Anything to Stop the Pain - BPD and Non-BPs

One of the most searched-upon subjects in this blog (and talked about in our ATSTP Google Group) is the subject of lying by someone with BPD. The nons are confused by untruthfulness on the part of someone with BPD and wonder how the person with BPD can have any credibility or trustworthiness when, clearly, they continue to tell bold-faced lies. In my response to a recent poster within the ATSTP group, I recently made a new revelation about truthfulness and lying by someone with BPD.

I have long said that someone will lie when telling to truth would cause more emotional suffering than lying would. However, that statement seems to indicate that there is a level of calculation when the lies arise. It infers that someone, when actually telling the lie, is deciding beforehand whether to tell the truth or not. For people with BPD, feelings = facts. It is not the events that matter to them, but how they feel about these events that truly matter.

So, two things have come to mind for me in this regard. One is that the experience of “reality” is filtered through those feelings and the person with BPD will reflect how they feel about them. If they have strong feelings about what has happened, they will actually experience things in a different manner than those of us who are rational in the face of the same events. It can hardly be called a lie in some ways because it is how they experienced reality. I lsitened to an audio CD on Buddhist a while back and there was a statement made that went like this: An artist doesn’t paint a picture and then put his “style” into the painting. He paints the picture through the lens of his style. That is how he or she sees the world. The same seems to be true for people with BPD and their emotions (rather than style).

The second thing that came to mind is the actual telling of the lie to a particular person. If someone with BPD feels that, by telling the truth, his or her feelings will be invalidated and judged by the other person, they will lie either by admission or by omission. If they don’t feel safe sharing the “truth” (and to them the truth is their feelings, not the events/behaviors themselves), they will not trust the other person with their feelings. In order to get a more truthful report from a person with BPD, one has to learn to listen to the feelings and not judge those feelings – which is extremely invalidating to the person with BPD and at the core of their “personhood” (since their feelings are immediate and strong and block out other more “objective” views of the situation). If you can listen to the feelings and validate those (for feelings are not right or wrong, they just ARE), I suspect you will get much more truth out of a person with BPD. But the truth you will receive is the truth for them, which is, of course, their feelings about an event. Still, once you start actually hearing and validating these, the level of trust accorded to you by the person with BPD will go up measurably.

Bon Dobbs :: Sep.25.2007 :: Validation, Lying, Borderline Personality Disorder :: No Comments »

I found this in the Amazon blog of the guy who was the editor of the
Mindfulness and Acceptance book…

(snip)
Acceptance, mindfulness, values - how do we use them in dealing with
our emotions? We need to:

Learn to accept our feelings, without being dictated to by them and
without quickly acting to remove ones we do not like. Trying to get
rid of feelings only drives them underground, while simultaneously
giving them more capacity to control behavior without our awareness.
Acceptance of emotion requires another step, however.

Learn to watch our thoughts, without reflexively adopting the
worldview mindlessly structured by them. Thoughts are easily
programmed, and they are nothing to be right about - or wrong about.
They are just thoughts. Some of those thoughts will not be attractive,
because they are constantly being programmed by sources we do not
control. We will hear in our own minds the echoes of judgment, bias or
prejudice to which we are exposed nearly every day.

The point is not to “feel bad” about the existence of such thoughts in
our heads, nor to feel self-righteous about the thoughts that we agree
with - the point is to be more conscious, open and flexible in how we
translate thoughts into action. Knowing how to do that requires a
final step.

While staying aware of our feelings and thoughts, make mindful choices
about what we’ll actually do based on chosen values. Our emotions are
a legacy of our entire development as a species, and our thoughts are
an echo of our history. Fear, anger and desire are part of the human
condition. They can sensitize us to what is going on in the moment -
but we have to learn how to have them without being had by them.

The emotional imperative of “now” is just too automatic and mindless
to be trusted. We need to learn to be guided by our values and
choices, not just our emotional and cognitive programming. Human
beings are the only animals who can interpose mindful awareness and
values-based choice between urges and actions. Now, more than ever,
that is what we need.

