It was extremely sad to see that David Foster Wallace killed himself last month. He was a talented writer and an excellent observer of the human condition. Apparently, he suffered from major depression and had ceased his medications. Really sad. I was reading an article about him in the current issue of Rolling Stone and found a quote that summarizes my attitudes toward people with BPD’s view of themselves. I’m not saying Wallace had BPD – I really don’t know enough about him to say – but this view of oneself encapsulates the deep feeling of shame that accompanies BPD:

There’s good self-consciousness, and then there’s toxic, paralyzing,
raped-by-Bedouins self-consciousness. I think being shy basically means
being self-absorbed to the point that it makes it difficult to be around
other people. For instance, if I’m hanging out with you, I can’t even
tell whether I like you or not because I’m too worried about whether or
not you like me. (David Foster Wallace)

You see, I often hear Non-BPs (the loved ones and family members of people with BPD) tell me that they feel that their loved one with BPD is extremely “selfish” or very “Narcissistic.” I always try to caution them on this statement because, when someone is in pain, yes, they will tend to look inward, but it’s not selfishness or Narcissism, in my opinion. It’s the ravages of deep shame and shyness that cause people with BPD to take such a view of the world. A person with BPD will dread the judgment, punishment and/or disapproval of other people. That is the kind of self-consciousness that is present in BPD.

To further follow up on this idea, here is a quote from me to a member of the ATSTP list from about two years ago. I was responding to the “lack of empathy” that his significant other (SO) was showing toward him:

It is frustrating and part of it seems very selfish on their part. My
wife actually showed sympathy for me this morning - I had a bit of an
upset stomach, so she said “I hope you feel better” a couple of times.
Of course, initially she thought I was mad at her or something (there
was still a lingering feeling that it was about her).

I also think there’s a step beyond empathy, and that’s compassion. I
think if you look at the spectrum of understanding for other people
you have something like self-centeredness (but not necessarily
positive) - pity - sympathy - empathy - compassion. (and there’s
probably a bunch of feelings in-between. The spectrum seems to run
from extreme self-interest to selflessness, of course, I could be
wrong on all of that - just an idea. It is easy to have compassion and
unconditional love for your kids, but for your SO it can be more
difficult because there are expectations on each side of the equation.
When your SO doesn’t live up to those expectations, even if they are
simple consideration, it is disappointing. I know it is difficult with
my wife as well - some of the time. Even my kids are wary of my wife’s
behavior at times.

I wonder if our SO’s don’t have much understanding of other people’s
pain because of the judgment factor. Perhaps they believe that
with “understanding” comes a level of judgment at least for
themselves. Or it could be that they believe no one actually
understands them, so the process of understanding others is pointless.

Bon Dobbs :: Oct.30.2008 :: Celebrities, Suicide, Other Disorders, Shame, Borderline Personality Disorder :: No Comments »

Unfortunately, the concept of cheerleading is something that I mention in WHINE, but I left out as a tool for a Non-BP/BPD relationship. I mention it when talking about what NOT to do in when a person with BPD is emotionally dysregulated (or experiencing an EDM – emotional dysregulation moment). I am planning on providing a “supplement” to WHINE on this website when I finish working on it. I left out a few things that can be effective in a relationship with someone with Borderline Personality Disorder, and these things have come up in the ATSTP Email Support Group. So, I’ve decided to address one of these, cheerleading, now.

Not all interactions are appropriate for cheerleading; in fact, many interactions are not. If you tell someone “you can do it” when they deeply believe that they can’t, this could lead to a mistrust of your opinion of them. In the case of dealing with an emotional person, typically, “positive mental attitude” statements are unhelpful and invalidating. Saying there’s “no need to be sad/scared/angry” for example just serves to invalidate the emotion that the other person is already feeling.

Many people think that effective cheerleading statements involve saying that one person is “proud of” the other, “believes in” the other or “loves” the other. The problem with each of these is that 1) those statements are about how YOU feel and 2) Those statements don’t necessarily foster effective behavior.

