Anything to Stop the Pain - BPD and Non-BPs

I was both encouraged and dismayed by Jane Brody’s article about Borderline Personality Disorder in the NY Times. Here is the text of the original:

June 16, 2009
Personal Health
An Emotional Hair Trigger, Often Misread
By JANE E. BRODY

In the popular 1999 movie “Girl, Interrupted,” Winona Ryder portrays a young woman who tries to commit suicide, then spends nearly a year in a psychiatric hospital with a diagnosis of borderline personality disorder.

The film, based on a 1993 memoir by Susanna Kaysen, was gripping. But experts say it oversimplified this common yet poorly understood mood disorder.

Georges Han, a recovered patient now studying at the University of Minnesota for a Ph.D. in psychology, describes borderline personality disorder as “a serious psychiatric disorder involving a pervasive sense of emptiness, impulsivity, difficulty with emotions, transient stress-induced psychosis and frequent suicidal thoughts or attempts.”

Moods can change quickly and unpredictably, behaviors can be impulsive (including abuse of alcohol or drugs, reckless driving, overspending or disordered eating), and relationships with others are often unstable. Many patients injure themselves and threaten or attempt suicide to relieve their emotional pain.

People with the disorder are said to have a thin emotional skin and often behave like 2-year-olds, throwing tantrums when some innocent word, gesture, facial expression or action by others sets off an emotional storm they cannot control. The attacks can be brutal, pushing away those they care most about. Then, when the storm subsides, they typically revert to being “sweet and wonderful,” as one family member put it.

In an effort to maintain calm, families often struggle to avoid situations that can set off another outburst. They walk on eggshells, a doomed effort because it is not possible to predict what will prompt an outburst. Living with a borderline person is like traversing a minefield; you never know when an explosion will occur.

A Misleading Label

The name of the disorder was coined in the 1930s, in a misleading reference to the border between neurosis and psychosis. Experts say it has nothing to do with either condition.

Rather, affected individuals seem to be born with a quick and unduly sensitive emotional trigger. The condition appears to have both genetic and environmental underpinnings. Brain studies have indicated that the emotional center of the nervous system — the amygdala — may be overly reactive, while the part that reins in emotional reactions may be underactive.

As children, people who will develop the disorder are often “hyperreactive, hypervigilant and supersensitive,” Valerie Porr, a therapist in New York, said in an interview. Typically they receive a host of misdiagnoses and treatments that are inappropriate and ineffective.

“Some children need more than others in learning to regulate their emotions,” said Marsha M. Linehan, a psychologist at the University of Washington who devised the leading treatment for borderline disorder.

“These kids require a lot of effort to keep themselves emotionally regulated,” Dr. Linehan said in an interview. “They do best with stability. If the family situation is chaotic or the family is very uptight, teaching children to grin and bear it, that tough kids don’t cry, these children will have a lot of trouble.”

Even in a normal family, such children need extra help. Dr. Linehan told of one mother who said: “I was an ordinary mother, and my child needed a special mother. I took training and became the special mother he needed.”

Borderline personality disorder afflicts about 2 percent of the general population, according to the Diagnostic and Statistical Manual, and it is twice as common as a much better-known disorder, schizophrenia. (Other studies suggest the prevalence is as high as 6 percent.) Many borderline patients hurt themselves, and 10 percent die by suicide.

Yet as common and serious a problem as it is, Dr. Linehan said that patients often have difficulty getting the help they need — partly because therapists tend to regard borderline patients as manipulative and demanding of an inordinate amount of time and attention.

Ms. Porr, a social worker who specializes in helping families of borderline patients, said therapists with traditional analytic training often provide ineffective treatment, then experience feelings of failure and frustration. Psychotherapeutic drugs have not been effective in controlling the disorder. As a result, 70 percent of these patients drop out of traditional treatments, Ms. Porr said.

Ms. Porr tries to help families learn to handle the problem and not make it worse. She said in an interview that families need to understand why borderline patients act and react the way they do, then respond in ways that validate the patients’ feelings and help them regain and maintain emotional control.

