Transplanting a Seattleite

“Another study by Arntz & Haaf (2012) examined how those with BPD make evaluations
in an interpersonal therapeutic context. Participants had telephone therapy sessions with an
alleged mental health professional who was instructed to act as either an accepting, negative, and
neutral therapist. Similar to Veen & Arntz (2000), this study used several VAS to measure the
extremity and valence of participants’ ratings of the therapists.”

(I’m reading https://repository.lsu.edu/cgi/viewcontent.cgi?article=1426&context=honors_etd)

OK, I want to know more about the ethics panel that signed off on this thing. I mean, on some level, I’m pretty sure this was driven by feelings of vindictiveness on the part of therapists who had spent a lot of time working with people who had BPD diagnoses. It just feels mean, and absolutely designed to increase distrust. Also, kind of hilarious. I supposed I should look it up. I guess as long as the participants _knew_ that this was acting?

“ What was unexpected was the fact that the group with the highest Dichotomous Thinking
scores came from the Low-BPD group during the downward comparison condition, though this
group’s average DT score was statistically the same as the low-BPD group’s score in this
condition.”

I actually really kind of love this finding? I don’t know that the author saw it the way I do, tho. I suspect that people comparing up do a fair amount of work internally to reduce distance. If I were to compare my skill at makeup to someone who is a stylist for, I dunno, Taylor Swift or Beyonce or whatever, obviously, I am pathetic and they are amazing. But I might try to convince myself that the distance is much smaller than it actually is. I would do this because this comparison is only gonna highlight how shitty I am compared to that person’s work. I might say to myself, “Obviously, they do this for a living, so they are going to do it better than me, but all things considered, I did pretty good for an amateur!” But if I’m trying to compare my ability to bake a cake compared to someone who rarely bakes, maybe used a boxed cake mix and not a very good one, I might really exaggerate just how much better my cake was than the person who used the not very good boxed cake mix. I’m gonna benefit self-esteem-wise in this comparison and so maybe I milk it for all it’s worth and then some. This might tend to manifest as higher DT scores in downward comparisons. “Oh my god can you even believe how disgusting this cake is! Who baked this! My homemade cakes are from scratch and I used” look you’ve all heard me on the topic of my baking.

I lie, of course. Mostly when talking about my cakes, I complain about how people describe them as “not too sweet”, and I will sometimes go off on people for describing my cooking as “the best diet food ever”, which if I were preparing diet food I might be happy about, but since I’m not, I am, decades after I basically quit feeding people who said shit like that to me, still bitter about.

What triggered all this? Well, I very strategically did not respond to something my sister posted on FB (linked to an article at the LA Times, which I _just_ unsubscribed from so while I still have access, I did not read it, but I believe the gist of it was some kind of concern trolling about kids eating food in pouches? I don’t know the exact beef. If it’s sugar, there are no-sugar-added options. If it’s recyclability, you can do TerraBoxes. *shrug* and then commented adding, “if you can’t teach your kids how to use a spoon, don’t have kids”) that was needlessly provocative, but having seen, at long intervals, over a decade of this kind of thing, and knowing the kind of person my sister actually is in real life (a highly skilled practical nurse who specializes in providing extremely compassionate care for children who have dire and often terminal medical conditions), I have really started to think a bit about why she does this, because we have a multi-decade history of me saying, hey, maybe not say this kind of shit, that turns into a meandering and pointless conversation and in the end, it comes out that something totally unrelated is really bothering her and if we’d just started with that, we could have skipped all the rest of the unpleasantness.

She’s getting over a wicked bad cold, so that may really have been most of it, altho when her voice comes out, presumably I’ll get some additional story about either a client’s parents bad behavior or something along those lines. Hopefully not something really sad about a client, altho fundamentally all the clients stories are incredibly sad.

You never know, tho — it could have just been blowing off some steam from the stress of the countdown to the election. People are really struggling out there. Take good care, and if you’re a complete asshole, I’ll chalk it up to the stress of the election and hope we all feel better after we’re past it.

While I did the catch-up posts from the trip, those are really daily activities posts. Some things happened over the course of the trip that I did not necessarily specifically write about, but which have gotten me thinking. This is what happens when you have over 2 weeks of time in closer than normal proximity to your immediate family and limited socializing options that do not also include that family. Learning things!

I have all kinds of trauma background, and it has distorted who I am in a bunch of ways and also intensified who I am in some very specific and extremely functional ways. Specifically, I think I was always going to be the sort of person who surveyed their surroundings, identified and prioritized what about those surroundings needed to be fixed or could be improved and then set about creating plans and implementing on those plans to effect those changes.

I fix problems. It is not just what I do. To a probably unhealthy — in some sense — it is who I am. I narrowly escaped workaholism and identifying with a career by being AFAB in a conservative social environment, so I basically putter.

It is absolutely unnecessary to present arguments to me about how there are alternative ways to pass one’s time, live one’s life, etc. I am painfully aware, in detail! To quote a recent Nathan Pyle comment about people who won’t use a decimal measuring system: “Oh, they definitely know.”

