The Emotionally Sensitive Person

By Karyn Hall, PhD

An Emotionally Sensitive Person is one who experiences more intense emotions than most other people do. When someone is emotionally sensitive, they often hear statements like “Stop overreacting,” or “You’re so dramatic.” Many are labeled as being “too sensitive” because their emotional reactions are quicker, last longer, and are stronger than other people expect.

Life is so complicated that we typically try to simplify it, often by putting people and events into black and white categories. But like much of what we tend to simplify in that way, being an emotionally sensitive person is not a you-are or you-are-not kind of descriptor.

Despite the emphasis our culture has on logic and self-control, the emotional part of everyone’s brain is pretty powerful, particularly given the right circumstances. Jonathan Haidt, in The Happiness Hypothesis, talks about the brain being like an elephant with a rider. Picture a huge six-ton elephant, with a rider on top. This represents the two basic systems in our brains.

Haidt says the rider is the logical, rational part of the brain that is reflective, it’s the part of you that deliberates and analyzes and plans for the future. The elephant represents the emotional system, the one that is instinctive, that feels pleasure and pain and wants gratification right now. But the rider is so small relative to the elephant, anytime the six-ton elephant and the rider disagree about which direction to go, the rider is going to lose. And that happens more than you might realize.

Anyone who has eaten a bag of potato chips when they said they would only have twelve, or who has compulsively called an ex when they vowed they wouldn’t, or who has said angry words they later wished they hadn’t, understands the power of emotion. And that’s just for everyday issues, not for the really big, this-matters-to-the-core kind of situations. For people who are emotionally sensitive, the elephant (the emotional part of the brain) is even more skittish and more difficult to manage.

Some individuals may have a focused sensitivity. This means they are noticeably more emotional than most people about a certain issue, like their weight or their children, or that they may be emotionally sensitive at certain times. Some may have always been emotionally sensitive and some may have experienced events that have led to or added to their sensitivity.

For others, their sensitivity is more general and varies along a continuum. At one end of the continuum are the individuals who are slightly more sensitive than the majority of people and at the other end of the continuum are those who are so emotionally sensitive it is difficult for them to function.

Because of the pain they feel and our culture’s tendency to value logic, some emotionally sensitive people may wish they didn’t experience emotions at all. Wouldn’t life be easier without sadness and fear? But emotions provide important information and skills such as signaling when to get out of dangerous situations (fear), the ability to be in relationships (love) and a capacity to appreciate positive experiences (joy). The emotional part of the brain provides motivation and commitment and is just as necessary for living as logic.

Being emotionally sensitive has its challenges and for some those challenges require professional help. Some people suffer deep pain on a daily basis because of their emotional sensitivity. At the same time, those who are emotionally sensitive often have a deeper capacity for caring about others, can be artistic and creative, and are often the people who bring about change through their passion for causes. Learning to manage your emotions so that the pain is lessened and there is room for joy can help you use the energy from your emotions effectively, make balanced decisions and be more effective in problem solving.

Related posts:

1. The Emotionally Transmitted Disease
2. BPD: What’s in a Name and How does it feel to be that person?
3. 10 Signs you’re a highly sensitive person (HSP)

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A therapy that helps to rebuild broken lives

SHEILA WAYMAN

Tue, Dec 27, 2011

ANNE* ALWAYS felt she was different from everybody else and, having had a difficult early childhood, by the time she was a teenager she did not think she belonged in this world.

“I believed I was invisible – I didn’t think people saw me,” she says. “I was insecure and very mixed up about my own identity; I did not know who I was, or how to fit in to life.”

From her mid-teens on, she attended a succession of psychiatrists and counsellors and was prescribed various medications for her “mood”. However, becoming a wife and mother gave her a new, positive feeling of belonging, and she moved on to become a mature student, followed by short-term work placements and voluntary work.

But when, in her 40s, life threw up challenges over which she had no control, her thoughts and emotions began to change rapidly.

Old fears of being abandoned returned; she became angry and impulsive. She started to self-harm and contemplate suicide; she misused alcohol and became dependent on prescribed medication.

It was only then that she was diagnosed with borderline personality disorder (BPD) and she began to understand the impact it had on her.

BPD is a broad category of mental health problems, often defined by “really powerful emotional distress and sometimes a lot of problems in relationships”, says Jim Lyng, a counselling psychologist with Cluain Mhuire, a community-based adult mental health service in the southeast of Dublin.