Treatments That Can Help

Experts say that even suicidal patients are unlikely to benefit from the kind of extended hospitalization depicted in “Girl, Interrupted.” More often, a few days in the hospital should be followed by psychotherapy directed at helping them learn to live more effectively with their cognitive misinterpretations and emotional instability.

Dr. Linehan practices dialectical behavior therapy, the only therapy that has been demonstrated to be effective in a number of randomized clinical trials. She said two other approaches, called mentalization and Stepp, were also likely to be helpful.

Dialectical behavior therapy, a derivative of cognitive behavior therapy, helps patients identify thoughts, beliefs and assumptions that make their lives challenging and then learn different ways of thinking and reacting.

In effect, Dr. Linehan tells patients, “Your problem is that you don’t know how to regulate yourself, and I can teach you how.” She said thousands of therapists have been trained in dialectical behavior therapy, and many others practice it without special training.

But the value of the therapy can be thwarted if patients return to an environment that misunderstands them. Thus, Dr. Linehan said, it is important for others to recognize that people with borderline personality disorder are genuinely suffering. “They are in excruciating pain that is almost always discounted by others and attributed to bad motives,” she said.

The idea is “to validate the person’s emotional reactions, to say, ‘I understand how you feel,’ to pay attention, not to the situation, but to the emotion behind it,” Dr. Linehan said.

Alan E. Fruzzetti, a psychologist at the University of Nevada, said that families have to learn how to “soothe themselves, to realize that though the situation is awful, not to blame or be judgmental of the person but to see the person as also suffering.”

Reacting in a nonloving way magnifies the trauma tenfold, he said in an interview, adding: “You may have to leave a bad situation, but you must come back in a loving way, maybe say something like, ‘That blowout yesterday, I really want to understand your experience.’ ”

Therapists trained in dialectical behavior therapy can be located through the Web site www.behavioraltech.org.

What I was dismayed about was the reaction on Tara Parker-Pope’s Well Blog. The reactions were decidedly negative and clearly misinformed. There are many people (mainly ex-husbands and children of BPs) that posted comments that essentially said “it’s incurable” and “stop the abuse of the Non-BPs.” I know from my interaction that hope and management is possible. My “followers” recently took a survey at my request and the “before and after” (before reading my book and participating in the ATSTP list) reactions were as follows:

Before -> After

Desperate->amazed

Overwhelmed->confident

Outraged->compassionate

Despondant->hopeful

Traumatized->becoming

Angry->relieved

Desperate->empowered

Change and healing IS possible with BPD and loved ones. I feel that Tara Parker-Pope introjects her negative opinion about BPD without actually doing what is necessary to make things work.

 

I have recently made a realization about the other Non-BP writers and myself. I realized that our goals are completely different. When reading other books about being a loved one of a person with Borderline Personality Disorder (mainly those written by lay people, as opposed to professionals), I have found that essentially we fall into three categories. These categories are:

Those that are chiefly concerned with stopping the emotional abuse doled out by the person with BPD. This category is the largest of the three. Most books written about being a loved one of someone with BPD fall into this category. These books include: “Tears and Healing”, “Stop Walking on Eggshells”, “The Essential Family Guide”, “The Siren’s Song”, “Loving and Loathing”, “One Way Ticket to Kansas” and others. Typically these are written by ex-spouses as guides to getting out of emotionally abusive situations and protecting oneself from emotional abuse. Most of these have an emphasis on boundaries or limits, tough love and abusive dynamics (such as the victim-rescuer-perpetrator triangle or Stockholm Syndrome). If your goal is to stop the abuse directed at you from your loved one with BPD, I believe reading these books can help you do that; however, I don’t think you should expect to keep the relationship and, if you do keep the relationship, I wouldn’t expect that it would grow to be a close, loving relationship. The tools and techniques in these books will not help you build such a relationship with someone with BPD.

Those that are written by people who have recovered from BPD and wish to promote a better understanding of the disorder. These books include those by Rachel Reiland, A.J. Mahari, Tami Green and others. I find these books to be helpful for the intended purpose. It certainly helps a loved one understand what it feels like to have the disorder. However, I also find that many of these books are short on what a loved one can do to build a loving relationship with a person with BPD. These books are inspirational for people who want to recover from BPD, but I don’t feel they provide the complete picture when it comes to the loved ones.

