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Why Aren’t There More Resources for Adult Self-Injurers?

Even getting adults to commit to group therapy can be a challenge. Adults are burdened with more responsibility than adolescents and may have trouble finding the time and effort to make the commitment for their own healing, even when resources are available.

Why Aren’t There More Resources for Adult Self-Injurers?

By Renée Fabian 03/21/17
Over time, self-injury itself can become a habitual, nearly addictive behavior, and 8.7 percent of self-injurers are also addicts.

Erin Hardy, a Wisconsin-based therapist, found herself in a quandary when an uptick of people who self-injured came to her about five years ago. This was a new area to her practice, so Hardy sought consultation with her colleagues on resources, but they came up empty. An internet search left Hardy with unsatisfactory results.

“All the sudden I had this flood of individuals that were engaging in self-harm,” says Hardy. “There is really nothing [online] about self-harm other than the theme of, ‘Anybody who self-injures has borderline personality disorder,’ and … ‘there’s no cure, nobody can get better.'”

Undeterred, Hardy kept searching until she found S.A.F.E. Alternatives, an organization co-founded by Wendy Lader and Karen Conterio in the mid-1980s dedicated to self-injury recovery with the belief, “people can and do stop injuring with the right kinds of help and support.” Through their S.A.F.E. Focus program, Hardy got the training and materials she needed to lead a dedicated self-injury support group in her city.

Today, a similar internet search for self-harm resources yields information focused on adolescents. As one PsychForums member put it, “I have been online searching for several hours today regarding finding help for self-harm, and I’m 40. I have been seeing that it is mostly in young people, and feeling pretty embarrassed and ashamed that I’m an adult dealing with it. I feel like I should have grown out of this long ago.”

The pervasive idea that self-injury is a behavior relegated to emo teenagers is simply false. Self-injury affects 4 to 5.5 percent of adults, yet the stigma persists, leaving millions of self-injurers to struggle in silence and feel invisible.

Defined as intentionally harming the body without suicidal intent through behaviors such as cutting, burning or hitting oneself, self-injury serves as a maladaptive coping skill to deal with difficult emotions, experiences and feeling states.

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Dialectical Behaviour Therapy (DBT) and the Buddhist Philosophy

DBT deals with intense and labile emotions. There is a connection between mindfulness and emotion regulation. Mindfulness facilitates adaptive emotion regulation.

Dialectical Behaviour Therapy (DBT) and the Buddhist Philosophy

Posted on March 20th, 2017
Ruwan M Jayatunge M.D.

Dialectical behavior therapy (DBT) is a modified form of cognitive behavioral therapy (CBT) that was developed in late 1970s by Marsha M. Linehan a psychology researcher at the University of Washington (Linehan, 1993). DBT is an empirically supported treatment for suicidal individuals (Linehan et al., 2015). It can be adapted to treat borderline personality disorder patients with comorbid substance-abuse disorder (Koerner & Linehan, 2000) and depressed elderly clients with personality disorders (Lynch et al., 2003). DBT addresses deficits in emotion regulation, distress tolerance and interpersonal relationship.

The patients with borderline personality disorder have faulty schemas and splitting in the patient’s relations to others. They have frantic efforts to avoid real or imagined abandonment. Often they have pattern of unstable and intense interpersonal relationships, impulsivity, emotional instability and recurrent suicidal behavior. In addition they are impacted by chronic feelings of emptiness. Borderline personality disorder is treated with psychotherapy and medication. Dialectical Behavior Therapy and Buddhist Psychotherapy are effective in treating borderline personality disorder.

The basis for DBT is stemming from the mindfulness practice of the Buddhist teachings and the philosophy of dialectics. Mindfulness according to the Buddhism is bare attention a sort of non-judgmental, non-discursive attending to the moment-to-moment flow of consciousness (Sharf, 2015). Mindfulness meditation has three overarching purposes: knowing the mind; training the mind; and freeing the mind (Fronsdal, 2006). As described by Palmer (2002) developing the capacity for being mindful and living in the moment allows a greater potential for feeling appropriately in charge of the self.

DBT combines mindful awareness largely derived from Buddhist meditative practice. Kirmayer (2015) concluded that Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psycho-therapeutic intervention. Since the 1990s, mindfulness meditation has been applied to multiple mental and physical health conditions, and has received much attention in psychological research (Tang & Posner, 2013). Mindfulness has been described as a practice of learning to focus attention on moment-by moment experience with an attitude of curiosity, openness, and acceptance (Marchand, 2012) Schmidt (2004) states that mindfulness is strongly related to compassion, and it is compassion that serves as a source for all healing intentionality. Both mindfulness and self-compassion involve promoting an attitude of curiosity and non-judgment towards one’s experiences (Raab, 2014). The core mindfulness skills (focus, compassion, curiosity, inner calm, balance, and awareness) lead to serenity.

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Selena Gomez on Instagram Fatigue, Good Mental Health, and Stepping Back From the Limelight

“DBT has completely changed my life,” she says. “I wish more people would talk about therapy. We girls, we’re taught to be almost too resilient, to be strong and sexy and cool and laid-back, the girl who’s down. We also need to feel allowed to fall apart.”