At www.dbtselfhelp.com (which is a wonderful resource that I highly recommend) the worksheet on cheerleading states that there are three types of effective cheerleading statements. Mainly, that site is for self-cheerleading, so I will try to adapt these to relationship cheerleading. The types are:

Three types of cheerleading statements:
1. Statements that provide the courage to act effectively
2. Statements that help in preparing for the situation, getting ready to be effective, to focus on what works
3. Statements that counteract myths about interpersonal behavior.

In WHINE, I suggest a tool that can help with #1, which is the tool to “Be Brave.” While a person’s inclination may be to avoid an uncomfortable situation or to behave in a conditioned or ineffective manner (because of lack of courage or self-assurance about the situation), being brave in the face of uncomfortable situations reinforces itself and serves to support type #1.

Some examples of #1 might be:
“You can do hard things.” (which is my favorite and can apply to both #1 and #2)
“Remember the time you did [whatever]. That was so brave of you in that situation.”
“I’m impressed with your courage in the face of that.”
“Yeah, that is really hard. At the same time you have faced something like that before…”

If you combine “Be Brave” with “You can do hard things,” you go a long way to being more effective, because these two concepts help counteract the idea that you are “walking on eggshells” around someone else and that your feeling that avoidance of an emotional situation is the best route to take. I believe taking on an emotional situation head-on is more effective than letting it fester - both for you and for the person with BPD.

In type #2, the focus should be on effective behavior for a future task. #2 is quite important and, in some ways, is the most difficult type to effectively navigate. Because of conditioned ineffective behavior and the sway of negative emotions, a person might be tempted to repeat ineffective behavior, based on the emotions that they are feeling. A work (or school) situation is a good example of this dynamic. If someone is having a problem with their boss, they might, in anger, have the urge to quit the job or lash out at the boss (or the customers). Work situations can be especially frustrating for a highly emotional person. Work that they consider menial or “beneath them,” overbearing bosses, long periods of downtime in which a person can ruminate or become paranoid that others don’t like them, all contribute to frustration at work.

Some examples of #2 might be:
“You have every right to be angry. Still, the last time he said that sort of thing, you reacted positively. I think that worked out pretty well.”
“Bosses can be a real pain. I know when my boss gets on me; I try to do [something effective]. I’ve seen you do that in the past, so you know you’re capable.”
“You had a similar situation when [whatever] happened and you handled that well.”

In type #3, you are debunking deeply-held beliefs about interpersonal behavior. This technique can be tricky, because a person who is overcome with emotion might not be able to see the other side of the coin. In this type, you are basically reiterating that a person has the rights to their feelings and emotions and helps counteract the idea that other people might not like them just because of an emotional situation.

Some examples of #3 are:
“It’s hard when your co-workers are angry at you. I know I don’t like that either. Yet sometimes it’s about their anger more than your behavior.”
“I think you have the right to state your feelings about the situation.”
“You have every right to ask for what you want, even if you think that will annoy them.”
“I think there’s a lot of validity in how you feel, certainly as much as how they feel.”
“Sometimes I think you have to stand up for your rights. I’m impressed when you have done that in the past.”
“Sometimes people get annoyed when you don’t do exactly what they want. However, you have rights and feelings too.”

Bon Dobbs :: Oct.22.2008 :: Resources, WHINE Book, DBT-FST, Emotions, DBT, Borderline Personality Disorder :: 2 Comments »

I stumbled across this article from 2006 in the Health section of the NY Times regarding treatment and BPD. I think it illustrates that certain treatments can be more traumatic on the patient than others (or no treatment at all). Personally, I think it also could make the case for CBT/DBT (or another behavioral treatment) because those treatments are generally focused on effective skill-building for the here and now, rather than dredging up the past right away, which could cause more trauma to the patient.