Those that promote an effective, skillful path to building a loving relationship with someone with BPD. As far as I can tell, I am the only “lay person” in this category. There are some professional books, such as “New Hope for BPD,” which attempt to achieve this goal, but no other first-hand experience books that I have found other than my two books, “When Hope is Not Enough” and “But I Love You”. If your goal is staying with your loved one with BPD and building a loving, compassionate relationship, I think I am your only choice.

I implore you to consider your goals and choose your path accordingly.

Here’s an interesting article about Victim Identity and Emotional Abuse…. The original is here.

The Line between Victims and Abusers
Steven Stosny
Created May 15 2009 – 6:52am

Victim identity is focus on damages suffered at the hands of other people. The desire to be identified as a victim creates a sense of entitlement and a motive to devalue anyone who does not offer special recognition and validation of victim status or compensation for it.

In our Age of Entitlement, it is often difficult for friends and therapists to detect abuse in intimate relationships and to discern who the primary abuser is. This is especially hard in cases of emotional abuse, with no objective evidence like police reports or medical records. The following characteristics of primary abusers and victims are not fool-proof, but I have found them to be highly reliable, based on the dramatic change of attitudes by the end of treatment.

Research and clinical experience clearly indicates that abusers are likely to:

• Underreport, hide, minimize, or justify their abusive behavior
• Describe themselves as victims
• Feel abused when their partners disagree with them or don’t do what they want
• Label their partners’ behavior as abusive
• Attribute malevolent intent to their partners’ positive behavior (manipulative, deceptive)
• Pathologize their partners (emotional or personality disorder, incompetence)
• Use negative labels (nag, irrational, hysterical, lazy, unreliable)
• Have great difficulty describing their partners’ perspectives
• Show little or no compassion
• Exhibit self-righteousness

Research and clinical evidence traditionally has shown that victims were likely to:

• Underreport or hide their partners’ abusive behavior
• Not label obviously abusive behavior as abuse
• Blame themselves in part for the abuse they reveal
• Make excuses for the abuser’s behavior
• Bend over backwards to see the abuser’s perspective
• Describe the abuser at least partially in sympathetic terms
• Exhibit self-doubt

How the line got blurred: Emotional Reactivity and the Victim Identity Movement

Abuse victims, like anyone in relationships with high emotional reactivity, build automatic defense systems [1], which include preemptive strikes – if you expect to be criticized, stonewalled, or demeaned, you may well do it first. Victims can easily develop a reactive narcissism that makes seem like abusers.

But emotional reactivity between intimate partners, although more frequent in the Age of Entitlement, is a small part of the story. A more potent variable in blurring the line between victim and abuser is the reactivity of a social movement.

The victim protection movement began as a noble attempt to counteract the most insidious aspect of the abusive dynamic – blaming the victim, which has the effect of making the victim feel ashamed of being abused. But as is the case with all effective social movements, the pendulum has swung too far the other way. We now have a victim identity movement, fueled by an industry of self-help authors and advocates, that has conferred a certain status to being a victim and thereby blurred the line between victims and abusers.

For example, in the beginning of my career, I saw many male abuse victims who would become angry and verbally aggressive at the suggestion that their partners abused them. Now obvious victims, along with those who are not victims but who have identified with descriptions in self-help books, become angry and aggressive if they are not recognized as victims.

The primary mistake with victims is urging them to think and sound like abusers. Due to the victim identity movement, some genuine victims will now:

• Describe their partners as abusive
• Minimize or justifying their own aggressive behavior
• Dismiss their partners’ perspective
• Attribute malevolent intent to their partners’ positive behavior
• Use negative labels (selfish, controlling, pig)
• Pathologize their partners
• Exhibit self-righteousness
• Show no compassion

The primary mistake with abusers is to reinforce their victim-identity by:

• Emphasizing childhood or other experiences in which they were mistreated
• Validating their resentment and anger as “appropriate,” which validates the distorted perspectives that go with anger and resentment
• Reinforcing their sense of entitlement – they should be respected, which, to them, means their partners must submit
• Confronting them in shame-inducing ways, before they learn to regulate shame with compassion

