and then.

I will keep going but I do have to get sleep. Anxiety dwindled when writing this and getting very sleepy. Thank you and I hope this will help hpds and nons in searching for answers.
S

I really hope that I can help others in my quest for a happier ME and a better me. So I am posting for helping myself and others if they can take something from my writings of experiences and issues I have.

Well I saw the Dr. BECAUSE I always knew I was different than my friends. I just didn’t understand it. I had some sort of “quality” or whatever that drew boys, then men later on to me. I would think my cheerleader friends were pretty or at least prettier than me. This was even in junior high. WAY before I was sexual with anyone.

I thought I was just being myself and doing my own thing. But time and time again it would be that I was the one approached by a boy or guy or even a man later. So even when I still had my innocence just learning about myself I stood out.

I will never forget when I first really realized that “I must be pretty” in my own mind because a girlfriend of mine that I cheered with stayed for a ball game after I left and she came up to me the next day at school and gave me a boys phone number. She said a boy from the other town came up to her and asked her my name and wanted her to give me his name and number. I was shocked and I said REALLY? Because SHE was attractive too and I said are you sure he wanted you to give it to ME? She said that he even said my jersey number from the ballgame and described me when I was cheering etc. And up until that moment I had little boyfriends/flirt friends in my class maybe a grade or two from me, but I think I learned to validate my beauty by what others saw in me.

Then I had a serious boyfriend or at least serious for being in jr high and I thought it was like he was rescuing me from my misery even though he did not know of our home life as I never talked about it. But, he broke up with me out of the blue without really a reason, but I know now it wasn’t that he didn’t care for me it was that he was 2 years older I was not allowed to date as far as going in a car with him especially alone and he just got his driver’s license. But to a 13 year old girl who desperately needed to be loved and escape her childhood, it was a devastation. I had plenty of other boys wanting to go with me, but I could not grasp why HE didn’t want me anymore. I still was friends with him stayed supportive in hopes he would want me back. I know this is long ago, and possibly only women can understand how bad a little girl wants love and to be in love, and especially one that doesn’t get that at home.

But, after I got over it, I became the kind of girl that didn’t trust. I was really into the first love stuff with the can’t keep your hands off each other can’t wait to talk to them and can’t eat because your butterflies in your belly are bouncing off the walls just waiting for him to call. I LOVED that feeling. But you know what? Now I look back and feel that is more anxiety than it is anything else. It makes you sick to miss someone that bad. BUT, isn’t it better to feel sick than it is to not feel anything at all, RIGHT?? Or is it??

Well I vowed no one would ever break my heart again. EVER. And they didn’t. But also, no one every really got close enough in “my walls” that wisdom you so graciously pointed out that I created myself. I never really thought about that. That was an awesome analogy that I am expecting and was expecting the PERFECT white knight kind of guy to get through the walls around me when I the one who keeps them there. How ironic. Because I thought I needed to be “rescued” but no one can rescue us except ourselves I know this now. But anytime anyone got too close especially too quickly or came on too strong, I gave them the boot.

YES, I felt bad, but not bad enough to stay with them. I had a lot of guys get jealous and try to control me right off the bat but I always showed them that I was in control of me not them. I could turn a situation around to show that I was the “hurt one” and they were the one projecting hurt, when it was me that was breaking away and running from them. I would use one thing that “I just could not get over or deal with” if it was possible abusive behavior or another girl (which I would full well know they didn’t want) but I would stick with that story and even through begging by the guy of not to break things off, I would eventually do that. Now there were about 2 others that broke up with me, but joke was on them in the end because one I didn’t really feel crazy over and the other was just a very sexual passion kind of relationship. We never even went out on a date. We would go to dances or bars wherever we knew the other would be there and hook up. Well he decided to get back together with his ex gf and of course I played the part and made him feel as if I would truly miss him. BUT, other than the almost greatest sexual passion I had felt UP until that TIME of course, I didn’t miss him.

It was really and truly a sad thing. Sometimes when I was alone I would have about 5 guys calling me all at once and I would close my eyes and say now just choose who you want the most, and sometimes I wanted all of them in certain ways, and sometimes I didn’t want any of them at all, but I wanted and needed the adoration they gave me. My calls started at the beginning of around 5pm and would last til well into 12am or later and received and wrote many letters and all of them saying pick me over the others. There were some with girlfriends that I knew would be interested and I would tell them no chance if you have a girlfriend because I won’t hook up with you like that. They would break up with the girlfriends.