With all that in mind, I have recently been sorting through in my mind how people _respond_ to Me Being Me, which is to say, Me Identifying, Prioritizing, Planning and Implementing on Plans to Correct Problems.

I would characterize one of the largest groups of people, and one that I simultaneously resent and admire, as responding roughly with: Took You Long Enough. As a general rule, the resentment derives from perennially unrequited wishes that Someone Would Just Explain It To Me and Perhaps Provide Assistance, and the admiration derives from, If Only I had Fixed This Sooner.

The next group of people, which includes my daughter, responds with: This Is Great, How Did You. That feels good, in that it is validating, and creates a feeling of shared or at least aligned values, and also it it exhausting, but now I have to explain myself which is not always possible and even when possible requires effort. I feel some chagrin also, because I know I am often in this group.

Following that group of people is my son, and oh, so, many other people in my life: Why Did You Change That, Why Did You Not Change That Sooner OK Now We Have to Always Do That the Same Way in All Circumstances What Do You Mean No It Is More Complicated Than That. This group of people is exhausting and enraging. I think the rage comes from recognizing myself, or at least my younger self (hopefully only my younger self) in that group. The exhaustion is self-evident, I mean, look at the sequence. But finally, this group of people also inspires a certain nefarious glee in me: if I can just get them to understand, they will take all that energy and brutally subject lots of other people to the same change and as long as I program them correctly, they will fix a lot of stuff so I don’t have to. Nefarious means “wicked or criminal”. I do fully understand that this is a Bad Thing to Think or Feel. The Collins dictionary suggests that glee is often felt at someone else’s misfortune. It says everything about English that we have single syllable word that means Schadenfreude, and then we spend all our time pretending that we don’t have a word that means Schadenfreude, and as if that were not horrifying enough, we also use that word to refer to group a capella singing. I mean.

My life is decades of ferociously paying attention to reality, and then maneuvering to financially benefit from where reality is headed while also having a sense of humor and internal narrative that is essentially non-stop FAAFO.

The next group of people I will carefully not identify members of. I do not see myself in this group, but perhaps that is a failure of self-insight. They respond to me being me by asserting that there is no problem. I think a lot about this group of people, because just straight up fingers in ear, la la la la la never stops astonishing me.

According to thesaurus.com: “Astonish is more neutral [than amaze]—it is commonly used in both positive contexts (He astonished them with his insight) and negative ones (His lack of awareness astonished her). Astonish suggests your surprise or sense of wonder is so intense that you’re bewildered by it.”

I will give some persistent examples of reality-denial. When I was planning this recent trip to Europe and expressing concern about our short time in Dublin after getting off a red-eye. I didn’t want to miss out on everything while I adjusted, so I started — weeks in advance — adjusting my getting-out-of-bed time earlier and my going-to-bed time later, and more connected to the sun, in hopes that would help (it did). I also booked our hotel room including our travel night, so we would be able to nap on arrival. I know that is a no-no in some theories of circadian rhythm adaptation, but I’ve done the stay-up-continuously thing repeatedly over the years and it is only getting worse and more dangerous in terms of being accident prone and coming down with a cold. Transatlantic flights are too short to get enough sleep, and the earlier awakening is just too much to adapt to in one go. But before I could even _explain_ the plan I had to deal with the red-eye and time shift, I was immediately interrupted with, “oh but you will adapt in a day”.

*blink*

When I was younger, I would get cranky and become accident prone if I missed a meal or it was delayed too long. I was told by nearly everyone I knew back then that this was a Me Problem. I eventually decided to fix it unilaterally — I quit coordinating meals with people who created delay, I socialized in non-meal contexts, I brought snacks. After I had been doing that for a while, I realized that the people who were telling me that was a Me Problem _also were cranky and accident prone_, but me talking about it made it harder to deny the reality.

Hunh.

My son worked quite hard to have a work shift yesterday, the day after we returned from our trip. I had tried to talk him out of it. He wasn’t scheduled — he _asked_ to be scheduled. I told him very clearly to be very cautious driving because accidents were more likely when sleep deprived or when sleep rhythms were disrupted. That’s part of why we didn’t rent a car in Dublin (also, you do not need it in Dublin, and our visit was short enough that we did not really have time to leave the city). I just did not feel like arguing with him, so I was like, sure, fine, whatever.

He got into a fender bender.

*blink*

I felt like a terrible parent. I _knew_ that this was a risk! I did not bother to explain it to him! Why! I am a parent! He is still not an adult!

Step one: no more driving that day. I had two accidents in rapid succession (both minor) when I was around his age, the first was due to inattention and the second due to the emotional impact of the first. No _way_ was I going to subject him to the risk of that happening to him. Easy to avoid. Give it a day or two. That did mean I had to drive him to work and then back home, later than I wanted to be up. See above! Should have talked him out of that shift!