Successful Treatment and Friendly Support of Victims
No treatment or support of victims can be successful by urging them to disown their compassionate nature and think more like abusers. Rather, treatment should attempt to build on their strengths, i.e., expand the good things about their nature in a way that ensures safety and growth. A deeper level compassion helps them see the damage an abuser does to the self by harming loved ones. Then they can leave compassionately, for the abuser’s own good. This is a far more empowering stance that will feel more authentic, avoid residual bitterness that adversely affects parenting, and be less likely to stir revenge from an abuser who feels humiliated by separation. And it will not create a pendulum of pain [2], in which victims leave out of anger and resentment only to return out of guilt and shame.

Successful Treatment and Friendly Support of Abusers
Abusers must access the natural state of compassion they first experienced as very young children and relived when they were falling in love. Most will then recognize that they have fundamental values that are more important to them than their egos and that their egos were constructed in large part as defense against the shame of violating or losing touch with those values. Motivated by defense of ego, they violate their deepest values and devalue those they love. Motivated by their deepest values, their need to defend a fragile ego subsides, along with their need to control, criticize, dominate, and devalue others. (Boot camp post [3])

Notice that appeal to the deepest values of clients and friends makes the distinction between abusers and victims less important. A compassionate victim, knowing that the abuser cannot change without becoming more compassionate, will leave. An abuser who becomes more compassionate cannot continue to abuse.

 

 

A quiz to find out if you’re “walking on eggshells” around your partner:

The Walking on Eggshells Quiz

If you find that you are, and think that your partner has Borderline Personality Disorder traits. I suggest you check out the resources that I provide on this site – that is, if you want to stay with your partner and want to learn how to make things easier and better. “Stop Walking on Eggshells” is a great title for a book; however, the book itself will not teach you the skills necessary to stay in the relationship effectively. I have found that the skills in that book (commonly known as SWOE) actually breed resentment and further division in a partner relationship. I know because I tried those skills, and they made things much worse.

 

 

One of the things I have noticed about Dialectical Behavior Therapy Family Skills versus Mentalization Based Skills is that they operate at a different link on the behavioral chain. In “When Hope is Not Enough” I have a section called “the BPD Dynamic.” What this dynamic outlines is a behavioral chain. That chain goes like this:

Event -> Interpretation -> Emotional/Physical Feelings -> Action Impulses -> Expression and Behavior

DBT-FST seems to me to operate at the Action Impulses to Expression and Behavior link, while validating the Emotional/Physical Feelings link. Don’t get me wrong, the DBT-FST skills are extremely powerful in communicating with someone with BPD. Yet, the change that is requested is at the end of the chain. I have heard that Marsha Linehan is quoted as saying something like, “Just because you feel like a crazy person, doesn’t mean you have to behave like one.” The point here is that DBT is a behavioral therapy and by modifying behavior, that works backwards toward regulating emotion and tolerating distress. In other words, DBT trains you to behave differently based on your feelings. When you gradually learn that your new behavior is more effective than the previous behavior, you break the conditioned chain between Action Impulses and Expression and Behavior. That is the essence of the DBT skill “Opposite Action.” An interesting side note is that by practicing Opposite Action (that is, doing the exact opposite of what your feelings implore you to do – such as engaging when you feel sad, rather than hiding under the covers all day), you actually feel better, because the action does work backward. Dr. Paul Ekman found that configuring one’s face to mimic a certain feeling actually causes that feeling to be experienced. That is the theory behind DBT’s “Half Smile” skill. Ultimately though, by working at that link in the chain, the person still feels the emotion, yet he or she just behaves differently than the emotion originally informed him/her to behave.

MBT on the other hand takes on the on the problem at the Interpretation link. By asking questions and being open to alternative interpretations, the person with BPD is more likely to have a broader view of other people’s behavior and the events in life. DBT never asks about the intent or motivation of the other person and just takes the interpretation as a given in a person with BPD. If a person with BPD says something happens and that something means X, then in DBT it means X. There is very little questioning of the validity of the interpretation X. In MBT, however, the interpretation X can be questioned and alternative interpretations (such as Y or Z) can be examined. The nice thing about this is that when the person with BPD is faced with a similar situation, he/she is less likely to jump to conclusion X and might consider Y or Z.