May 30, 2006

Behavior

A Case in Point for the Maxim ‘Do No Harm’

By RICHARD A. FRIEDMAN, M.D.

Everyone knows that talking about your feelings is supposed to be good for you. In part, that’s probably why psychotherapy is widely viewed as a healthy pursuit. Conventional wisdom has it that self-knowledge is always a boon, and, like wealth, you can never have too much of it.

That’s what I thought until I met Helen.

Helen was a successful 52-year-old professional who had been married for 30 years. After watching “The Celebration,” a movie in which the family patriarch is publicly unmasked as a sexual predator by his children, Helen recovered what she believed were memories of sexual abuse by her father.

Over the course of several months, she felt depressed and angry and decided to start psychotherapy for the first time. Her therapist recommended twice-weekly sessions and encouraged her to discuss her childhood and memories of sexual abuse.

She became more depressed and anxious during the initial treatment, hardly unexpected given the traumatic material she had to deal with. But then something alarming began to happen.

Helen began to abuse alcohol, something she had never done before, and to cut her wrists superficially, an old behavior that she had stopped in her 20’s.

Helen was confused. If therapy was supposed to help her, why did she feel so much worse? What could explain the fact that this previously high-performing professional woman had become a serious alcohol abuser who was cutting her wrists several times a week with a razor?

The problem was that Helen had what psychiatrists call borderline personality disorder, and therapy had encouraged a process of self-exploration that proved toxic to her.

She did not have the psychological resources to deal with the intense emotions that this kind of therapy unleashed.

Borderline patients frequently use alcohol or drugs to try to stabilize their overly reactive moods, and they often injure themselves to relieve unbearable psychic pain.

In hindsight, it’s easy to see that this was just the wrong treatment for this particular patient. Yet even when she was given a more supportive treatment, aimed at helping her cope rather than delve into her feelings, she still floundered and didn’t function nearly as well as she did before having any therapy.

It will sound heretical coming from a psychiatrist, but there are some patients who feel worse and get worse when they are in psychotherapy. For some, the problem is getting the wrong type of treatment; for others, it may be the relationship with the therapist that is problematic, regardless of the specific treatment.

In an analysis of psychotherapy studies, Dr. Michael Lambert, a professor of psychology at Brigham Young University and a well-known expert in psychotherapy research, found that about 5 percent to 10 percent of patients deteriorated with psychotherapy.

This is not a trivial problem considering that 3.5 percent of all Americans were in psychotherapy each year from 1987 to 1997, according to a 2002 study published in The American Journal of Psychiatry by Dr. Mark Olfson of the College of Physicians and Surgeons of Columbia.

Although we are not very good at predicting which patients are likely to get worse with treatment, it’s not that hard to spot them once they are in therapy and things aren’t going well.

A few years back, one of my residents was treating a young man in psychotherapy who had great difficulty deciding what he wanted to do with his life.

He wasn’t depressed, but he was a very passive person.

It became clear that the patient was using the treatment not to understand his passivity, but to indulge it; he enjoyed talking about what he should do, but made no steps outside of therapy despite many attempts to address his behavior. We stopped his psychotherapy and referred him for vocational counseling.

The possible benefits of no treatment go beyond just patients who get worse in therapy. Some patients have been in psychotherapy for so long that it isn’t clear what the advantage of treatment is; in some of these cases, stopping therapy gives patients a chance to discover that they might do fine without it.

Others might seek treatment during a crisis or when they are grief-stricken. As painful as these situations can be, if people are generally healthy and have good social supports, they are likely just to feel better with time and probably don’t need any treatment at all.

At first blush, it might sound paradoxical — even uncaring — but sometimes the best treatment is no treatment at all.

Bon Dobbs :: Oct.22.2008 :: Substance Abuse, Treatment, Emotions, Self-Injury, DBT, Borderline Personality Disorder :: 1 Comment »

NY Times article mentioning BPD. I’d love to comment, but will have to do so later….

