Anything to Stop the Pain - BPD and Non-BPs

From Marsha Linehan article on everything2:

Dr. Linehan’s education was based in the established field of cognitive-behavioral psychology, which the video refers to as `a technology of change’, focused on changing behavior through learning and experience. However, while treating borderlines in the early 1980s, Dr. Linehan decided that the cognitive-behavioral model that she was working with was insufficient, and that she needed to incorporate an element she calls `radical acceptance’. Dr. Linehan makes clear in her videotaped presentation that `acceptance’ was a real buzzword in psychology around the time that she started to promote DBT, but she maintains that her idea of `radical acceptance’ is different. When most psychologists talk about `acceptance’, she states, they mean `acceptance as change’, accepting the client in order to create a change, accepting the client’s unfulfilled potential instead of the client’s actual being. Dr. Linehan believed that for her borderline clients to get well, therapy needed to involved a level of acceptance that would go above and beyond `acceptance as change’. For inspiration, she turned to Eastern psychology as translated into Zen Buddhist meditation practice. However, fearing that her colleagues due to their cultural biases would not take her work seriously if she were to call it `Zen Behavior Therapy’, Dr. Linehan also researched Western philosophical traditions. There she discovered dialectics, the approach in which thesis paired with antithesis brings synthesis. Dialectics seemed appropriately seasoned for the Western palates of the practitioners who would be reading her work, and thus, DBT was born.

http://www.everything2.com/index.pl?node_id=1688345

bon :: Jun.09.2007 :: DBT :: No Comments »

A link from self-injury.net, a site by a young self-injurer. These biographies were written by the author of the site. They include:

• Diana, Princess of Wales
• Colin Farrell
• Fiona Apple
• Johnny Depp
• Courtney Love
• Angelina Jolie
• Amy Winehouse
• and others

I wonder if any of these people are also borderlines. No star is willing to come out and publically say they are.

http://self-injury.net/doyousi/famous/

bon :: Jun.07.2007 :: Celebrities, Self-Injury :: No Comments »

This is a portion of a message that I posted on WTO many months ago. I will probably cut some more out of it and post it here, because I think it is important. I have removed some of the details and responses to other messages that would not make sense here:

I think people often make mistakes in “self-diagnosis”. For all I know, half the people (or more) viewing these messages are not dealing with BPD at all, but instead something else. That is one of the reasons that a couple of months ago, I specifically asked a mother on this board whether her daughter was diagnosed with BPD and how old the daughter was – because the behavior that she described could be attributed to many “disorders” (including the disorder of being a teenager).

There is a movement within the psychiatric community to change the name of BPD. Some also want BPD to be classified as an Axis I disorder. So, it could be that “borderline personality disorder” will not exist anymore and BPD will not be a “personality” disorder anymore. The point of saying this is that I think the traits of which you speak are shared among many different disorders, personality or otherwise.

In the CBT community, one of the things they talk about is “cognitive distortions” - basically thinking in a way that doesn’t match the “objective” facts. Here is a snip from “The Feeling Good Handbook” about cognitive distortions:

All-or-nothing thinking: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.

Overgeneralization: You see a single negative event as a never–ending pattern of defeat.

Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

Disqualifying the positive: You reject positive experiences by insisting they “don’t count” for some reason or other. You maintain a negative belief that is contradicted by your everyday experiences.

Jumping to conclusions: You make a negative interpretation even
though there are no definite facts that convincingly support your
conclusion.

Mind reading: You arbitrarily conclude that someone is reacting negatively to you and don’t bother to check it out.

The Fortune Teller Error: You anticipate that things will turn out badly and feel convinced that your prediction is an already-established fact.

Magnification (catastrophizing) or minimization: You exaggerate the
importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow’s imperfections). This is also called the “binocular trick.”

Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true.”

Should statements: You try to motivate yourself with shoulds and
shouldn’ts, as if you had to be whipped and punished before you
could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should
statements toward others, you feel anger, frustration, and resentment.

Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him, “He’s a damn louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.

Personalization: You see yourself as the cause of some negative external event for which, in fact, you were not primarily responsible.