An example of the differences in the two approaches is as follows:

My daughter comes home from school after being teased by a boy on the playground. My daughter ends up throwing a thermos at the boy’s head.

With DBT, I would validate her anger and ask her how she could behave more effectively the next time this teasing occurs. So next time she will behave more effectively and not throw the thermos.

With MBT, I would validate her feelings and begin to probe with curious and straight-forward questions as to the intent of the boy. Perhaps he actually likes my daughter and that is why he is teasing. Perhaps he is showing off to his friends. If this approach is taken, my daughter is more likely to consider the boy’s motivation for the teasing. If she understands the motivation, she can actually never get angry and risk throwing the thermos.

All of that being said, I believe these skills have to be learned as a “ladder” to effectiveness. You can’t start at point E without going through points A-D. DBT-FST provide the foundation for more advanced skills, like those in MBT.

I was thinking about it and discovered the following ways of thinking (there be may be more, but this is what I have for now). I am sharing this as a first look into where I am going with my latest book on achieving psychological, cognitive and emotional freedom in your life.

“If only”

If only is a way of thinking in which the person says to themselves “I would be happy or content, if only a certain thing occurred or if only I had a certain thing.” It is a way of objecting to the unfairness of the world. It is a form of projective, delusional thinking… Like, “if only I won the lottery I would be happy” or “if only my partner would have sex with me more, I’d be happy”… Etc. It is equivalent to asking oneself “If I could have one thing/state, I’d be ok”

“What if”

What if is different than “if only” because “what if” can be either positive or negative. What if can stimulate alternate views on the future and it can also be a substitute for “if only”. If used as an iterative testing framework, “what if” can help a person understand the possible outcome of variable changes. However, one must not assume the outcome of a “what if” – sometimes, because of the complexity of variable conditions, changing one variable could lead to unexpected outcomes.

“As if”

“As if” is an engagement of pretend mode in which some pretends as if they know something or something exists when they have no insight into the subject matter – they don’t get it – they merely bullshit their way through “as if” they get it.

“As is”

“As is” is a way of accepting reality as is and not struggling against that over which you have no control or that which you can not change. As is accepts that which is as it is and changes that which can be changed.

One piece of advice that I would provide to partners of people with BPD is that if you can’t accept the person “as is” and love them for what they are, it is most likely never going to work out in the long run. If you can’t accept them “as is” and consider any changes in the relationship or in their behavior as a bonus, then you are actually engaging in “if only” thinking.

I haven’t written anything about either Nadya Suleman or Kate Gosselin in my blog, because I really don’t know that much about either of them. However, recently I have been watching each of them a bit and trying to figure out what the heck is up with them. Each has a multitude of children, conceived by in-vitro. Each seems to desire public approval/affection. I am not suggesting either of them has Borderline personality Disorder (BPD), because I don’t know enough about either to suggest that that condition (of which I write about in this blog) is even suspected in either. I have seen others suggest a variety of conditions for each of them including BPD (and NPD), but I just don’t know.

The reason I am posting this message though is because both of them seem to have a craving for affection, attachment and love. It appears to me that each had all these children such that they could be unconditionally loved by as many people as possible. I wonder what happened in their childhood (or if anything happened) that would drive this strong desire to have as many children as they have had.

I have decided to add phone support to my bag of tricks today.  Here’s how it works…

Step 1: Click on the “Buy Button” and purchase a number of hours of phone support.

Step 2: I will authorize your payment, but not charge you (debit cards may not have the money available though)

Step 3: I will send you an email with a set of times that are good for me and you can deicide on one of the times or suggest others.

Step 4: I will set up a temporary conference call number with a code into which we both will call.

Step 5: We will have the phone call.

Step 6: I will charge you.

That’s it. I am doing this in response to several requests for phone support that I have received through email.

Here’s the “Buy Button”:

 

This is NOT mental health counseling or therapy of any kind. It is consultant, learning, advice and support.