October 21, 2008

Mind

When All Else Fails, Blaming the Patient Often Comes Next

By RICHARD A. FRIEDMAN, M.D

Doctors and psychotherapists generally don’t like it when their patients don’t get better. But the fact is that lots of patients elude our clinical skill and therapeutic cleverness. That’s often when the trouble starts.

I met one such patient not long ago, a man in his early 30s, who had suffered from depression since his teenage years. In six years of psychotherapy, he had been given nearly every antidepressant under the sun, but his mood hadn’t budged.

Weeping in my office one day, he explained that he was depressed because he was a failure and a whiner. “Even my therapist agreed with me,” he said. “She said that maybe I don’t want to get better.”

I could well imagine his therapist’s frustration. She had been working with him for nearly three years without significant progress, and she was now doing what many clinicians do when the chips are down: blame the patient for failing to improve.

“I think he has an unconscious desire to remain sick,” she told me.

About a month later, I saw this patient respond remarkably well to a novel treatment. Free of depression at last, he was joyful and relieved — an odd reaction, you must admit, from someone who secretly wished to be ill.

Not just that, but he no longer felt like a failure and was much more upbeat about his future prospects.

I decided to challenge him. “How come you’re feeling so much better despite the fact that nothing in your life has really changed in the past few weeks?”

“Well, I guess I just think like that when I’m down.”

Exactly. His sense of worthlessness was a result of his depression, not a cause of it. It’s easy to understand why the patient couldn’t see this: depression itself distorts thinking and lowers self-esteem. But why did his therapist collude with the patient’s depressive symptoms and tell him, in effect, that he didn’t want to get better?

For an all too human reason, I think. Chronically ill, treatment-resistant patients can challenge the confidence of therapists themselves, who may be reluctant to question their treatment; it’s easier — and less painful — to view the patient as intentionally or unconsciously resistant.

I recall an elderly woman who was referred by a colleague for intractable depression, in which I have a special interest. I was eager to help her.several months and many treatments later, I began to get frustrated that she was no better and noticed that my thinking about her shifted. I wondered whether there was something about the sick role that she found rewarding.

After all, she had constant visits from friends and family members, not to mention an army of medical experts who were all trying, in vain, to cure her. If she got better, she might lose all that care and attention.

Then one morning, shortly after starting a new combination of antidepressants, she called. I did not recognize the cheerful voice. “I’m feeling really good,” she told me. “Not depressed at all.”

My delight aside, I felt chagrined that I had begun to write her off as a help-rejecting crank.

Of course, it makes good medical sense for therapists to rethink the diagnosis and treatment of any patient who fails to improve. But this is a double-edged sword.

Another patient, a young woman with unstable moods, was recently hospitalized with a diagnosis of bipolar disorder. When she failed to respond to two mood stabilizers, the staff began to entertain a diagnosis of borderline personality disorder, which involves emotionally chaotic relationships and impaired ability to function in the world.

“She’s pretty aggressive and demeaning, and we think she has some serious character pathology,” one of the residents told me.

But partly treated bipolar disorder can mimic borderline personality disorder, and after she received a third mood stabilizer, her “personality disorder” melted away, along with her provocative behavior.

This patient had frustrated her clinicians with her lack of response to treatment. In turn, her doctors reacted by changing her diagnosis to a personality disorder. The change in thinking shifted the blame from the clinicians to the patient herself, who was now viewed more as bad than sick.

To be sure, some patients really do want to be sick. People with Munchausen syndrome, for example, deliberately produce physical or psychological symptoms for the express purpose of assuming the sick role. And they will go to extraordinary means to defeat doctors who try to “treat” them.