If we do not learn how to be wiser, we have a difficult road ahead of
us as a species: expanding waistlines and expanding hate; indulgence
and suppression; rigidity and loss of control. Feel-goodism meets the
technologically expanded capacity for dehumanization. All linked to
the demand to change the emotion now.

We are conscious beings riding in a primitive emotional vehicle
programmed for another day and time. That vehicle is careering down a
mountain road with only a prayer to save us. Unless we learn to drive.
(unsnip)

Bon Dobbs :: Sep.21.2007 :: Resources, Mindfulness :: No Comments »

On a site that I previously mentioned, I found the top ten ways to improve emotional literacy.

Bon Dobbs :: Sep.18.2007 :: Resources, Emotions :: No Comments »

More Americans suffer from borderline personality disorder than either bipolar disorder or schizophrenia, but few know much about it. Leonard talks to Dr. Frank Yeomans, clinical associate professor of psychiatry at the Weill Medical College, and Christina Knight, and Kiera Van Gelder, two people recovering from BPD.

Bon Dobbs :: Sep.14.2007 :: Borderline Personality Disorder :: No Comments »

Below is a response I gave to a member with a girlfriend with maldapative BPD responses:

The purpose is really about HER and not you though. She thinks that
she is not lovable and is a bad person and is shameful inside. So when
you tell her or show her that she is not unlovable she feels a little
better. The big problem in this dynamic is the middle steps and the
assumption that she can only get validation from the outside. She
needs to learn a new way to solicit what she needs without using FOG.
She just knows no other way. A good way to do this is to have her use
DEAR MAN. Here is a link to the DEAR MAN skill:

http://www.dbtselfhelp.com/html/ie_handout_8.html

You will notice that it says: “Describe the situation when necessary -
sometimes it isn’t stick to the facts and no judgmental statements”

Clearly your girlfriend is NOT doing that. You might want to look into
the GIVE and FAST skills yourself:

http://www.dbtselfhelp.com/html/ie_handout_9.html
Look at “Be GENTLE” it says:

“People tend to respond to gentleness more than they do to harshness.
Avoid attacks, threats, and judgmental statements.
No attacks. This one is pretty clear. People won’t like you if you
threaten them, attack them or express much anger directly.
No threats. Don’t make statements like “I’ll kill myself if you….”
Tolerate a no to requests. Stay in the discussion even if it gets
painful, then exit gracefully.
No judging statements. No name calling, shoulds or implied put downs
in voice or manner. No guilt trips. ”

Clearly your girlfriend is not doing this either.

Here are the FAST skills:

http://www.dbtselfhelp.com/html/ie_handout_10.html

Read them, because I think your “giving in” feelings can be lessened
by using these. You usually use the GIVE and FAST skills together.

The assumption part is that YOU are required to make HER feel better.
In the long run, this is never lasting because you could always go
away, make another decision and go against her. That is the dynamic of
fear of abdonment IMO - it is that you will ultimately figure out that
she is a bad person (like she feels about herself) and leave her to
her on devices. All of the things that your girlfriend does boils down
to this pattern. She feels bad about herself, she feels ultimately
unlovable, she feels that the world is hostile and she feels that one
day she will be exposed for the bad person she is. That is why she
does the sex stuff, rages at you, uses FOG, etc. Her tactics are
extremely disordered but, up until now, they are effective for her (at
least for a short time). She is not getting to the root of her issues
though. SHE is the only one who can make herself feel better, not you
or anything else. Unfortunately, untreated she will continue along her
pattern, because she hasn’t addressed the core shame issues.

In the case of DBT, they work on behavior (healthy tactics) that,
after repetition, become conditioned. It could be said they don’t work
on the “root” either - they can’t “fix” her. What they can do is
replace “unskillful” tactics (FOG, cutting, threating suicide, etc.)
with “skillful” tactics (also know as “skillful means” from Buddhism).
The tactics they supply are: Mindfulness, Emotional Regulation,
Distress Tolerance and Interpersonal Effectiveness (of which DEAR MAN
is a skill). Anytime you reinforce an unskillful tactic, you make it
stronger. If you ignore it, it will subside and it is best and
quickest to subside if there is another skillful tactic (that you
reinforce) waiting in the wings.
 