Now, at times everyone, disordered or not, does some of these
things. In the case of BPD, many of these distortion can into play.
But these distortions are shared with other disorders and with “normal” thinking.

bon :: Jun.07.2007 :: DBT :: 1 Comment »

Hi all. I have been monitoring the “non” email lists and have found a common idea that I believe is a misconception about borderlines.

A taste of this idea can be seen in this paraphrased comment:

When will my BP be willing to take responsibility for his/her actions? When will he/she try and fix the harm he/she has done to me and the kids? When will they finally admit they are WRONG?

This attitude is common among “nons.” What it represents is anger and sadness on the part of the non and a desire for the borderline to behave in a “normal” way.

Unfortunately, the borderline will not behave in a “normal” way until the source of the behaviors are either accepted or changed. This site (and many others about Borderline Personality Disorder) posits that borderlines behave in the way that they do because they are in pain. This pain is deep and emotional and is characterized by shame. They do not feel guilty for what they do. No, they feel shameful about who they are. They believe that they are bad/wrong people. Why do so many kill themselves? To stop the pain.

The anger that the “non” expresses comes off to the borderline as judgment of their feelings. One of the key “causes” of BPD is an invalidating environment. If they are acting in a way the “non” feels is “wrong” the expression of that feeling on the part of the non is a judgment of the BPD’s feelings. In other words, they have internalized that it is wrong to feel that way. The problem is: they feel that way anyway, whether the non believes it is wrong or not. They behave in such as way to stop the painful emotions (mainly shame) and the judgments that come from the invalidating environment.

People in the “non” support groups don’t want to hear this. Why? Because they too are in pain. They are angry and want to be told that none of this is their fault. The disorder is not their fault, but the continuation of the “invalidating environment” is. A quote from an article of DBT Family Skills Training:

Facilitated by DBT’s nonjudgmental framework, DBT-FST offers the possibility of significant emotional and behavioral improvements in the whole family system as well as for the individuals in that system. This is accomplished through:1) presenting the biosocial model to patients and family members in a non-blaming manner similar to the approach employed in psychoeducation models;2) offering support and education to family members in the form of teaching DBT skills; and3) reinforcing skillful behaviors (in particular using rehearsal and feedback) through increasing the levels of empathy and validation in the family.

(emphasis mine)

Note the “non-blaming” manner. This illustrates a new environment that the family members can help create that supports the BPD and eliminates blaming (or judging). The second two points are the ways in which things will change -teaching skills that can be used instead of the old maladaptive behaviors like cutting or starving or raging.

While many nons might be angry at me for pointing out that they need to change also, I feel that these skills provide a sense of control over the situation. The non-judgmental approach applies to the nons too - meaning, we can’t “judge” the actions of the non are “wrong”. Instead, we can see the actions of the non can be painful to the borderline.

That said - many nons don’t want to hear that they have being acting toward their borderlines in painful ways. They too don’t want the blame. But I am not saying these things to “assign blame.” No, I am saying these things to try and help empower the non with skills that help the borderline with his or her feelings. In that way, life can get better for all involved.

Bon Dobbs :: Jun.06.2007 :: Anger, DBT, Borderline Personality Disorder :: No Comments »

Tools and the Borderline

I found this post to the thread “Author of Eggshells Workbook is a Moron” from a cached copy of the “Crazy Talk” web forum.

Unfortunately, the Crazy Talk board has moved to a new server and the old threads were not carried over. I guess Google will maintain it in their cache for a while. The thread itself is a quite interesting version of several borderlines’ views on the SWOE workbook. Here is a particularly insightful post responding to the idea that borderlines are “manipulative”:

I don’t think that, in most cases anyway, that the “manipulative” BPD behavior is deliberately so, despite appearances - thus it cannot be truly manipulative, by definition. These behaviors DO have a function and an objective, as do all behaviors (including brushing one’s teeth), but we do not describe ALL non-disordered people’s attempts to find or maintain love or get attention or avoid pain manipulation - only when it truly is just that.

I think a new word is called for.