And then, on the way home from that shift, I explained to him in some detail that hunger and jetlag affect everybody, in predictable and dangerous ways. They make emotional regulation harder. They impair decision making. If someone says, when they haven’t eaten in longer than their usual time between meals, that they are not hungry or it does not matter, they are fine, they might lack self-insight or they might be lying, but either way, they are denying the reality, _and I know that_. If someone says, they are recovered from a multi-hour time shift in a single day, they might lack self-insight or they might be lying, but either way, _they are wrong_.

At first, he thought I meant him, personally. I was like, absolutely not! This is _everyone_. It took me a long time to learn this. There are no exceptions. We are human. We work in a certain way. If you think this does not apply to you, you are denying the reality of your humanity. It took a while (see above paragraph about exhausting) but he did get it. And that is _always_ true of my son. That’s why he is in the the group _before_ reality deniers, not in the reality denying group. They are not the same.

The reality deniers actually have at least two major subgroups. There are the people who deny entirely the existence of a thing like jetlag, or a thing like hunger impacting emotional regulation and/or physical performance or whatever. Then there are the people who agree that jetlag and hunger affect some people, just not them. I don’t really care, just like I only occasionally care (and never for very long) whether the shit coming out of people’s mouths is a lack of self-insight or lie. The distinction matters. When someone denies jetlag as a Thing, you can Science in response, and if they argue with that, they have sorted themselves into the Don’t Get Into the Mud with a Pig category and your next task is clear: walk the fuck away, and if people ask later, show the Science, and lather rinse repeat. I suppose you could find yourself in a situation where you cannot walk away but there is no point in talking to these people, so at that point, you are signing up for violence so think hard, and try to figure out a clever way to walk away instead.

But when someone acknowledges that jetleg is a Thing, but it does not affect them — or, worse, asserts it will not affect you so do not do anything to mitigate the Thing! Which is what happened to me in that recent conversation pre-trip. Don’t worry! I implemented on my plan, and I have been thinking carefully about that interaction ever since — it is harder to Science them. They are accepting the Science, and asserting that there is a range of impact, and the impact on them — or you, or whoever — is negligible. This is much, much harder to deal with.

Figuring out how to think clearly about this category of people is rapidly rising to the top of my Problem List.

Happy New Year’s Eve!

We are well, and are having a great break from the school routine.

I’ve gotten lots of walking, lots of time with extended family, and lots of fun activities; I’ll update more in a couple of days.

In the meantime, I’ve had a super relaxing afternoon reading a book I bought a while ago and then never got around to reading. _The Blind Spot Effect_, in chapter 3, Shortcut to Flow State, has this absolutely hilarious sentence in it. (Unintentionally hilarious)

“The fact that they are considered rock stars in the world of behavioral economics shows how relevant their findings are across fields of study.”

The “they” in question are Kahneman and Tversky and things like _Thinking Fast and Slow_ heavily inform _The Blind Spot Effect_. I like the basic idea of this book — and honestly, while I have issues with Kahneman and Tversky’s work, in general, there is quite a lot to like there as well. But the author is … overselling things? Maybe that’s the right way to put it? I mean, _yes_, mindfulness and insight are super awesome for helping us see ourselves clearly and cut through our own denial / bullshit so that we can interact with reality more closely, which in turn is helpful for actually accomplishing whatever the hell we want to accomplish and can even contribute to one’s enjoyment of life and be restful and so forth. All good stuff.

I’m still not adopting this way of thinking about thinking, tho. I still prefer the frames approach.

Anyway. I’m now into the author’s explanations of availability and confirmation biases, and how to push back on them. *shrug* Obviously, I behave in a way that says I think it is a good idea to push back on this stuff. Yay? Also, I’ve become really aware recently of the trouble I cause by being so relentless about pushing back at this stuff so, you know, maybe display the moderation that I do not.

“How can two people come away from the same situation with two completely opposite stories?” Oh, I don’t know, they’re both wrong, but different from each other? I mean, we’ve all seen that happen for sure. “Two people can have a conversation and, because of their differing perspectives, pick out key elements of it that bolster their own side of the story.” Honestly, this would be an unusually sane and reality based version of conflicting stories. “Yet sometimes only one person is right, right?” Wait, what is the author talking about here? Then goes on to tell a story about a slide deck confusion with a co-presenter, and concludes — as one would, I mean, it is a slide deck — that it didn’t really matter who was right even tho it could have been demonstrated which person was right and now she does not even remember because you know team spirit. Which is _definitely_ a characteristic of this author! To a somewhat horrifying degree, really, altho she’s clearly _trying_ to also be Team Reality by following it up with, “People who intentionally manipulate and lie don’t get to have their truth be “right” just because it’s their perspective, and luckily, the truth as a way of revealing itself.” Obviously, that is hopelessly inadequate for my commitment to Team Reality.

Her next example is bizarre — these things are really all over the place.