Bon Dobbs :: Sep.11.2007 :: Best of, DBT :: No Comments »

The danger of seeing validation as an end-all, be-all is clear from
our last few messages. In DBT’s Interpersonal Effectiveness section
there are (at least) 3 skills that are seaparate and distinct. They
are used in different circumstances and can be used in combination.
They are:

1) GIVE
2) FAST
3) DEAR MAN

GIVE is used to “keep the relationship” and can be used when OTHER
people have strong feelings. The GIVE skills are:

Gentle (Be)
Interested (Act)
Validate
Easy Manner (Use an)

FAST is used to keep you self-respect. THe FAST skills are:

Fair (be)
Apologies (no)
Stick to values
Truthful (be)

Last, DEAR MAN is used to get what you want (including change in the
other person). They are:

What to do:
Describe
Express
Assert
Reinforce - this is the IMPORTANT part about changing behavior. You
will notice in SWOE, this Reinforce, I believe, is replaced with
Reiterate (I don’t have a copy of SWOE handy to check).

How to do it (these are left out of SWOE):
Mindfully - stay on point, you can ignore or use “broken record”
Appear Confident
Negotiate (be willing to)

So, you can see here validation is only for one thing - and it is not
change. It is for opening the communication lines - to know that you
hear and that you’re listening.

http://www.dbtselfhelp.com/html/ie_handout_9.html

Bon Dobbs :: Sep.11.2007 :: Best of, Validation :: No Comments »

I used to think it didn’t really matter if it was BPD or not. If the
person is behaving in a “borderline fashion” I used to think “ok,
well let’s read SWOE and follow the directions for taking MY life
back” - but I have changed my mind about the importance of the
diagnosis. The reason behind my changing my mind is that I believe
that BPD is an emotional disorder and that the core feeling behind
it is shame (and pain) - unlike PTSD, where the core emotion is
fear. If a person has a great deal of fear (a phobia for example),
treatment for this problem can be quite different than treatment for
shame. One might use exposure therapy to gradually desensitize the
person to what they fear and gradually they might begin to fear
less. However, if shame is the core feeling, then the natural
reaction to that emotion is to hide it and exposure just creates
more shame.

Inconsistency also seems like a harbinger of BPD. I think that
with wildly swinging emotions, people with BPD are widely
inconsistent. My wife can be manic and organized and get things done
one moment of one day and then depressed, crying and avoidant the
next. Now, you might think she is bipolar - but her moods last hours
(and sometimes minutes), not days or weeks.

A lot of her moods are governed by her medication schedule. She
recently (last week) switched off Xanax (whew!) and is
now taking Ativan, which she says “doesn’t work”. She of course
takes high doses and mixes it with alcohol, and has periods of
dyscontrol. We went to a neighbor’s birthday party on Saturday and my wife did something embarrassing.
I just took her home and went back to the party. But the
key here is that she is highly unstable in her moods. She uses the
drugs and alcohol to try and quell the pain, but they cause even
more instability.

I think that is why we often make mistakes
in “self-diagnosis”. For all I know, half the people (or more)
viewing the messages in my group 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 an email list 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. 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.

Self-harm is sort of a sure sign of BPD (although not all
self-harmers have BPD) versus, say, PTSD. And the basic self-image
thing is also key. In fact, one of the things that many “nons”
don’t “get” about people with BPD is that the borderlines hate
themselves. The nons come to the table saying “this person (the
borderline) is SO selfish!” and they are angry about all the
behavior (which they have every right to be angry, the behavior is
quite frustrating). However, they don’t understand that behind this
maddening behavior is a deep, painful self-loathing. If that self-
loathing (and shame) is NOT there, then it is not BPD. From my
experience, there are not people with BPD that are OK inside. They
are not evil (let’s not bring up Hitler again, please - I’m sticking
with Princess Di as my BPD historical figure), they are
just “broken” inside.