But a vast majority of patients want to feel better, and for them the burden of illness is painful enough. Let’s keep the blame on the disease, not the patient.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

Bon Dobbs :: Oct.21.2008 :: Other Disorders, Blame, Treatment, Borderline Personality Disorder :: 1 Comment »

A short article from About.com regarding an Article in Biological Psychiatry about moving BPD to Axis I:

Experts Argue That Borderline Personality Disorder Should Be Shifted to Axis I

Thursday October 16, 2008

In a recent paper published in Biological Psychiatry, Dr. Antonia New and her colleagues at the Mount Sinai School of Medicine and Bronx VA Medical Center argue the case for shifting borderline personality disorder (BPD) from Axis I to Axis II of the Diagnostic and Statistical Manual of Mental Disorders (DSM).In the most current, fourth edition of the DSM, BPD is diagnosed on Axis II, which is reserved for “longstanding disorders,” such as personality disorders. In their paper, Dr. New and her colleagues argue that research has not supported the distinction between BPD and Axis I disorders, and that moving BPD to Axis I will spur new research on this serious condition.

Bon Dobbs :: Oct.20.2008 :: Treatment, Biology, Borderline Personality Disorder :: 1 Comment »

After learning about BPD and reading a biography of Kurt Cobain, I suspect that, if he was not a borderline, he suffered from a similar disorder. So, here is a detailed analysis of the case for Kurt Cobain having Borderline Personality Disorder.

Substance Abuse

I don’t think I have to cite any references on this one. The bio I read makes it clear that Cobain was a junkie and used consistently. Also, despite his slim frame (5′7″, 130 pounds), he used far more heroin than others in his final days and his body was, for the most part, able to take it. He did overdose numerous times. Abuse of pain killers (of which heroin is one), is not uncommon with BPD (sometimes called “Bellman’s Syndrome”).

His heroin use eventually began affecting the band’s support of Nevermind, with Cobain passing out during photo shoots. One memorable example came the day of the band’s 1992 performance on Saturday Night Live, where Nirvana had a shoot with photographer Michael Levine. Having shot up beforehand, Cobain nodded off several times during the shoot. Regarding the shoot, Cobain related to biographer Michael Azerrad, “I mean, what are they supposed to do? They’re not going to be able to tell me to stop. So I really didn’t care. Obviously to them it was like practicing witchcraft or something. They didn’t know anything about it so they thought that any second, I was going to die.”

Eating Disorder (or chronic pain leading to one)

Kurt Cobain had a chronic, undiagnosed stomach disorder from which he developed an eating disorder, being unable to keep down food.

Throughout most of his life, Cobain battled chronic bronchitis and intense physical pain due to an undiagnosed chronic stomach condition. This last condition was especially debilitating to him emotionally, and he spent years trying to find its cause. However, none of the doctors he consulted were able to pinpoint the specific cause, guessing that it was either a result of Cobain’s childhood scoliosis or related to the stresses of performing.

Volatile Relationships

His relationship with Courtney Love was volatile. He also had volatile relationships with others in his band and with managers and ex-girlfriends.

Love arranged an intervention concerning Cobain’s drug use that took place on March 25. The ten people involved included musician friends, record company executives, and one of Cobain’s closest friends, Dylan Carlson. But Bassist Krist Novoselic tipped him off as he considered the idea to be “stupid”. However, by the end of the day, Cobain had agreed to undergo a detox program. Krist Novoselic drove him to the airport to catch his flight, but Cobain was far from wanting to go, in a fit of panic, Cobain drew violence and the two fought at the airport, eventually Cobain freed himself and ran through the airport lobby screaming “fuck you”, this would be the last time Krist would see Kurt alive.

Shame and Unstable Self Image

His lyrics probably do the best for this…

All Apologies:
I wish I was like you
Easily amused
Find my nest of salt
Everything is my fault
I’ll take all the blame
Aqua seafoam shame
Sunburn, freezeburn
Choking on the ashes of her enemy

Dumb:
I’m not like them
But I can pretend
The sun is gone
But I have a light
The day is done
But I’m having funI think I’m dumb
Or maybe just happy

Radio Friendly Unit Shifter:
What is wrong with me?
What is what I need
What do I think I think?