ETA:

December 31 2nd UO park day

We got up around the same time, but I did not rush. I was watching Hagrid, and it went from “opens at 7”, well after other similar open at 7 rides had listed wait times, to, “Delayed”. We did not go into Islands. I canceled the Mythos reservation after discussing it with my sister. It turns out T. still wanted to go, so he ultimately went on his own. He had done everything already, so that’s all he was going to go into the park to do. LOL

A. and I rode the boat (since we were going to Studios anyway). We did Race through New York, Mummy, Gringott’s, MIB, Simpsons. Then we reviewed all the rides at UO, and concluded that we did not want to go to shows or to playgrounds, nor did we want to do a couple kiddie rides or things like Dumbo rides, or coasters that went upside down. Hagrid’s was too long a wait (still 2 and a half hours). We discussed lunch options, and tried Finnegan’s, but it was a 25 minute wait. We contemplated Citywalk, and decided we wanted quiet. We tried Tuk Tuk market, but everything is pre-made. So we had a chicken sandwich and a pizza at Jake’s instead. Then, off to the room to relax, where I typed this.

We also had dinner at Jake’s, and after that, we packed up to get ready to catch a flight home. We are ready to go home; we had a really nice trip. Oh, and I gave my sister the Lewis N. Clark packable bags, because I’ve decided I never really use the red packable backpack, and the blue packable duffel — which I do use — clashes so much with my outfits that I want something that coordinates better. Also, she said she needed an extra bag. Worked out for both of us!

A while back, I finally succumbed to the guilt The Guardian pokes at their readers and gave them money. Now I get those headline summary emails so I wind up there even more. This is probably an error in judgment, altho I did encounter this really interesting article:

https://www.theguardian.com/science/2022/aug/28/i-just-go-into-my-head-and-enjoy-it-the-people-who-cant-stop-daydreaming

Go ahead and go read it. It’s really interesting and worth knowing about, whereas this is just me trying to reconstruct what’s going on over in psychiatric diagnosis-land and predict where they will go next.

I had a bunch of reactions to the article. First, I was like, yep, I did a lot of that Back in the Day and honestly, I sorta miss it. I had a lot of strategies over the years for dealing with the relentless boredom of the Kingdom Hall. When I was quite young, I’d sneak books in and read them, but predictably, someone would eventually notice. Then I resorted to reading the books that were legitimately there, of which the only one with any persistent interest was obviously the Bible, and the only really worthwhile books in there for a girl are Esther and Ruth. And honestly, you can only read those so many times before you’ve basically memorized them.

So after _that_, I just sat there and went inside my head. Also, I had a ludicrously early bedtime and didn’t need anywhere near the sleep they wanted me to sleep so that I wouldn’t bug them (and enforcement involved beatings with a stick if I read by the hall light, which, fortunately, they backed down on after I dolefully responded to a teacher at school who thought it was great that I read so much and then I said, no, it’s bad and explained about the beatings).

Sorry about the lack of trigger warnings, but _I DID_ start with an article about maladaptive daydreaming, and if you read the Guardian piece and looked up dissociative disorders, you should have been expecting some severe trauma stories next!

Obviously, I _don’t_ miss being bored out of my school for a number of hours a week that qualifies as a substantial part time job. But the daydreams were really, really, really vivid and because I could control them, obviously more enjoyable than my actual life. When I learned there was a corner of TikTok land in which people describe how to go into alternate reality, I was like, hunh, sounds like they’re doing what I did to avoid going bonkers during church (for the record: I never lost track of what was going on around me! I polled reality and nothing happened very fast so a delay wasn’t particularly noticeable. I didn’t do in church what I sometimes did at home, which was to stare at a wall and just let my mind empty completely. Couldn’t do that in church; people would freak out).

My second reaction to reading the article was, I wonder if this would explain schizoid and schizotypal personality disorders. I tend to think of those two as autism plus other things, with a big question mark next to avoidant personality disorder as possibly being the same.

Heck, it might explain schizophrenia — maybe someone just got stuck in their daydream and forgot to come back out, or maybe people are interacting with a part of the person’s awareness that’s there as a sentinel and overloading the amount of resources the person has devoted to the sentinel. That’s the problem I ran into with the stare at a wall activity. I left an internal timer, not expecting to be interrupted, but for some reason that I never did find out, my mother came upstairs unexpectedly and found me non-responsive, eyes open, sitting in a chair and nothing she could do was getting me to respond (experimenting with catatonia for fun! Yes, my early life had some really, really big problems!). She thought I’d had a seizure or was doing drugs or who knows what but she panicked hard and I never did find out why she’d come upstairs in the first place. Future sessions of staring at a wall involved much more careful planning.

Anyway.

Other people have asked roughly the same question.

https://www.psychforums.com/schizotypal-personality/topic190248.html

“ I was just wondering whether or not Maladaptive Daydreaming, to which I am very much prone, would come under the umbrella of schizotypal or schizoid personality disorders. I've heard that fantasising can be a feature of Avoidant PD, which I do have.”