As for impulsiveness and extreme emotional liberation (especially via drugs or alcohol), I have seen
studies that say that those things can be transmitted biologically.
As you know, I have a 9 year old daughter (who has a fraternal twin
sister), who is specifically impulsive and subject to stormy
emotions. Over the weekend, she told me and her twin that she would
not want to run for student counsel because (in her words) she
gets “overtaken by anger” and would be really “furious” if people
didn’t vote for her. She also got angry and pushed my 3 year old son
over and he smacked his head on a bookcase (he’s ok though). When I
came in and spoke to her about it, she lied to me. So here’s a girl
that’s 9 years old and exhibits the signs of emotional unstability
and impulsiveness. But has she been abused? No. Has she been
invalidated? Yes, many times.

The reason I bring her up is that I think that BPD has a biological
base as well. There was a really interesting article that [a member of the list]
posted about biological and social contributors to BPD. Maybe I can
dig it up.

I brought up an unstable personality because, when mixed
with shame, causes extreme personalization - but it is
not unique to BPD (the unstable personality or the personalization).
The shame, however, IS (I think). I saw a study that showed that
people with BPD reported feeling shame 14 times a day.

SHAME is considered the core emotion
by some psychotherapists. That just tells me that I’m not completely crazy if I
say, “if there’s shame, there’s BPD - if not, it’s probably
something else”. But hiding shame is the natural reaction to it. So,
we nons may not see it initially.

My wife has BOTH BPD and PTSD - because of childhood sexual abuse
(the PTSD). However, as I said before, I think there is also a
biological component to BPD and I’m not sure that you HAVE to have
been abused to have BPD; whereas with PTSD, trauma is necessary
(it’s built into the name for heaven’s sake). On the flip side,
Marsha Linehan said “not everyone who is sexually abused gets BPD”
(I’m paraphrasing) - so it seems to be her belief that there must be
a biological pre-disposition there. So, if we look at her biosocial
model, we see that there are biological components in combo with
an “invalidating enviornment” (not necessarily abuse). So it could
very well be that shame is 1) built into some people (my 9 year old
feels a lot of shame herself BTW) or 2) that the “invalidating
environment” is not strictly abuse or 3) both. If I look at my 9
year old’s shame, it seems awfully unfounded to me. You can
attribute my wife’s shame to her being sexually abused (and a large
portion of BPs have been abused in some way), but my 9 year old, she
feels very shameful about the way she feels. She feels shameful in
her skin. She has already expressed suicidal ideation (at 9!).

As for cutting or “blood letting” - geting something out of your system - that’s quite wise. I don’t
know if you’ve ever read Jim Carroll’s books about his heroin
addiction (”The Basketball Diaries” and “Forced Entries”), but there
is a scene in one of them, Forced Entries I think, in which Carroll
lances and drains his infected needle sight on his arm. I know it
sounds yucky (and it is), but he really translates it in a wonderful
metaphor for getting all the filth out of his system and liberating
himself from the pain he is in.

The suicide gestures are usually impulsive with BPD.

Of course, I could take suicide out of the equation, because I
could make the same statement about cutting (or burning oneself) -
that is, 95%+ of the borderlines I have come into contact with
(through their parents mainly) cut (or burn) themselves. My wife
cuts herself. She also picks her nails until they bleed. My 9 year
old with the emotional “issues” picks her nails until they bleed.
Her twin (and just to clarify, they are fraternal) sister does not.

A trained professional that works with borderlines
every day can diagnose BPD. You might remember the case that happened on another
list (ATSTP) in which the guy’s girlfriend sounded about as borderline as
possible, but when she went to U of Washington to get evaluated,
they said, “No, you have PTSD.” I don’t know how they told the
difference, but I suppose it had something to do with the
distinguishing charactersitics of BPD that are mentioned here: self-
injury, toxic shame and self-loathing, uncontrollable impulsiveness
and “emotional liberation” with mind-altering substances. Still,
those last 2 might show up in other disorders as well.
 