The other day I received a nice comment from a woman with BPD.  She told me that she was planning on revealing to her long time significant other that she has been diagnosed with Borderline Personality Disorder (BPD). She said that she was planning on giving him 2 books – “When Hope is Not Enough” (my book) and “I Hate You Don’t Leave Me”. She was hoping that her SO will better understand her by reading these. Personally, I was flattered. To have my book used in that way makes me quite gratified.

Here is a quote from the end of her message to me:

Another thing that I really appreciated about your book is that it’s both empathetic for the person with BPD and for those around him (sorry, not buying your “her” pronoun ). I found it incredibly non-judgemental for a book about BPD. Generally, books on the subject either gloss over the distress that relatives of BPs may feel (because it’s not the subject) or are incredibly insensitive in their descriptions of BPs. I can’t begin to tell you how much I appreciated that your book was not describing me as some cold-blooded monster revealing in torturing others. I was, however, intrigued by the part in which you talk about poor self-esteem in BPs as a pathological trait (I don’t have your book with me right now, so I can’t quote you precisely on this one). There’s one thing about BPs that can’t be denied, they’re poor partner choices. So when I tell my bf something along the lines that he could have done better than me, I think it’s pretty much a realistic perception. I mean – if only a small part of what is written about BPs is true (and in this regard, your book is the cream of the crop of non-judgementalness) it would still be realistic from BPs to think of themselves as poor partners, if not as poor human beings.

So, that was about it. Congratulations for the good job.

As you can see by her kind words, here is someone with BPD feeling that “When Hope is Not Enough” is empathetic and non-judgmental which was exactly my intention when writing the book. If you have BPD and want a book to help explain to your loved ones… “When Hope is Not Enough” is an excellent choice. Although it is short, it is dense and packed with information. I’d have to say “But I Love You” which is my shorter guide for loved ones of people with BPD is probably not quite as empathetic and non-judgmental as “When Hope is Not Enough”.

Over the past two days on the ATSTP Google Group, I have been happy to see some success exhibited. Many people on the Internet and on Internet email supports lists for Non-BPs will tell you that there is no hope of having a relationship with someone with BPD. Often I have seen that the only “advice” given to Nons is: RUN AWAY! Even on the “staying” sites and sub-sites, many people think that it will never get better EVER – which to me is a form of black-and-white thinking that Nons engage in.

While hope may not be enough, the BP/Non-BP partner relationship is not without hope at all. This week I received two messages from the ATSTP Google Group that gave me some hope. One was from a long-time member of the group (he’s been a member for about 2 years) and it goes like this:

I truly consider myself still part of the ATSTP community even tho I’m less deeply immersed in it now. And the reason I’m less deeply immersed now… is because I’ve learned the lessons I needed to and moved on. If this is my alma mater… consider it mission accomplished in preparing me for “college” or even the “job field” of succeeding with a BP. I arrived at grade-school level. I’m now at high-school-grad level… I recognize you, Bon, at the college-masters-instructor level. And I’m so grateful, that you have been here for me! So, thank you… keep up the spectacular work! You benefit not only your family, but so many of us out here in the world! You have made THE DIFFERENCE, in my life! I thank you profusely, and ask that you keep me ‘in the loop’ in areas which I might be able to help in or find interest in. Thanks SO MUCH, Bon! Thank you ATSTP! You’ve helped me learn and grow SO much!

It’s wonderful to hear that someone has truly benefited from the sharing, caring and skills teaching that go on at ATSTP. One success story (out of so many failures on other boards) really warms my heart.

Now as for the other message that I received – this one is from a “newbie” to the list. She joined on May 8th and has read my book “When Hope is Not Enough”. She just started applying the skills with her husband. Here’s her message:

This s#$t really works. (sorry to use that word but I wanted to express my excitement!) I used some validating words (the ones I could remember at the moment) and helped my husband calm down twice this weekend. I liked the results and am looking forward to finishing “When Hope is Not Enough”

So, here we have on person that is near the end of the path toward effectiveness and one that is at the very beginning. I’m just gratified that the methods that are provided in “When Hope is Not Enough,” on this blog and, most importantly, in the ATSTP Group are actually helping people get a handle on their relationship with their loved one with BPD.