An answer — from 2017!!! —

“I do it constantly. Most recently I conceived this whole rock opera upon the premise Manson (or me as a present day iteration) actually got a record deal and reframed the whole Helter Skelter thing as a "war for light" as some sort of Luciferian Lightbringer nonsense. I was totally wrapped up in it, writing lyrics and melodies in my head for weeks at work, "as if" my job were just "for now" and this horrifying performance art is my 'real gig' and just what this ridiculous society needs. Really reframing reality with the whole thing until dissonance creeps in and I realize I see myself as 20 years younger than I actually am and realize I'm way too avolitional and oppositional to ever do this for real. And yet for once, this time it really served to vent a lot of societal/institutional rage just in conceiving it.Also, my lyrics kind of come unbidden in a nursery rhymey way thats full of silly "clang association" and multiple entendres that my neurotypical friends love receiving at like 2:30 in the morning. Or not. I was ALL about this a couple weeks ago, totally ready to shock the world and stomp all over model cities on stage, beat up mannequins etc...In true INTP (5w4) form, having dreampt it was as good as doing it and I'm much relieved to go back to poring over forums and articles in front of the TV.
STPD,BPD,BP,DD/NOS,ADD”

I included the whole thing, because it’s quite detailed and _all_ of it maps really well to q-sters who describe how they fell into q-land, and how they came back out. Also, the list of diagnoses is _highly_ suggestive that a lot of diagnoses are actually interacting with _things people are doing inside their head on purpose_. Or with purpose. Or whatever.

If you want more:

https://www.quora.com/Is-maladaptive-daydreaming-a-symptom-of-schizotypal-personality-disorder

The “cure”, such as it is, is what I found to be personally true. Fix your life, and maladaptive daydreaming isn’t needed any more. This is probably why I keep thinking that every addiction and other problem with mental health can be improved by improving one’s life circumstances (whether that’s decluttering or finding people to hang out with who actually care about you or exercising or eating better food or getting enough sleep or whatever).

This link breaks maladaptive daydreaming down in ways where it suggests that many of the components of daydreaming have highly functional alternate uses:

https://qr.ae/pvgHhr

Someone at quora linked to this:

https://maladaptivedaydreamingguide.wordpress.com/2015/04/04/part-i-fantasy-and-fall-of-the-self/

This _does not_ resonate with me at all. Not saying that’s not going on with other people, but that doesn’t feel like what I was going through.

The APA has a phenomenal podcast series called “Speaking of Psychology”. I’ve recommended the recent episode about perfectionism to a number of people, and more recently, I listened to an episode about Borderline Personality Disorder. It does a great job of explaining the evolution of how Personality Disorder in general is conceptualized (on the “borderline” of psychosis and neurosis, the many, many, many distinct personality disorders, and the new to DSM-V alternative section in which it is a general personality disorder with a list of specific symptoms). It touches on standard therapies for Borderline Personality Disorder in the US and around the world, and also its heritability. The clinician scientist interviewed for this episode is part of the general vibe of the community, in that she doesn’t blame parents for “causing” psychological problems like personality disorder, while simultaneously making fairly onerous and specific suggestions for how parenting styles can connect with underlying personality / genetics / wtf to trigger a disorder.

This feels unhelpful.

I mean, she’s already noted that burnout for therapists who treat people with borderline is a real problem, and that the disorder is highly heritable, and therefore the parents being asked to do this extra work are themselves probably personality disordered and may or may not be diagnosed themselves and may or may not have been effectively helped.

NOT mentioned in the podcast is the tendency of people with personality disorders to choose partners on the autism spectrum. There are a bunch of reasons for this. Notably: people with autism don’t necessarily notice or understand what they are encountering in a person with a personality disorder, and won’t necessarily immediately run away; also, people with autism themselves have pretty limited choices for partners. Most importantly, a person with a personality disorder may find hanging out with a person with autism to be extremely calming and relaxing and un-triggering and so forth. In any event, I have personally noticed that a lot of people with autism tend towards the blunter end of the communications spectrum, so if the kid with the personality disorder is going to need a bunch of softeners and validating and so forth, and the not-personality-disorder having parent does have autism, that’s _really going to be a much bigger lift than the therapist is imagining_.

I’m really sorry to say that I don’t have a nice, tidy suggestion for what to do instead. I think this suggestion is a total non-starter. I applaud the high degree of realism reflected in the observation that personality is pretty set and stable even in toddlers (I have all kinds of additional observations to add along the lines of “or even earlier”). There’s a lot to learn from this episode and a lot to think about, but the industry continues to suffer from disproportionate resources being diverted to people with borderline personality disorder while simultaneously accomplishing absolutely nothing. Well, okay, they might be making it worse.

R. and I have a couple of long-running questions between us. Our son has both ADHD and autism diagnoses. Our daughter has an autism diagnosis. It’s pretty clear that there is a lot of subclinical if not actual ADHD going on with R., and throughout is family, and in parts of my family. Obviously, R. and I are both autistic, and one of our debates is which one of us is “more” autistic. (OK, we _know_ that that is not a question that is answerable, and honestly does not really make sense. Further, our definition of “more” is unstable from moment to moment. It can be, more cartoonishly meeting the diagnostic criteria. It can be, more disruptive of day to day life / relationships / etc. It can be, More Superpower / Mad Skillz.)