More accurately, the behaviors in question are more like “tools”. Lacking a circular saw, I may try a hatchet to cut my board so I can cover my window and keep out the chill. It is not as effective, and is potentially damaging and will make a pretty ratty and half-assed covering, but it is the only tool I have to do what I need to do.

Granted, those with BPD/PD loved ones need to find ways to protect themselves, but applying such language ideas as “manipulation” does not give the “other” proper tools, either.

The overall effect is two people standing around with hatchets trying to make a straight cut down the length of an oak plank. Ain’t gonna work.

bon :: Jun.05.2007 :: Manipulation :: No Comments »

The Virginia Tech shootings made me want to say a thing or two. There was immediate a lot of talk about gun control and of the shooter’s ability to buy guns and ammunition despite having been found by a court to be a danger to himself and others. I think that the pundits should discuss the real issue here and it is not gun control. While it may still be a good idea to have stricter gun laws, it is not the gun that did the killing; it was Cho himself that used the guns as a tool of murder.

The true problem was that Cho was mentally ill and did not seek treatment for his mental illness. I am not going to postulate as to what actual diagnosis that Cho had (I am not qualified to do so) - I will suggest that his true problem was probably emotional. He was unable to control his anger and rage. I would also like to point out that he carried around shame and self-hatred. When inner shame is left untreated, it often leaks out as anger and rage. It is extremely difficult for a person with inner shame to take ownership of that shame. Instead, it bubbles underneath the surface and comes out as anger toward those that have wronged them. I suspect this was Cho’s real problem. He was humiliated throughout his life and, quite possibly, had a biological pre-disposition to emotional dysregulation. The combination of these two factors - biological and environmental - adds up to self-hatred, shame and a persecution complex. I am not suggesting that all people with this sort of make-up and history are dangerous or would take that rage out on other people. In fact, many people with those issues end up taking their inner rage out of themselves - through suicide or risky behaviors. It seems to me that Cho couldn’t handle his shame or his intense emotions, so he acted to take revenge on other people. In doing so, he handled his emotions poorly (obviously). He probably also believed that shame to be true; meaning, he hated himself and thought other’s teasing and bullying was deserved. In pointing out the feeling that he believed to be true (that he was a bad, worthless person), he took revenge on all other people, regardless of whether they participated in his belittling.

The point of this post is to say that what we really need in this country is better and more assessable mental health care. We need to teach people, adults as well as children, about the functions of emotions and the skills that can be utilized to handle those emotions. We educate people about academic subjects everyday, but do very little to teach self-regulatory skills for emotional states. For some people, these emotional regulation skills are the very ones that can save their lives (and, in Cho’s case, the lives of others).

bon :: Jun.04.2007 :: Emotions, Anger :: 1 Comment »

Recently, I have had about 20% of the searches on this site involve someone trying to find out about lying. These searches included: “pathological liar”, “BPD and Lying”, “why does bpd lie?”, etc. It seems one on the most difficult things for the non to accept is BPs lying. Here is a note I posted on WTO some time ago about lying - I think it still applies.

As for lying, I believe that all people lie (or are willing to lie) when the truth is too painful to be told - even ifthat feeling of pain is not based in reality. Do BPs lie more than other people? My short answer is “Yes”.

I think the main reason is because of the intense sense of shamethat they feel. I have come to realize that shame is the core emotional component of BPD. I have also come to realize that many people mistake PTSD for BPD (although BOTH can be part of the mix,my wife has both components). In PTSD FEAR is the key emotional component. In depression, it is sadness. In Intermitant Explosive Disorder it is anger.

BPD is a “personality” disorder because shame is not a “primal”emotion - like fear, anger, joy, sadness, disgust and contempt. No,shame is an emotion evoked in relationship to other people’s senseof judgment. You can’t feel shameful without a sense that what you’re doing (or, in the case of BPD, what you ARE) is “wrong”.