I know if someone reads this they might would think oh poor thing, I was a geek or wallflower in high school and couldn’t get a boyfriend until I was grown and out of college. Well guess what, I envy those girls who knew what they wanted to be or waited and maybe it was because boys weren’t interested, but what I miss the most is my innocence. I miss that so much because I feel I was robbed of it. I had to grow up too early in my house and be the mom to my siblings and my parents and in some ways I still am having to instruct my parents (now divorced) on what they should do because they act childish.

My husband knows all of this about me and he knows that I wanted to be better. I asked him a few years ago why he stayed with me through all the rough times even when we dated, why he didn’t run. He said he saw the potential in me even then and knew I was different from my family. It really hit me that he truly loved me then. And he has helped me become so much better and we wanted a better life for our kids then what I had growing up.
S

I agree fully about when I get a feeling to recognize it at that moment. Sometimes that works for me and sometimes it doesn't because I overanalyze and dwell. Sometimes I'm spot on with things and other times I think I'm the one being gaslighted into thinking what I see right in front of me is not what I'm actually looking at. Sometimes I see not really what I WANT to see because who would want to think their husband or bf is interested in another woman but it is more what I THINK I know at the time. It can sometimes become so awful to think things and then I think, my husband wasn't good at flirting when I met him what would make me think he ever flirts with women now. He is the most laid back down to earth not anything like I get to picturing in my mind. I don't like doing that and I certainly don't have time to worry about it because I am a very busy working mother of three very busy girls and have to stay focused and don't have time to shut down in my life. So occasionally I dwell too much the cup runneth over and I have a blow up with accusing words to him and he doesn't know what hit him.

I do not feel as far as self destructive physically wise that Ihave ever been. Never cut myself or threatened suicide or did dangerous things to hurt myself. Now the sex thing might be the most destructive thing with me because I should not have been so mature as a teen to know what pleased men, but I learned what did and I did it. and this is the honest truth that I loved sex with men, not boys especially, but I never once had a real orgasm with any of them. But I DID enjoy it and did not feel I was missing out on much because I was in a euphoric state when I would be with them. And if you know anything of anatomy, women have vaginal orgasms as they have intercourse so it wasn't all a loss in that aspect.

I was always in control of myself... or so I thought, but in that aspect it was the one time I could let someone else have total control over me and I am not talking about abusive or rough stuff as asphyx had said I think we enjoyed in an earlier post. But mulitple sex partners IS destructive, just not in the same category as suicide or cutting. It was a gamble and a risk and I'm very fortunate to not have got something uncurable that would have been with me and hurt my kids or anything when I had them later.

I wanted to please the men in my life and they were consumed by me, not just loved me. These older men 6-7 years older would want me when I was 16-17, and even try to get me to commit to marriage. Of course I ran from that idea. Sometimes they would fight between themselves and this I did not enjoy at all and would try to just break away from all of them, and finally did. But it took one getting a gun after the other before I realized what kind of danger it could lead to by me not making up my mind of who I wanted. And I would break up before moving onto the next one, but the dust wouldn't even settle on the first one before I moved onto the next one.

I agree totally with your analogy of the "infraction". And just because i'm agreeing with you doesn't mean I don't still live that. I can create a whole mass hysteria in my mind of "why doesn't he do this or that for me anymore" he hardly ever calls when he is away from me. He sometimes forgets to kiss me when he walks through the door. He does X, or Y, or Z and that must mean A, B , or C. etc etc. and the list can go on and on.

And on my inteligent normal side I TOTALLY understand this. He is busy, I AM BUSY, and don't have time for the same things I am expecting of him. BUT, on this darker irrational thinking side I can come up with some crazy crap of what it all means and I feel neglected or even rejected and I start to question if I'm pretty or if he just doesn't see it anymore or if he is tired of me etc. etc. etc.

This isn't every day that this occurs, but this is something that I have not been able to kick totally. Of course when I was in high school, I never questioned and never got jealous or anything. You want to know why??? becaue I never stayed with anyone long enough to get to that point. If I even THOUGHT they were looking at another girl, I wouldn't say anything, but I would go home and think of how I am going to let this one go. And hence my mind would come up with something that I absolutely could NOT live with and that sealed the fate of our relationship and also using something to say that HE hurt me (which by the way I never felt hurt in all of this-just felt wronged) and they would swear they liked or loved ME and not another girl they had no clue who I was talking about but I would insist until their begging subsided and they agreed to not call me anymore after we broke up.