This had nothing to do with what you think
If you ever think at all
Bi-polar opposites attract
All of a sudden my water broke
I love you for what I am not
Did not want what I have got
Blanket acne’d with cigarette burns
Speak at once while taking turns

And of course, there are probably twenty more examples in his various lyrics. The only other musician that I can think of off the top of my head who consistently used the words “shame” and “I’ll take the blame” is Ian Curtis (Joy Division’s lead singer who also committed suicide).

Suicide Attempts

I think these go without saying, considering his eventual actual suicide. But we know of at least one other:

Following a tour stop at Terminal Eins in Munich, Germany, on March 1, 1994, Cobain was diagnosed with bronchitis and severe laryngitis. He flew to Rome the next day for medical treatment, and was joined there by his wife on March 3. The next morning, Love awoke to find that Cobain had overdosed on a combination of champagne and Rohypnol (Love had a prescription for Rohypnol filled after arriving in Rome). Cobain was immediately rushed to the hospital, and spent the rest of the day unconscious. After five days in the hospital, Cobain was released and returned to Seattle. Love later stated that the incident was Cobain’s first suicide attempt.

Bon Dobbs :: Oct.17.2008 :: Blame, Suicide, Celebrities, Pain, Shame, Emotions, Substance Abuse, Borderline Personality Disorder :: 4 Comments »

 An article about emotional regulation in BPD….

Emotion-Regulating Circuit Weakened In Borderline Personality Disorder

Differences in the working tissue of the brain, called grey matter, have been linked to impaired functioning of an emotion-regulating circuit in patients with borderline personality disorder (BPD). People with BPD had excess grey matter in a fear hub deep in the brain, which over-activated when they viewed scary faces. By contrast, the hub’s regulator near the front of the brain was deficient in grey matter and underactive, effectively taking the brakes off a runaway fear response, suggest researchers supported in part by NIMH.

The imaging studies are the first to link structural brain differences with functional impairment in the same sample of BPD patients. Similar changes in the same circuit have been implicated in mood and anxiety disorders, hinting that BPD might share common mechanisms with mental illnesses that have traditionally been viewed through the lens of biology.

Michael Minzenberg, M.D., of the University of California, Davis, and NIMH grantees Antonia S. New, M.D., and Larry J. Siever, M.D., of Mount Sinai School of Medicine, and colleagues, reported on their magnetic resonance imaging (MRI) findings in the July, 2008 issue of the Journal of Psychiatric Research Their functional imaging findings were reported in the August 2007 issue of Psychiatric Research Neuroimaging.

Accounting for up to 20 percent of psychiatric hospitalizations,4 BPD affects up to 1.4 percent of adults in a year. It is characterized by intense bouts of anger, depression, and anxiety that may last only hours, often in response to perceived rejection. People with this difficult to treat disorder typically experience tumultuous work and family life and may engage in risky, impulsive behaviors. Cutting, burning and other forms of self-harm are common. The completed suicide rate in BPD approaches 10%, and at least 75% of afflicted individuals attempt suicide at least once.

Previous findings of lower-than-normal grey matter matter - neurons and their connections - in the regulator hub, called the anterior cingulate cortex (ACC), hinted that this might affect the way the brain works in BPD.

To find out, the researchers first used functional magnetic resonance imaging (fMRI), to compare responses of 12 adult BPD patients with those of 12 healthy controls to pictures of faces with fearful, angry and neutral expressions. In response to fearful faces, the amygdala, the fear hub, showed exaggerated activity in the BPD patients, while the ACC was relatively underactive. Since ACC activity would normally increase to dampen an overactive amygdala, this suggested weak regulation of emotion in the circuit.