Affecting an estimated 1-2 per cent of the population, the disorder is characterised by impulsive and often life-threatening, self-destructive behaviour. Problems tend to start to show before a person reaches adulthood, as they begin to cope with their emotions in extreme ways.

“In a heightened state, people start to make desperate choices,” he explains. Talking of deliberate self-harm or attempts at suicide as “cries for help” misses the point, he suggests. “They are desperate attempts to cope.”

Luckily for Anne, she is living in one of the few areas of Ireland where the successful, evidence-based treatment programme of dialectical behaviour therapy (DBT) is available. Within weeks of diagnosis, she started DBT at Cluain Mhuire.

DBT was developed by Dr Marsha Linehan from the University of Washington to help people with a history of repeated self-harm and suicidal behaviour, many of whom would be classified as having borderline personality disorder.

And it was only this year Linehan disclosed that she has struggled with the disorder herself – so first-hand experience informs the therapy.

It involves a minimum of one year of treatment, with both a weekly one-to-one session of psychotherapy and a weekly group session for learning new skills in managing emotions.

Participants keep a daily diary of their feelings and responses to them. Telephone support is also provided for difficulties that may arise in between sessions.

“Fifty per cent of DBT is learning to accept and 50 per cent is learning to change,” says Lyng. “It sounds simple, but it is very difficult to put into practice.”

For people struggling with extreme emotions, DBT can be “the difference between complete chaos and not being understood, to having some framework to cope with what’s going on and to start building a life worth living”.

When DBT was piloted in Cluain Mhuire more than 10 years ago, the benefits were so overwhelming – a dramatic reduction in the use of inpatient psychiatric beds and in attendance at hospital emergency departments by participants in the two-year follow-up period – it quickly became a “serious option for many of our clients”, he says.

Now a special DBT group for people aged 18-25 who are self-harming has been started on a pilot basis at Cluain Mhuire and it is thought that they will benefit faster as the behaviour they are trying to change is less entrenched.

Self-harm is on the rise in Ireland. The 2010 annual report of the National Registry of Deliberate Self-Harm showed hospital attendance for self-harm was up for the fourth year in a row.

A total of 11,966 presentations to hospitals in 2010 were due to self-harm and these involved 9,630 individuals.

With a 4 per cent rise in the rate of self-harm overall, the most notable increase in 2010 was among 20-24 year olds.

There is a strong link between self-harm and suicide; it is estimated that between a quarter and a half of those who take their own lives have previously carried out a non-fatal act.

DBT is not for everybody, says Lyng, but it is the treatment with the most international research supporting its effectiveness.

And he is frustrated and concerned at its limited availability across the State in a mental health system that is effectively a “post code lottery”.

To be able to avail of DBT, people have to live in the catchment area of the approximately 10 teams of mental health professionals that are offering it, in the east of the State and across Co Cork.

Private services offer elements of DBT, he says, but not “comprehensive” DBT programmes.

There are between 20 and 25 participants in the two DBT programmes currently running at Cluain Mhuire and it has had people moving into its catchment area to try to access the treatment.

Although DBT requires a lot of resources initially, it is, in the long term, a much better use of the health services, Lyng argues, rather than leaving people to turn up at emergency departments with the physical consequences of their disturbed emotions or admitting them for very costly inpatient psychiatric care, which has not proven to be effective.

There is a good chance that people completing the programme can be discharged completely from the mental health services.

Anne has not reached that stage yet, but DBT has “given me hope”, she says.

“It is a new way of living.” If she is having a bad day, she can now draw on coping skills to manage her emotions.

“I know what to do when I become overwhelmed. I am beginning to know who I am and I am not struggling so much with identity issues. It allows me to function in the real world,” adds Anne, who believes it is a “massive injustice” to people like her who can’t have this treatment.

*Name has been changed
© 2011 The Irish Times

Related posts:

1. Mentalization Based Therapy Shows Promise with BPD
2. On the edge: Group helps families cope with borderline personality disorder
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Anyway, I was reviewing a document about the general principles of CBT (called SelfHelpCourse.pdf), and it outlines an important point about events, thoughts and emotions. I have pointed out in several articles and in my book about the behavioral chain:

Event -> Thought -> Emotion -> Action Impulse -> Behavior

The document says this about the different reactions a person may have to an event:

For instance, if someone you know passes you in the street without acknowledging you, you can interpret it several ways. You might think they don’t want to know you because no-one likes you (which may lead you to feel depressed), your thought may be that you hope they don’t stop to talk to you, because you won’t know what to say and they’ll think you’re boring and stupid (anxiety), you may think they’re being deliberately snotty (leading to anger). A healthier response might be that they just didn’t see you.