Bon Dobbs :: Sep.11.2007 :: Best of, Shame, Self-Injury, Borderline Personality Disorder :: No Comments »

I actually wrote this message on WTO some time ago. I think I am going to post some of my “Best of” message postings from WTO and from ATSTP lists - after removing any personal information from other posters. I’ve posted so many messages I would be worth it (I think) to share some of that information to the Internet public at large through this blog. So here goes (the Best of #1):

Actually, these communication methods work with anyone, anytime.
They will work in normal communication and during “OZ” - and I am
trying to always be in this mode. It is difficult and takes a ton of
effort, because it is against my normal way or interacting. At first
it will seem really akward, but, with practice, it becomes easier
and more natural.

I used every one of the methods with my BP-ish (In other words,
emotionally sensitve and ashamed) pre-teen daughter last night.

Here’s the situation (I’ve compressed it slightly because it was
longer than this):

I come home from work and she’s all smiles. Then, she asks me where
I was late the night before (I was at a training group) and I
say “Uh, um (trying to think of the right words) … I was at a
course that I take…”

She says, “You’re lying.” (Because of the “uhs”).

I say, “Why do you say that?”

She says “Because you said ‘um’…”

So, I say “You seem sad and angry about people lying to you. Do you
think that someone lied to you today?” (Acknowledgement, I
recognized her feelings and identified them, not based on what she
said, but how she said it) See, it was not about me or the current
situation.

She says, “When people lie they say ‘uh’ a lot and people lie to me
all the time.”

I say: “Boy, that must make you feel really angry and sad to feel
that people lie to you. (Validation of her feeling) If I thought my
friends were lying to me, I’d feel pretty angry and sad too. Anyone
would feel angry and sad if they felt they couldn’t trust their
friends (Normalization, meaning, it is normal to feel this way when
you perceive that situation).”

[OK, quick aside - you will notice I didn’t try to 1) fix it or 2)
deny how she feels. It could be that her friends are not lying to
her at all. In the past, I might have said - “I don’t think their
lying to you, you must be wrong…” (invalidating). But that is
poison, because she actually FEELS like they are lying, whether they
are or not. Also, I can’t fix her feelings. So, trying to fix it
(”I’ll have to talk to these kids and …”) is not the answer -
because it is about her FEELINGS, not about what “really” happened.]

She says, “Yeah, I guess so, but it still makes me really angry.”

I say, “Yes, I can see you’re really angry. Maybe you can think of
something to do when you think people are lying to you.”
(redirection, I put the responsibility for feeling back on her and
suggest she come up with a course of action)

So she says, “I guess I could just ignore them.”

And I say, “I guess you could, are there any other things you could
do?”

So, we got no real conclusion. But what this conversation kicked off
was a very open, sharing conversation with her right before bed in
which she shared with me her shame about being lied to (that is,
that she thinks that other people think she is a bad person and that
is why they lie) and many of her feelings (almost all of them
negative BTW). In that conversation, I continued to use those
techniques to acknowledge what she said and validate, normalize and
redirect.

Usually she will just say “I don’t want to talk about it”. So,
by doing this I got my foot in the trust door. BPs don’t trust you
enough to reveal their feelings. Why? Two reasons: 1) the shame is
too great to tell the whole truth, because they think that you’ll
think they are a “bad” person and 2) You have never listened in
the “right” way before, so they don’t feel heard at all. Has your BP
every said “No one understands me” or “You don’t understand me”?
They don’t feel heard/connected to you (or anyone).

Bon Dobbs :: Sep.10.2007 :: Best of, Resources, Emotions, Validation :: No Comments »

http://bpd.about.com/od/forfriendsandfamily/a/SET.htm 

 When borderline personality disorder makes communication difficult, following the SET method may help. SET stands for support, empathy and truth. It was developed by Jerold J. Kreisman, MD and Hal Straus, the authors of I Hate You, Don’t Leave Me and Sometimes I Act Crazy.

Why SET Works

The symptoms of borderline personality disorder (BPD) can result in the BP asking for conflicting things or being unable to recognize that the another person cares for them, especially during times of stress. A person with BP may be unable to experience conflicting feelings at the same time, and tends to see things in black and white with very little shades of gray.