Suspecting that this functional impairment mirrors structural differences — as has been found in depression — the researchers next used anatomical MRI to compare grey matter in the same patients and healthy controls. Consistent with the fMRI results and the earlier findings, grey matter density was increased in parts of the amygdala and decreased in parts of the ACC, in BPD patients relative to controls. This suggested an abnormality in the number or architecture of neurons in these key components of the emotion-regulating circuit, which other evidence links to impaired functioning of the serotonin chemical messenger system.

Bon Dobbs :: Oct.16.2008 :: Biology, Emotions, Borderline Personality Disorder :: No Comments »

Here the text of a report on BPD in Malaysia…

Personality disorder common, says expert

By Brenda Lim

2008/10/12
IPOH: Stormy relationships, intense mood swings and suicide attempts are among the experiences faced by Malaysians with borderline personality disorders (BPD). For those living or working with them, the experience is like “walking on broken glass”.

“They consume you emotionally. They want to get under your skin and into your mind,” said psychotherapist associate professor Dr Brian Ho Kong Wai at his plenary talk at the Seventh Perak Mental Health Convention yesterday.

The usual reaction was to reject a person with BPD, which only reinforced their feelings of betrayal and abandonment.

BPD was a common psychiatric disorder, he said, estimating that one or two out of every 100 Malaysians had it, and that it was more common in women.

According to Ho, Susanna Kaysen, who wrote her memoir entitled Girl, Interrupted, had BPD, while other celebrities, including Marilyn Monroe and Princess Diana, were said to have many traits indicating that they had BPD.

Besides having difficulties in maintaining close relationships, those with BPD had feelings of emptiness and engaged in risk-taking behaviour which put them in circumstances which were inherently dangerous, he said.

They might also be confused about their identity, have brief transient psychotic or disassociative episodes, experience significant disruption to their relationships and work, and be sensitive to criticism and feared rejection, he added.

Are people with BPD manipulative?

“We are all manipulative. We don’t become what we are without being manipulative.

“If you are a businessman, you will network with others. Is that being manipulative?

“Someone who is truly manipulative will not be discovered as such. We are talking about those who are faulty in the skills and ways of dealing with people.”

Ho said that problem could have been caused by childhood BPD, a common disorder from neglect or abuse, or a traumatic event which led to a person failing to mature from seeing “black and white” such as good-looking heroes and ugly villains as described in fairy tales, to accepting “grey” areas.

“Everything is clearly right or clearly wrong to them. There is no middle ground. What they perceive as good is idolised and omnipotent.

“When they find that it is gone, it is hated and rejected. There is a lot of negativity.”

He said the main treatment of BPD was not medication but building trust and negotiating with patients, helping them accept changes, identify their emotional reactions and learn new skills like being mindful and adapting.

“You have to do a little re-parenting in helping them to grow and go. Remember that some of them had traumatic childhood experiences and lacked nurturing.”

While many improve as they grow older, those who recover more quickly are those who are likeable, honest, able to see the truth about themselves, willing to try to improve themselves and seek therapy, and have a supportive group of friends and family.

Bon Dobbs :: Oct.14.2008 :: Odds and Ends, Borderline Personality Disorder :: No Comments »

A few months ago I posted a piece on the validating statement and earlier today I posted on the I-AM-MAD communication tool. While both recommend validation (actually one is a sub-set of the other), sometimes if you are new to validation the statements and questions that I recommend can seem (as Wandering Coyote put it in her comment) “so trite, so patronizing.” It can seem that way (or rote) if you don’t validate with honesty. If you’re “reading from a script” the validation will seem empty to the other person. The key thing IMO is that you really try and empathize with the other person’s feelings and not judge those feelings as crazy, stupid or wrong. If you can find the truth in those emotions and speak to that, validation will not sound as rote or scripted. A person with BPD can be a good emotional bullsh*t detector, because, at times, that person can be all emotions. If you put your emotional glasses on and try and find the emotional truth to another person’s situation and you PRACTICE the skills with honesty, validation works well in those emotional situations. It helps to combat the invalidation that a person with BPD has grown to expect from the hostile world around them.