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WILLINGNESS

• Cultivate a WILLING response to each situation
• Willingness is doing just what is effective in each situation, in an unpretentious way.
• Willingness is listening very carefully to your WISE MIND, acting from your inner self and your deepest core values.
• Willingness is becoming aware of your connection to the universe and to the person you are interacting with.
• Willingness engenders listening and mentalizing.
• Ask yourself, in 5 years from now, will the situation that causes the distress matter?

WILLFULNESS

• Willfulness is like sitting on your hands when action is needed, refusing to make changes that are needed.
• Willfulness is about the desire to be right in a situation, regardless of what is needed to get through effectively.
• Willfulness causes you to fight any suggestions that will improve the distress and thus make it more tolerable.
• Willfulness is being rigid and inflexible.
• It is the opposite of doing what works, of being effective. Willfulness is trying to fix every situation or refusing to tolerate the distressful moment.

That last example in willfulness is particularly important to read and consider. Often, I find the loved ones of borderlines to be “fixers” and try to solve each problem for the borderline. Being willing to listen, and really hear what the other person is feeling and going through is usually more effective, despite the distress it may cause, than telling the other person what to do or giving advice.

Adapted from dbtselfhelp.com, with edits and additions by Bon

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The Holidays can be a time of stress

The holidays are often thought of as a time of warmth and happiness, family gathered around the table creating wonderful family memories. But for many of us, it can also be a time of angst and anxiety. (link to the article)

There are many reasons you may feel stress. Perhaps you are a student struggling with school and are afraid of criticism from your family. You may be unemployed and don’t want to face questions about your job search or finances. Maybe you’ve put on or lost “too much” weight this year and are feeling self conscious. If you have been struggling with depression, mood swings or anxiety, you may be more emotionally vulnerable. This time of year could remind you of someone who has become ill, passed away or moved.

There are as many reasons for holiday stress as there are individuals. All of them are what we at Silver Hill call “triggers” – they can bring about or literally “trigger” feelings of anxiety, loss and frustration.

The holiday season and family events can be enjoyable and help build meaningful connections with the people in your life, but if triggers set you off, you may instead find yourself caught in a riptide of emotion.

In the Silver Hill Dialectical Behavior Therapy (DBT) Program, we teach our patients strategies to deal with triggers like these. Three of the strategies are Radical Acceptance, Coping Ahead and Wise Mind.

Radical Acceptance

People usually do not change much from year to year. Personality traits you find irksome will still be there. Your snarky nephew will continue to be snarky. The self-obsessed sister will still be self-obsessed. Your mother-in-law will continue to make comments about your appearance or weight.

Expecting them to be kinder and gentler will only lead you to disappointment. Remember, unrealistic expectations are disappointments waiting to happen. Making matters more interesting, people tend to regress when they are around family. You may too. So if your brother really was a “brat,” don’t be shocked if he becomes a grown-up version of his former self. Accepting this fact, and dealing with the people as they are, will reduce your stress.

But Radical Acceptance works to your advantage because the flip side is also true: People who were good will most likely still be good. Your ever warm and wonderful grandmother will continue to be that way. The cousin with the infectious laugh will not let you down, and your always helpful brother-in-law will be his old self too.

Find a way to accept your own personal cast of characters, the good and the bad. It will help you with the next strategy called “Cope Ahead.” 

Cope Ahead

Coping ahead is an extremely useful strategy in every aspect of our lives. Its core tenet is exactly as it sounds: Plan ways to cope ahead of the situation.

Think about the day, location and people in advance. Imagine what you might feel, what thoughts might go through your mind, and what urges you might have. Then come up with a strategy for dealing with those difficult moments.