As a result, the BP experiences her current feelings as being her persistent feelings.

SET allows friends and loved ones of people with BP to honestly and address the person’s demands, assertions, or feelings, while still maintaining appropriate boundaries. It is important to do these steps in order, as each step builds upon the other.

Support

Support refers to an initial statement which indicates the loved one supports the person with borderline personality. It is a statement that begins with “I” and demonstrates concern and a desire to help. It can be anything that establishes a foundation for the relationship or interaction: “I want to try to help you feel better,” “I care about you,” or “I am worried about how you are feeling.”

The support statement is meant to reassure the BP that the relationship is a safe one, and that her needs matter even during this difficult moment.

Empathy

Empathy refers to communicating that the loved one understands what the BP is feeling, and focuses on “you.” It is not a conveyance of pity or sympathy, but instead a true awareness and validation of the feelings of the BP: “I see you are angry, and I understand how you can get mad at me,” “How frustrating this must be for you.”

It is important not to tell the BP how she is feeling, but instead put her demonstrated feelings into words. The goal is to convey a clear understanding of the uncomfortable feelings she is having and that they are OK to have, thus validating her feelings. Without such a statement of empathy, the BP may feel that her feelings are not understood. It is important to use feeling words, as in the examples above.

Truth

Truth refers to a realistic and honest assessment of the situation and the BPs role in solving the problem. It is an objective statement that focuses on the “it” — not on the subjective experience of the BP or Non-BP. Often the BP may seem to be asking, or demanding, something impossible, not taking an active role or responsibility in resolving the issue, or even presenting you with a “no-win” situation. The truth statement is meant to clearly and honestly respond to the difficult demand or behavior of the BP, while placing responsibility appropriately: “This is what I can do…,” “This is what will happen…,” “Remember when this happened before and how you felt so bad about it later.”

It is important to use the support and empathy statements first, so that the BP is better able to hearwhat you are saying, otherwise the truth statement may be experienced as little more than another, and expected, rejection creating even more defensiveness or anger.

Validation and Support Are Not Agreement

When first learning about SET, it can seem that you are being asked to agree with the BP. It important to clarify that validating feelings does not mean that you agree with them, only that you recognize that the BP is feeling them. The supportive communication described in the SET model does not mean that you are letting the BP off the hook, instead you are focusing on honest communication and ensuring that you are being heard, not just reacting to and defending against what is being said.

Bon Dobbs :: Sep.09.2007 :: Resources, Validation, Borderline Personality Disorder :: No Comments »

(AP) The suicide rate among preteen and young teen girls spiked 76 percent, a disturbing sign that federal health officials say they can’t fully explain.

For all young people between ages 10 to 24, the suicide rate rose 8 percent from 2003 to 2004 - the biggest single-year bump in 15 years - in what one official called “a dramatic and huge increase.”

The report, based on the latest numbers available, was released Thursday by the Centers for Disease Control and Prevention and suggests a troubling reversal in recent trends. Suicide rates had fallen by 28.5 percent since 1990 among young people.

The biggest increase - about 76 percent - was in the suicide rate for 10- to 14-year-old girls. There were 94 suicides in that age group in 2004, compared to 56 in 2003. The rate is still low, fewer than one per 100,000 population.

Suicide rates among older teen girls, those aged 15-19 shot up 32 percent; rates for males in that age group rose 9 percent.

“In surveillance speak, this is a dramatic and huge increase,” Dr. Ileana Arias said of the overall picture. She is director of the CDC’s National Center for Injury Prevention and Control.

More research is needed to determine whether this is a trend or just a blip, said one child psychiatrist, Dr. Thomas Cummins of Children’s Memorial Hospital in Chicago. “We all need to keep our eye on this over time to see if this is a continuing trend.”

http://www.cbsnews.com/stories/2007/09/06/health/main3239837.shtml

Bon Dobbs :: Sep.08.2007 :: Suicide :: No Comments »