I know that sounds so insane, but it is how I was.

Wisdom,

YOU HIT THE NAIL ON THE HEAD when you said that we "lash out" or want to get even. When I feel hurt, the first thing I reflect is anger. And I think (to myself) not outloud of course, is well, you just wait. You think your going to treat me that way I will do this or that and SHOW YOU that you cannot treat me this way and so forth. Of course I don't follow through with anything and I never let that escape my lips of anything in my head that I was thinking of doing. BUT, the worst part is I won't show hurt first I show anger which helps nothing. It makes him defensive to where he can't even say he is sorry because I was so angry. After I calm down, THEN I think more rationally.

He says I can argue with myself, and I sort of do because I tell him what I'm thinking PLUS what he is thinking so he says why does he need to say anything. I know again... crazy!

I was different than any other girl/woman that I knew of at that time. I had a friend who slept with anybody that would be with her but she really didn't have seductive qualities or abilities about her because no guys wanted her or were hooked on her or anything of that nature. They would sleep with her because no one else was available.

I had a guy tell me once, and I was just waiting on him at the drive through of the little place I worked at for a while and he wrote me a note when he came back through the window. He drove off and he said, why do you always give me those "f me eyes". Of course the f word was not edited. I remember getting a thrill from that even though I wasn't trying to do that was maybe just a little flirty and I never really knew what exactly it was about my eyes that men loved. I like my eyes I guess, but there was something about them that the guys really loved.

Now, I know what that can do and as I explained before I know that I should control that and not linger in eye contact with a man that can miscontrue that for something other than just listening to what he has to say and moving on. This be at work, the store, whereever. I try to control that in myself. I am almost 20 years later of when I was doing all this in high school, but I still have an attractive quality I guess you could say and I know what I am capable of.

One thing I have to really watch is when I'm around boys my daughters age. They have said things to others that got back to me that I am what they call a MILF. I had never heard the term and had no clue what it meant until my friends son told her what was being said. So, I for certain dont even want that label on me of being a woman that attracts young boys. I would get no satisfaction or joy or anything out of that. It would be an embarrassment to my girls if that was ever said of me. So no matter what is said, I make sure to not be too friendly to anyone of the male species. I have very close friends that I would die if they ever thought I wanted that attention form their husbands. And I don't, so I'm very careful because I know what capabilities are of what I COULD DO.

It was a TOTAL addiction. A movie reference I made in an earlier thread was a movie I watched years ago called She's Out of Control with Tony Danza as the dad of a young girl coming into her own after braces and glasses removed and she becomes the new hottie girl of the town. In the movie she tells her dad it is kind of a kick having that power over boys, he tells her to be careful of what she does with that power.

I think for a normal girl that could be good advice that she would follow. But for an HPD, we thrive off that power and gives us a sense of elation that we are desired, adored, loved. All the things we weren't given when we were young. All the things we still want years later no matter if it is senseless to others.

I think in jr high I wanted to be sexy but not sexual. But toward mid high school I was both. I have always stood out in a room and don't know for sure if it is me and my looks or if it is the underlying signals I might have given off. I'm not bragging of my looks only telling you what I have observed. People even today meet me now and they are shocked that I am the mother of 3 plus the mother of 2 teens of those three kids. Of course that flatters me. I've never had work done on myself, and I 'm small by genetics, but I do take good care of myself. I dress conservatively but stylish but I'm not into style like most women. I like what I like and what fits me and what makes me comfortable.

But latter high school I was very sexual and I was addicted to not really so much the sex as I was the being needed wanted and desired by the men I was sexual with. To be the object of desire is a euporic state that can't really be eplained without being able to experience it. I'm not saying I want a stalker who would want to kill me rather than anyone else have me, but just being desired to the point that that person can't eat sleep or breathe without me. I think that is the ultimate thing for an HPD. At least for me it was and part of me is still that way. But I'm an educated career woman and mother of three. I don't have a whole lot of spare time to put into getting attention and the normal side of me knows I really shouldn't need that kind of attention.