One of these six may work:

• Identify your allies. Talk with one of your supportive people and agree to be each other’s ally. Discuss strategies you can use if either of you is feeling overwhelmed.
• Take a breather. Fresh air is always good. Being stuck inside only makes us feel enclosed and suffocated. Walk outside for a twenty minute breather. Physical activity gets our endorphins pumping too, which is also a mood enhancer.
• Change the conversation. Someone just can’t stop needling you about your unemployed child? Change the topic. Get them talking about something they care about – something positive. Maybe they ski or paint or got a new puppy. Ask them how it is going.
• Go to another room. If everyone is watching the game and you just can’t stand it, find a quiet room if possible. Family events can begin to feel very crowded. We all need some space.
• Call a friend. Yes, family times are “no phone zones” and we certainly don’t encourage you to keep your phone out as an excuse not to deal with everyone around you. But if it really gets overwhelming, step away, call a trusted friend and quietly vent. Once you’ve regained your composure, you can walk back in and fully participate.
• Ask a lot of questions. Find someone you’d like to know more about, think of questions to ask them and when you get there, make sure you do. Maybe your niece has just started art school or your mother-in-law knits. Just knowing you have a plan to talk with someone will ease your anxiety going in – and they’ll love the attention.

Use Your Wise Mind

Our last strategy is about perspective: Don’t get overwhelmed by events. Be aware of what is going on, and stay true to yourself. Remember, you are your center. If you eat too much, you may be sorry later. Drink too much and you may say things you regret. Enjoy, but be in the present moment. Practice the mindfulness exercise we discussed in an earlier blog: Pause if you need to, breathe in and out to help regain composure.

Using your Wise Mind also means developing something of a “Teflon Mind.” In other words, let things roll off your back. Yes, your aunt said something annoying. But it’s her problem, not yours.

Remember, the purpose of the holidays is to bring family together, not push them further apart.

DBT teaches people to have meaningful connections with each other, because after all, connections make life meaningful. Using DBT skills this holiday can help you gather around the table, build positive memories and have a good time.

– Bradley W. Bloom, LCSW
Silver Hill Hospital

Silver Hill Hospital’s blog is intended only to provide information; it is not intended to provide diagnosis or treatment. If this is an emergency, please call 911.

Note: I modified this story to apply to the the holidays, rather than to Thanksgiving only.

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TRAGIC AMY WINEHOUSE HAD ‘MENTAL ILLNESS’

TROUBLED Amy Winehouse suffered from an undiagnosed mental illness, a relative has revealed.

The talented soul singer could have been struck down by the little-known Borderline Personality Disorder.

Sufferers have feelings of anger, emptiness, shame and guilt and become emotionally volatile.

And it can also push them into substance abuse and eating disorders, both of which Amy succumbed to.

Yesterday a member of the Back To Black star’s family said: “It was never diagnosed, because unfortunately she would never agree to a proper diagnosis.

“I’m not an expert, but from what I’ve read on Borderline Personality Disorder it kind of fitted with her.”

Meanwhile Amy’s dad Mitch, 61, said he wished his daughter, who died in July aged 27, had sought counselling.

He said: “She never stopped trying.

“She hated the way she was when she was drunk and when she was ill.

“And you know, the way I look at it, she died trying.

“She didn’t give up. She died trying to make her- self better.”

This article, although short, points out several interesting things about people with BPD. Since there’s no guarantee she had it, I’m going to generalize a bit. First of all, it is tragic that BPD is “little known” because it is much more prevalent than bipolar disorder. The article says: “Sufferers have feelings of anger, emptiness, shame and guilt and become emotionally volatile. And it can also push them into substance abuse and eating disorders, both of which Amy succumbed to.” This is very true. A person in extreme emotional pain will do anything to stop the pain. The article ends with “She died trying to make her- self better.” I’d like to amend that statement to “She died trying to make feel her-self better.” That’s the nature of the disorder and that’s what many non-BPDs do not understand. It’s all about his/her feelings (IAAHF) and not about controlling, manipulating or calling for attention.

See larger image Lioness: Hidden Treasures (Audio CD) List Price: $13.98 USD New From: $9.25 In Stock Used from: $7.99 In Stock Release date December 6, 2011.

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Now research suggests that, beneath all the screams and kicking and shouting, lies a phenomenon that is entirely amenable to scientific dissection. Tantrums turn out to have a pattern and rhythm to them. Once understood, researchers say, this pattern can help parents, teachers and even hapless bystanders respond more effectively to temper tantrums — and help clinicians tell the difference between ordinary tantrums, which are a normal part of a child’s development, and those that may be warning signals of an underlying disorder.