All people have different capabilities for handling emotions. BPs seem to have a diminished capacity for handling theirs - and, since shame is key, they are more likely to “hide” the truth (even from themselves). In the case of lies, if they feel that the truth would reveal something shameful, they lie IMO. In the case of my wife, she lies if she feels that she will be judged for telling the truth.That is where the shame component arises. If she feels that I (or anyone) will judge her behavior (really, her feelings) as “wrong”or “bad”, she will likely lie, either by admission (actually sayingsomething that is not true) or omission (leaving out the truth). The deal seems to be that she feels the shame in telling the truth, that shame is painful (as it is for everyone) and to avoid that pain, she lies. In other words, her lies are all about protecting herself frompain and judgment (even self-judgment) and have nothing to do with me. It is not personal.

If avoidance of pain is considered “disassociation” (which in some cases avoidance of intense pain DOES cause real disassociation),then I think you could say that she “disassociates” from the painful truth.

On a final note, I also believe that this shame-sense is misplaced.They have nothing to FEEL ashamed of - sure, they do all kinds of “shameful” things, but only in relation to other people. If my wife cuts herself, she does so without shame and not to get other people’s attention. Still, at the core of her being is a sense ofshame - like she has a deep, dark secret she must protect - even though there’s no real secret there. I suspect this comes from the BP’s shaky sense of self. She will do anything (including lie) to protect what’s not even there.

bon :: Jun.04.2007 :: Lying :: 1 Comment »

Main Assumption: BPD is an emotional disorder in which the sufferer experiences extremely intense emotions and has more trouble than “normal” people do returning to “baseline” (they have a long “refractory period”). Notice I didn’t say “moods” - it is not a mood disorder (like bipolar) because moods last a long time. Emotions are short lasting and can spur other emotions. Ever notice how your BP can swing from sadness to anger to shame to elation all in about an hour (or less)?

If that is accepted then the next step is: what does one do about that? The best answer I can come up with is to use validation. If you feel something emotionally, you usually don’t have a “choice” not to feel it. Emotions are very valuable to us - they can save our life (as evidenced by the automatic fear reaction when a car swerves in front of you). So, some form of the emotion is valid, even if you think it isn’t “right” in these circumstances.

So, how does one validate an emotional state? You must identify it first. So, if your BP looks angry, you say “It seems like you are angry. What happened?” Usually the “trigger” is something that just happened, even if it relates to some long-standing fear/disagreement. The trigger will be something that JUST HAPPENED - that is the nature of emotion (not mood) - it is immediate. These triggers may not be what you think they are at all - they may seem trivial to you, but to the BP, they are a BIG DEAL.

When they tell you want happened, VALIDATE IT. What I mean is don’t say it is “right” or “wrong” to feel that way, just that they do feel that way, because they do. In other words, if my wife says, “You called me this morning and didn’t say anything about how I got up and took care of the baby last night, I am so pissed!” I would say,”Wow, I can see that you’re so pissed, feeling that someone doesn’t acknowledge your hard work must really upset you. Anyone would be upset if they didn’t feel appreciated.” This does two things: it validates that they feel that way and it normalizes the feeling. It also does NOT admit that you did anything wrong. In other words, it validates the feeling, but not the circumstances that triggered it.

OK, so I’m done for a while more. If you do decide to try this technique, be careful NOT to make it about you. It is about how they feel, not about how you feel. This is the most difficult skill to learn because when they are yelling at you about something YOU have done, it is hard to remember it is not about you. You want to jump in there are deny or reframe the argument to defend yourself and make it about you. I would suggest not doing this. It may feel “right” at the time to do that, but it will not be “effective” to dealing with the emotional state in the BP.

Also, don’t try and solve their problem (don’t try and make it better), don’t apologize, don’t judge. I know it’s hard and really, please don’t take me wrong, I am not trying in any way to invalidate the pain and struggle you guys go through as nons - really, I go through it too. I am not criticizing what you have been doing so far or what is working for you. I am not saying, “you’re doing it all wrong.” If what you are doing works, by all means keep it up. If what you have been doing so far doesn’t work, try this out and see if things get better. If it doesn’t help, try something else.

bon :: Jun.03.2007 :: Emotions, Borderline Personality Disorder :: No Comments »