The other debate basically comes down to: does Walkitout have ADHD. I am _deeply_ aware of how the definition of attention deficit with or without hyperactivity has evolved over time. I am absolutely clear that I display a bunch of the “motor” like speech and behavior associated with the disorder (pressured speech, can’t sit, can’t sit still, etc.). I am also completely aware of the cartoonish qualities of my ability to hyperfocus. The current definition of ADHD has multiple subtypes, and I very obviously belong in the HI subtype (Hyperactive Impulsive) if I belong anywhere at all.

I _finally_ have time to poke around at this question (I’ve been working through some backlog lately).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253348/

This looks specifically at adults, notes that HI is really rare, and raises a bunch of questions about whether it really even exists. “Combined” (ADHD-C) exists. “Inattentive” (ADHD-I) exists. But the small number of people that were ADHD-HI in their study were actually _more_ inattentive than the ADHD-I group, which makes you really wonder why they weren’t ADHD-C.

They went into this with this perspective:

“In summary, current research suggests that ADHD-HI is rare, developmentally unstable, with no evidence of being a specific disorder, and often accompanied by subthreshold attention deficits suggestive of ADHD-C.”

Noted as a result of their analysis that:

“In this sample of 691 adults with ADHD there was no patient who met the DSM-IV cut off for having six out of nine hyperactive and impulsive symptoms and less than six out of nine inattention symptoms. This would indicate that the Hyperactive-Impulsive subtype in adults is either so rare that it represents a tiny minority of patients, or simply does not exist as a clinical condition in adults at all.”

Mind you, that’s all based on the DSM-IV criteria. I’ll see if I can figure out whether they did any validation off of the DSM-V criteria.

This is an imaging study, that is also able to distinguish between -C and -I. They rather conspicuously mention and then drop -HI.

https://pubmed.ncbi.nlm.nih.gov/30985833/

This Italian study suggests -HI is more common in women, and more likely to be associated with anxiety.

https://pubmed.ncbi.nlm.nih.gov/28580295/

Going further back in time, and adolescents, this one attributes the anxiety to the attention side, vs. the hyperactivity/impulsivity side.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607691/

Some people who run an anxiety clinic decided to test their population (mostly female) for ADHD and found some things.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6493806/

The impulse control NOS (nail biting)/motor tic disorder sounds a lot like my extended family! No subtyping in this analysis.

Part of the debate with R. revolves around the absolutely bonkers extent of my control-freakiness. As he has put it on occasion, I expend consider energy in controlling how much of people can perceive my control-freakiness. (From my perspective, this is me running my life so that, in the event I wind up in front of a nominally neutral arbiter, I win. Like all ridiculous but effective strategies, this isn’t easy to stop, even if I thought it would be a good idea to stop. Which I don’t. Hence the long-running discussions.) I -absolutely- have all the nail chewing, hair twirling, picking, you name it impulses. Everyone wandering around with headaches and tooth and jaw problems because they grind their teeth at night? I controlled for decades ago. Which makes me very sympathetic to the problem … but also you can kinda see how I _also_ have to really stomp on my natural, hey, here’s how you can fix that! impulses.

Am I an anxious person, who has so relentlessly managed that anxiety that it’s kinda … not there? Does that even mean anything? This feels too philosophical. YES I am impulsive in a way that is annoying to myself and other people. We are in wild agreement about that. The question is, is that a disorder, and if so, which one.

Years ago, I learned the term “non-exercise activity”, and I laughed hysterically when I saw the somewhat jaw-dropping estimates of the range of calories expended in this way. Basically, it turns out that leg bouncing, can’t sit still, driven by a motor type people burn _a lot_. And now, there are people trying to _teach people_ how to do it too.

https://blog.nasm.org/exercise-programming/neat-approach-weight-loss

So, where is the ADHD research community on actual _exercise_? Because I do less non-exercise activity when I do more actual exercise. (Homeostasis FTW)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945516/

Welp. Didn’t see that coming! Exercise good for ADHD population _and probably also borderline personality disorder_! Mostly, it is a really extensive literature review, and, as always, there just isn’t nearly as much high quality exercise research specific to whatever population you are interested (or, really, any population) that you might want. And, apparently, none for BPD. Nice summary, tho.

Discouragingly, in this study from 2021, kids diagnosed with ADHD were _less_ likely to have recently engaged in physical activity than kids not diagnosed with ADHD.

https://pubmed.ncbi.nlm.nih.gov/31838947/

Returning to the core question!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017439/

This is very technical, and I’m not convinced I understood it completely. Earlier (2010 article near the beginning of this highly edited, link heavy ramble), we had people questioning whether pure hyperactive / impulse Was Even a Thing. Well, the reason why it’s _not_ a thing, is because you can get inattentive from hyperactive/impulsive, _and when you do_, you wander off into ODD relatively quickly. The 2010 editing of the population to remove comorbidity etc. basically removed all the HI, leaving a few weirdos who managed to be hyperactive/impulsive without, you know, what happens to people with ODD diagnoses.