Read the entire story or hear the audio

What I found illustrative of this story was the first comment… An excerpt:

This was the worst piece of parenting psycho-babble I’ve ever heard. Explain to me what the child has learned from this besides how to manipulate his or her parents into getting his or her own way? It’s all well and good to study and understand the dynamics of a temper tantrum, but as parents, our responsibility is to help our children become civilized human beings. In our household, tantrums were an automatic “no” for whatever the child was asking for and, if one of my kids had slammed a chair against a wall, that child would have been in his room. Amazingly, my children had very few tantrums and none of them escalated to this level. Not only did they learn that this behavior is unacceptable, they also learned how to ask for what they wanted in a respectful and polite manner and how to negotiate if they really, really wanted something.

I’m sure it’s wonderful to have judgmental atttitudes about others’ kids behavior, but what it illustrates to me is that most people, especially parents, don’t understand the basic mechanics of emotions. And don’t know how to properly react to emotional outbursts. To me, this comment just describes an “invalidating environment”. Kids are not trying to manipulate the parents during a truly emotional outburst. No, their reacting just like their emotions inform them (anger/sadness) and behaving in a perfectly natural way. If you deal with the emotions properly, this behavior will not occur.

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New guidance for management of self-harm issued

23 Nov 2011

The healthcare guidance body NICE has today published a new clinical guideline on the longer-term care of adults, children and young people who self-harm. The guideline development group was chaired by Professor Navneet Kapur in The University of Manchester’s Centre for Suicide Prevention.

This new guideline follows on from the NICE guideline on the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (NICE clinical guideline 16). The new recommendations focus on the longer-term psychological treatment and management of self-harm.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: “Self-harm is a very broad term for a behaviour that can be expressed by those affected in very individual ways, which is why it is so important that each person receives the right care plan for them. The previous NICE guideline on the short-term treatment of self-harm focused on the first 48 hours of an episode and the care they received in the Emergency Department. This new guideline aims to help healthcare professionals support, in the longer term, people who are known to self-harm in reducing and then stopping the behaviour.”

Professor Kapur, Professor of Psychiatry and Population Health in the University’s School of Community-Based Medicine, said: “People may keep self-harm a secret which means it is difficult to know how widespread it is. Many cases are unreported unless medical treatment is required. However, it is thought to be common, especially amongst young people, with one UK study finding that 1 in 10 girls aged 15-16 had self-harmed in the previous year. This new guideline is an important step in improving health professionals’ understanding of self-harm and thereby helping to ensure people receive the treatment and support they need.”

You can listen to a podcast about self-harm by Professor Kapur here (link takes you to the NICE website).

Key recommendations include:

• Working with people who self-harm: Health and social care professionals working with people who self-harm should aim to develop a trusting, supportive and engaging relationship with them, be aware of the stigma and discrimination sometimes associated with self-harm and ensure that people are fully involved in decision-making about their treatment and care.
• Risk assessment: When assessing the risks of repetition of self-harm or suicide, identify and agree with the person who self-harms the specific risks for them, taking into account:

1. methods and patterns of current and past self-harm
2. specific risk factors and protective factors (social, psychological, pharmacological and motivational) that may increase or decrease the risks associated with self-harm
3. coping strategies that the person has used to either successfully limit or avert self-harm or to contain the impact of personal, social or other antecedents

• Do not use risk assessment tools and scales to predict future suicide or repetition of self-harm.
• Care plans: Care plans should be multidisciplinary and developed collaboratively with the person who self-harms and, provided the person agrees, with their family, carers or significant others. The care plan should identify realistic and optimistic long-term goals, including employment and occupation and identify short-term treatment goals (linked to the long-term goals) and steps to achieve them
• Interventions for self-harm: Consider offering 3 to 12 sessions of a psychological intervention that is specifically structured for people who self-harm, with the aim of reducing self-harm. The intervention should be tailored to individual need and could include cognitive-behavioural, psychodynamic or problem-solving elements. Therapists should be trained and supervised in the therapy they are offering to people who self-harm. Therapists should also be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.
• Treating associated mental health conditions: Provide psychological, pharmacological and psychosocial interventions for any associated conditions as described in the relevant NICE guidelines, for example, borderline personality disorder (NICE clinical guideline 78), depression (NICE clinical guideline 90), bipolar disorder (NICE clinical guideline 38).