Bon Dobbs :: Oct.14.2008 :: Validation, Borderline Personality Disorder :: No Comments »

Last week I wrote an email to someone explaining the value of validation and the stance one “should” adopt when using validation. Emotional validation is valuable when someone is experiencing an “emotionally dysregulated moment” (which in the ATSTP group we call “EDM”). These moments are common when someone has BPD or ERD.

Anyway, I posted an anonymous version of my message to the group and one of my group members (thanks Tides!) edited it into what she called the “I-AM-MAD” communication tool. I will post the content of the tool below and upload the PDF…. Oh, quickly… The formatting came out a little wonky. And “IAAHF” means “it’s all about his/her feelings” which is a concept in WHINE.

 I-AM-MAD

1. Identify the emotions.

It’s best to do this with “feeling” words, like “look”, “see”, or “sound”, rather than “know” or “understand”.

Examples:               “I see that you are frustrated.”

“You sound aggravated.”

 “You look really upset.”

2. Ask a validating question.

This encourages them to share their feelings about whatever triggered them.  Do not use “what’s wrong?”  If you use “what’s wrong?” they will hear “what’s wrong with YOU?”  Also, don’t assume you did anything wrong.  Remember, IAAHF (It’s All About His/Her Feelings).

Examples:               “What happened?”  (most effective because it is open-ended, requires more than yes/no answer)

                                “Did something go wrong at work [school] today?”

                                “Want to talk about it?”

3. Make a validating statement about their emotion.  

Validate the feelings expressed in step 2.  This helps reinforce that it is natural and valid to feel what they are feeling in the situation.  Again, remember IAAHF.  Don’t defend against blaming or projecting.  And don’t apologize at this point, even if you are guilty.  (Apologies for things you are actually guilty of can come later… after they have returned to their emotional baseline.)

Examples:               “Wow, it must have made you feel awful to have done poorly on that test.”

“Yes, it is frustrating when it seems that someone is taking advantage of you.”

“Yeah, that’s really disappointing.”

4. Make a normalizing statement about their emotion.

By relating the situation as common to all people or “normal” for them, this helps alleviate their stress about feeling judged or unaccepted.

Examples:               “I think anyone would feel angry if they had to do that”

“I would feel the same way if that happened to me.”

“I can see why you feel that way.”

5. Analyze the consequences of their behavior. 

By examining the consequences of both negative and positive behavior with the person, you help them to separate their emotional reaction from their behavior. The behavior may need to be changed, but the emotions are natural and should not be punished for. 

Examples:               “When you don’t ask questions about something that confuses you, I don’t realize that you are struggling, so I can’t help you. When you do ask questions though, I can either give you the information you need to solve the problem yourself or we can work together to figure out the best solution to the problem.

“When you yell at me, I feel disrespected and become upset too.  However, when you speak calmly to me, I know you have respect for me, so I am able to listen to you better.”

                                “When you refuse to talk to me, I don’t know what else to do except give you space.  When something is bothering you, it’s best to be open and honest with me so I know what’s going on and don’t make the wrong assumptions about what you need.

6. Don’t solve the problem for them. 

Solving one’s own problems helps to build self-confidence.  Empower the person by getting them to come up with a solution themselves.  When given the opportunity in a non-judgmental setting, most people will find that they can come up with solutions to their problems.  You can guide them through this process by asking helpful questions to ascertain what they need or want. 

Examples:               “How would you like to handle this?”

                                “What would help you make a better choice next time?”

                                “Is there anything I can do to help?”

(Note:  Sometimes you have to go back and forth to help them find the most effective solution. They may say, “I don’t know” or “I don’t care.” This can be tough.  Go back to step one to deal with any additional emotions that become apparent.)

 I AM MAD PDF Version

Bon Dobbs :: Oct.14.2008 :: Spotlight, Resources, Emotions, Validation, Borderline Personality Disorder :: 4 Comments »