It’s a lot to think about, really, and it clearly does not apply to me, which puts me very firmly back in the territory of, no, actually, I do not have and never have had ADHD. Period.

Also, I am hyperactive.

I think what we actually have going on here is reification into the individual of something that is an artifact of the social context. And yes, I know that this is an observation that has been made before. Teachers refer out for ADHD, because the kid is being disruptive, and can’t seem to pay attention. This is either going to be -HI and turn into -C (or ODD) or it’s going to be -C when detected. The kids who just are not attending rarely get referred out, because they are not being disruptive. The _parents_ may agitate for some action, and you can _really see_ how a pure-play -I would benefit from stimulants. A -C that stimulants do _not_ tip over into ODD will benefit from stimulants the way just about everyone benefits from stimulants. We really should never have told people to stop giving kids coffee, tea, etc. But that’s neither here nor there. Honestly, the attention demands of school / work / life are probably ridiculous, and we could make a lot of it work better for everyone with exercise breaks. Also, not relevant to the current question.

Also important is the difficulty of mutually regulating attention. Under this theory, autism is super important. I have no trouble focusing, and, for that matter, neither do my kids (or, really, R.). We do need to be interested, and we do need to be able to follow along; a lot of our disruptiveness and impulsiveness is breaking in with questions and derailing. That can probably be slotted much better under our autism than under ADHD. More collaborative parenting and teaching styles that incorporate the preferences / interests of the kids help with this.

I’ll have to do more thinking to understand whether I even believe my son has ADHD. I’m not convinced any more. He occasionally loses things, but the _way_ that he loses things is shockingly non-repetitive. When we problem solve a solution after something fell out of a pocket, it doesn’t happen again. He’ll occasionally do something novel, like recently he left a helmet behind at school, but he got it back again. I don’t know _anyone_ who doesn’t occasionally forget an item. He’s on time, unless he’s failed to understand what’s involved in getting to a place on time. He keeps track of a relatively complex schedule independently. These sound very NOT ADHD.

Hard to believe that it is time for A's 3 year re-eval. Apparently other people lost track of time, too, so forms came out a little late. I am unconcerned; it'll get done, and there will be more of the same and progress will continue.

I got some housecleaning done; things are finally shaping up a bit. Between the holidays, travel and being sick and other distractions, I got behind.

Minor trigger warning for some of my readers: this next bit is about family.

I woke up this morning with a weird realization. I was raised in a family and a religious organization with a very rigid set of ideas about family structure. And I don't just mean one-man-one-woman-no-divorce, either. I mean, man is head of household, woman obeys, etc. And in case it wasn't completely obvious, there is never, ever, ever supposed to be any difference of opinion between the 'rents. I absolutely don't agree with any element of this (why exactly two 'rents, why of opposite genders, why no differences of opinion, etc.). What I realized this morning is that children who are raised by otherwise loving caregivers who have important differences in values _and who place those differences front and center in their own relationship_, thus influencing the children to take sides, kids can get stuck in an awful insecure attachment loop with parents who otherwise probably would provide secure attachment structures. Because of the yo-yoing between I'm on this one's side, no I'm on that one's side.

Differences of opinion can be profound, but as long as they are not perceived by the kiddos as a side-taking sort of situation, I don't think the effect is particularly bad. The problem is the impact on attachment.

OK, so, some people are clearly not grabbing a clue from the title. YES, the book is loaded, larded, completely laden with f bombs. If that is a problem for you, this is not a book for you. Don't read this book if you aren't loving the f bombs. Seriously.

Sarah Knight has written an effective parody AND an effective self-help book. The topic of the self-help aspect is prioritization of time/energy/money in line with one's values. Most of the book is devoted to introspection on what aligns with your values and figuring out how to say no to things that don't align with your values but do exhaust your time/energy/money, without being an Asshole (TM). She explores some of the domain of being polite vs. being honest while saying no.

The books weaknesses require little contemplation to identify. Her evaluation function is too present-focused. It is only at the end of the book that she makes any effort to help the reader figure out what they should be doing now so that they don't wind up regretting not doing it later. A lot of duty/obligation stuff is devoted to getting you to avoid this situation, and since she is jettisoning duty/obligation, I think she should have spent more time on this.

But you know? It's her book. And it is fairly humorous.

It's hard to know if this would _help_ any particular reader. I don't know that I was helped by it (but I was vastly entertained, and a little disturbed by how many of the examples it wouldn't even occur to me to feel any guilt about). But if you feel like you are being nibbled to death by small requests difficult to say no to, but which are not advancing you along your spiritual path, hey, can it really hurt? There are at least several giggled in it.

Another library selection. I was looking for a book about narcissism, because a friend of mine has had problems with narcissists, then there is the obvious election thing. The book I found in the library was unsatisfying, so I thought I would pick up a book about personality disorders in general, since I have not too long ago had a strong interest in better understanding Borderline Personality Disorder and found learning more about it to be really rewarding in terms of better understanding, better ideas for how to be around people with this particular issue without making things worse (and possibly helping to support them emotionally), and in general feel more compassion.