Professor Tim Kendall, Consultant Adult Psychiatrist, Director of the National Collaborating Centre for Mental Health (NCCMH) and Medical Director at Sheffield Health and Social Care Trust, said: “Self-harm is very common and involves a wide range of methods, the most common being self-poisoning with prescribed or over the counter medicines, or by cutting. People self-harm for numerous reasons, and although self harm is not usually an attempt at committing suicide, it is a way of expressing deeper emotional feelings, such as low self-esteem, the emotional results of previous abuse and hurts. However, people who self harm are much more likely to die by suicide, and many suffer from long term physical effects of self injury and self poisoning, as well as psychiatric problems such as depression. It is very important that we help identify people who self harm sooner and to help them come to terms with the underlying problems and access treatment when they need it. This guideline is a really important step to achieving this”.

Dr Suzanne Kearney, GP in Aylesbury and guideline developer, said: “Although most people who self-harm do not wish to end their lives, it does increase the likelihood that the person will eventually die by suicide by between 50- and 100-fold. NICE has already published guidance on what services should be offered to people immediately after an episode of self-harm; with this new guideline on the longer term management, we hope to provide healthcare professionals with clear recommendations on how to work with people who self-harm and enable them to choose the right treatment for their individual needs.”

Mr Gareth Allen, guideline developer representing service user and carer interests, added: “Every person who self-harms is different; they do it for individual reasons and have their own individual needs. It is hoped the recommendations made in this new guideline will help healthcare professionals identify the needs and risks that should be considered when assessing a person who has self-harmed and the types of treatment available.”

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I’m gonna jump (link)

THE DOCTOR SAYS
By Dr MILTON LUM

The are several factors that increase the risk of a person commiting sucide.

EVERYONE’S life has its ups and downs, with feelings and emotions accompanying many of these situations. Most people adapt and cope with the downs. However, there are some who are so overcome with these emotions that they take their own life.

Suicide is an individual’s intentional act of ending his or her life.

Many suicide attempts are preceded by a history of self-harm, in which there is deliberate injury that a person inflicts on his or her body. This does not mean that the person who self-harms wants to commit suicide, but is an effort by the person to cope with intense emotions.

However, self-harm is an indication that the person needs immediate assistance.

Suicide is a common cause of death in young people worldwide. According to the National Health and Morbidity Survey 2006, there was a 6.3% rate of acute suicidal ideation, and 25.8% of chronic suicidal ideation. The highest prevalence rate of suicidal ideation of 11% was found in those aged between 16 and 24 years.

The National Suicide Registry Malaysia (NSRM) 2008 report stated there were 290 suicides in that year, of which 219 were men and 71 women, with Chinese comprising 53.5%, Indians 27.3%, and Malays 13.9%.

The youngest suicide victim was 12 years, while the oldest was 83 years. The NSRM estimated that there were 425 suicides between January and August 2010, averaging 60 per month, ie two daily.

It is estimated that the suicide rate is similar to that of the United States.

Although women are more likely to attempt suicide and other self-harm behaviour, it is the men who are more likely to succeed in suicide. The suicide rate in men in many countries is about three times that of women.

Risk factors

The reasons why some people commit suicide while others in similar situations do not, have not been determined. However, there are some factors that increase the risk of suicide.

Genetics is believed to be a risk factor as suicide has been found to be more common in certain families. There are several genetic mutations reported that may alter the chemicals in the brain, increasing the vulnerability to suicidal thoughts and behaviour. However, no specific gene for suicide has been identified.

Mental health conditions are the most significant risk factor, particularly serious and chronic mental health conditions. It has been estimated that about 90% of people who commit or attempt suicide have a mental health condition.

Severe depression is associated with misery and hopelessness – there is a 20-fold increase in the likelihood of attempted suicide than the general population.

Sufferers of bipolar disorder alternate between extreme joy to severe depression. About a third of these sufferers attempt suicide, and about 10% commit suicide.

Patients with schizophrenia are unable to think logically, and have difficulty differentiating between real and unreal experiences, with about 5% committing suicide. The risk is greatest when the diagnosis is made, but with the passage of time, they are better able to cope with their situation.

Anorexia nervosa is a condition in which anxiety about body weight leads to extreme efforts at limiting food consumption. About a fifth of anorexics will attempt suicide.

Patients with borderline personality disorder have altered thinking, unstable emotions, impulsive behaviour and unstable relationships. About half of these sufferers will attempt suicide, with an increased risk in those who were sexually abused in childhood.