Selena Gomez on Instagram Fatigue, Good Mental Health, and Stepping Back From the Limelight
MARCH 16, 2017 7:01 AM

by ROB HASKELL

On an unusually wet and windy evening in Los Angeles, Selena Gomez shows up at my door with a heavy bag of groceries. We’ve decided that tonight’s dinner will be a sort of tribute to the after-church Sunday barbecues she remembers from her Texan childhood. I already have chicken simmering in green salsa, poblano peppers blackening on the flames of the stove, and red cabbage wilting in a puddle of lime juice. All we need are Gomez’s famous cheesy potatoes—so bad they’re good, she promises. She sets down her Givenchy purse and brings up, in gaudy succession, a frozen package of Giant Eagle Potatoes O’Brien, a can of Campbell’s Cream of Chicken soup, a bag of shredded “Mexican cheese,” and a squat plastic canister of French’s Crispy Fried Onions.

“I bet you didn’t think we were going to get this real,” she says, and when I tell her that real isn’t the first word that springs to mind when faced with these ingredients, she responds with the booming battle-ax laugh that offers a foretaste of Gomez’s many enchanting incongruities.

But real is precisely what I was expecting from the 24-year-old Selena, just as her 110 million Instagram followers (Selenators, as they’re known) have come to expect it. Of course, celebrity’s old codes are long gone, MGM’s untouchable eggshell glamour having given way to the “They’re Just Like Us!” era of documented trips to the gas station and cellulite captured by telephoto lenses. But Gomez and her ilk have gone further still, using their smartphones to generate a stardom that seems to say not merely “I’m just like you” but “I am you.”

“People so badly wanted me to be authentic,” she says, laying a tortilla in sizzling oil, “and when that happened, finally, it was a huge release. I’m not different from what I put out there. I’ve been very vulnerable with my fans, and sometimes I say things I shouldn’t. But I have to be honest with them. I feel that’s a huge part of why I’m where I am.” Gomez traces her shift toward the unfiltered back to a song she released in 2014 called “The Heart Wants What It Wants,” a ballad about loving a guy she knows is bad news.

She sees her shrink five days a week and has become a passionate advocate of Dialectical Behavior Therapy, a technique developed to treat borderline personality disorder that is now used more broadly, with its emphasis on improving communication, regulating emotions, and incorporating mindfulness practices. “DBT has completely changed my life,” she says. “I wish more people would talk about therapy. We girls, we’re taught to be almost too resilient, to be strong and sexy and cool and laid-back, the girl who’s down. We also need to feel allowed to fall apart.”

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Borderline or Bipolar: Can 3 Questions Differentiate Them?

The Prisoner’s Dilemma paradigm separates the two, but that’s not practical as a clinical tool.

Borderline or Bipolar: Can 3 Questions Differentiate Them?

January 10, 2017 | Bipolar Disorder, Mood Disorders
By James Phelps, MD

Treatments for borderlinity and bipolarity are quite different. Which approach should you consider for a patient with impulsive risk-taking, episodes of irritability and hostility, fractured relationships, substance use problems, and severe depressions with brief phases of remission (maybe too good?) in between?

The Prisoner’s Dilemma paradigm separates the two,1 but that’s not practical as a clinical tool. What if you could pluck just 3 items from a standard bipolar screening questionnaire and increase your diagnostic certainty by 30% when faced with this common differential? That may be possible, based on a new study from Nassir Ghaemi and colleagues, led by Paul Vöhringer.2

Of course, replication studies will be needed before we can declare a new diagnostic approach is at hand. But in the meantime, I hope you might be curious: what 3 items from the good old Mood Disorders Questionnaire (MDQ)3 were so discriminating?

Vöhringer et al2 obtained an MDQ from 260 patients whose diagnosis was then established by structured interview (the usual gold standard in this kind of study). Then they analyzed the individual MDQ items looking for those that discriminate well between bipolar disorders and borderline personality disorder. They found 3, a “clinical triad,” that had remarkable statistical power:

1. Elevated mood: “You felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?”

2. Increased goal-directed activities: “You were much more active or did many more things than usual?”

3. Episodicity of mood symptoms: “If you checked YES to more than one of the above, have several of these ever happened during the same period of time?”

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Alan Fruzzetti speaks at McLean on Family Skills and Family Interactions with BPD

Living with mental illness: Learning to accept your positive traits with the rest

I’m empathetic, intuitive, resilient and intense.

Living with mental illness: Learning to accept your positive traits with the rest

Mental health blogger Fiona Kennedy looks at the positive traits associated with BPD

I came across an image on Twitter recently, listing the positive traits of people with borderline personality disorder (BPD). Among them were: passionate, empathetic, creative, artistic, intuitive, resilient, intelligent, witty, spontaneous, intense, devoted… You get the idea.

A few months ago, when I was firmly of the conviction that BPD was an illness, something I’d have for the rest of my life, I would have found this very reassuring. So much of what’s written about BPD paints people with this diagnosis in an extremely negative light, it’s always refreshing to come across something more positive. There would also have been a little niggling feeling of something not sitting right though – that BPD defined every aspect of who I am, good, bad and indifferent, that it was all out of my control.

However, in recent months I’ve been coming to a very different understanding of the term ‘mental illness’ and all that it entails. This is very new to me, and I’m still learning, so forgive me if I’m not making a whole lot of sense. I’m struggling to grasp the extent of it myself. But here’s a thought – what if what we know as mental illness isn’t actually an illness? The symptoms are very, very real, and I’m not denying those for a second. But what if those symptoms point to something more than just a label? What if they point to a reason for the label?

Let me try and explain. I’ve recently started working with a therapist who has some very interesting theories, the most significant of these being that two of the most common mental health difficulties, depression and anxiety, are not in fact illnesses, but emotion(s) tied to events from our past that our brains haven’t processed. Please don’t stop reading!! I was really, really sceptical too. But the more I’m learning about it, and actively experiencing the therapy, the more sense it makes.

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