During the lead up to the DSM V, there was talk that perhaps personality disorders would be reworked entirely, to be one true personality disorder list of criteria, and then a more detailed coding/listing of how it manifests. Dobbert's book was written before that debate occurred. In the event, the new approach is listed as an alternative. I was hoping that reading Dobbert might give me a sense of what is shared across personality disorders. Instead I wound up coming to a very different set of ideas.

I really liked this book, and I think it is generally very useful. The author is not mean spirited, nor does he engage in obvious name calling (you might go, well, duh, but you might read some books about personality disorder to get a sense of how rampant that is before you conclude that this bar is too low). He intends his book for a general audience; he himself comes from a forensic/criminal justice background, which shows up a lot in his discussion of antisocial personality disorder, and his inclination to think that conduct disorder should be rolled in to the personality disorders (I don't disagree with him). I particularly liked the section on Histrionic Personality Disorder, because I had no idea what that was (I'd heard of it, but didn't have any sense of it); once I read through it and told a friend, she immediately said, I know someone like that!

And that's perhaps the best thing about this. It is like a bird spotting guide or a nature book that you can take on a hike, only it is for people who make us all scratch our head and go, what the heck is that all about anyway? We can't figure out where the win is, they cause all kinds of problems in groups, are difficult to work around and sometime force us to quit participating in organizations or change jobs just to get away from them. Well, if you've ever wondered what was going on, maybe you'll find the same sort of value in this book that I did.

The set of ideas I came to after reading this was as follows. I knew that some of the schizo* personality disorders were confusing and difficult to tell apart (I don't have that problem any more!), and I had reason to believe (mostly because of reading people's posts on Wrong Planet) that they were either "cousins" of autism spectrum, or autism spectrum in its higher functioning forms compounded with other problems. Here's my first cut at that:

schizoid personality disorder = mainstreamed, HFA person with depression, who has not yet/ever found people of like minds. I think if you treated the depression, and then helped them Find Their People, they would wind up just looking like other autism spectrum people. Pretty varied, still gonna need a lot of alone time, and still reduced affect, but not NO affect. Might also have an asexual component; wouldn't know for sure until the depression was addressed and Their People were found

schizotypal personality disorder = HFA person, possibly from a spectrum family, weird ideas. Might think they are psychic. Might have a lot of odd ideas about UFOs, occult, etc. The spectrum component means they don't have any perspective taking ability so they don't realize that they shouldn't talk about this stuff around mundanes. Work on the perspective taking issues, walk them back from any paranoia they have developed, get them into a social skills program. Once they "get" that they need to be a little selective, and if you can help them find some flavor of Their People which isn't too terrifying, further descent into paranoia and delusions will probably halt/reverse.

obsessive compulsive personality disorder. Best BEST thing about this book: I can now actually keep track of the difference between OCD and OCPD. Never thought that would happen! I have some issues with his description of OCPD, in that his scenario has someone who weight cycles, which just makes very little sense to me. My sense is that OCPD tends to be more associated with anorexia type eating disorders than bulimic type eating disorders. But who knows. People are exploring the possibility that OCPD has autism spectrum components, but there is a tremendous amount of resistance, because if it turns out that is true, then a lot of the received wisdom in eating disorders, hoarding, etc. is going to turn out to have been entirely wrong headed. Also, it may turn out to be the case that there is a fraction of OCPD which is autism or autism like, but another chunk which has a very different etiology.

Don't blame Dobbert for any of that rambling mess! He's a very reasonable person and I am engaging in early stage, uninformed speculation. But his book is concise, clear, well cited and easy to read. It'll help you understand confusing people, I can almost guarantee it. At the end, he has a neat appendix of various psychologists/psychoanalysts/etc. contribution to the ideas in the book; it was there that I learned about (possibly again) Karen Horney, who I am going to try to read some of because I think a lot of her ideas about how people deal with (or don't) fears and anxieties might be quite fruitful to contemplate.

Another library pick. I wound up skimming. I was not particularly impressed. Kluger is simultaneously talking about many different ways of thinking about narcissism (from having higher self esteem than he thinks you should have to taking more selfies than he thinks you should to something more recognizable as NPD in the DSM), which makes it sort of hard to pin down why his approach is so irritating. Narcissism as a character trait in the extremely loose and changeable way he treats it doesn't strike me as anything negative at all -- many, many, many therapies and activists have been arguing that we must love ourselves before we can meaningfully love anyone else, after all. And women as a group aren't helped by continuing to downplay their capacities and achievements.

Also, he apparently wrote the Apollo 13 book a while back, and he really wanted to make sure the reader knows all about that, which made me think things like, who is the narcissist here and projection.

I'll keep looking for a better book about NPD. This isn't what I was hoping for, which I would loosely characterize as _The Buddha and the Borderline_, but for NPD. I want something written by a person who identifies as having (had) the problem, who has an activist bent, and who is right up to date on the clinical approaches to treatment, possible outcomes, etc. I know, I know. So demanding!