It is believed that a combination of other factors increases the risk of suicide. These factors may or may not be significant, depending on the person’s vulnerability at the point in time. They include:

• History of a recent traumatic experience, eg end of a relationship, bullying, loss of job, bereavement.
• History of a traumatic experience in childhood, eg sexual or physical abuse, bereavement, parental neglect.
• A parent with a serious mental health condition, eg severe depression, bipolar disorder, schizophrenia, or who committed suicide.
• A previous attempt at suicide.
• Social isolation, with few family members or friends.
• Misuse or abuse of drugs and alcohol .
• Unemployment or poor job satisfaction or security.
• Debt.
• Occupations which permit access to the means to attempt suicide, eg doctor, nurse, pharmacist, planter.

Danger signs

There are warning signs that indicate that a person is suicidal. They include talking or writing about death or suicide threats to injure or kill himself or herself, and actively seeking methods of committing suicide, eg stockpiling medicines, particularly sleeping pills, and/or pills used to treat serious mental conditions.

Other warning signs include:

• Complaints, talk or behaviour that indicate hopelessness or a meaningless life.
• Loss of interest in personal appearance, eg poor dressing, cessation of use of make-up.
• Reckless or risky behaviour without concern for the consequences.
• Sudden mood changes, anxiety, agitation.
• Increased withdrawal from interactions with family members and friends.
• Insomnia or sleeping all the time.
• Abuse or misuse of drugs or alcohol.
• Putting their affairs in order.

When warning signs are noticed, it would be useful to encourage the affected person to talk about it and to listen attentively. One should listen to what the person has to say to let them know that there is someone who cares about them.

A non-judgemental manner and empathy are essential. One should not influence what is said, but rather, facilitate honest and frank conversation.

Any questions raised by the listener have to be open-ended, and not end the conversation.

At the same time, the person’s doctor or nurse should be contacted. If it is not possible to do so, the accident and emergency department of the nearest hospital should be contacted as to how to get professional help for the affected person. If one assesses that the affected person has a high risk of dying by suicide before the arrival of professional help, one should contact the nearest ambulance service.

At the same time, any possible means of suicide should be removed from the immediate environment of the affected person. This would include medicines, household chemicals, sharp objects, etc.

Providing care to a suicidal person is stressful and distressing, and it can impact upon the carer’s mental health. Professional help may be required to address the carer’s emotions after the event.

Preventing suicide

Mental health is no different from physical health. Measures can be taken to improve mental health so that one is stronger emotionally and better able to cope with the downside of life, thereby reducing the risk of developing mental health conditions like depression.

Exercise is effective in the management of depression. Physical activity reduces stress and anxiety, improves mood, and promotes the release of brain chemicals called endorphins, which makes one “feel good”.

A healthy diet not only provides protection against physical health problems, but may also be vital in maintaining mental health.

Avoidance of social isolation is an important measure as it is a risk factor for suicide. Having friends is beneficial for mental health. If there is individual difficulty in making friends, you should consider joining a local activity group or support group. There is evidence that people involved in providing assistance to others through voluntary or charity organisations are mentally healthier than the general population.

Having a positive attitude is vital as persistent negative thoughts increase the risk of isolation. Cognitive behaviour therapy (CBT) is a type of talking treatment that assists in the management of problems by changing the thoughts and actions of the affected person.

Many people use drugs to help them cope with life’s problems. Their misuse or abuse may lead to more problems and increases the risk of developing serious mental conditions like depression.

Even recreational drugs like marijuana, which is perceived to be less harmful, increase the risk of depression and schizophrenia in some people.

Many people use alcohol to help them cope with life’s problems. Its misuse or abuse may lead to more problems and increases the risk of depression. It would be prudent to avoid exceeding the recommended daily alcohol consumption limits – ie three to four units for men and two to three units for women. A unit is the equivalent of about half a pint of normal strength lager, a small glass of wine, or 25ml of spirits.

A consultation with your regular doctor would be helpful if there are problems with drug usage or alcohol consumption.

However, the evidence is that an effective preventive strategy is to educate doctors on how to recognise and treat depression, and restricting access to lethal methods of suicide. Another promising strategy is to train particular groups of people on how to identify those at risk and refer them for treatment.

Support groups provide counselling and practical advice to people who are depressed, or have suicidal thoughts. The local support group are the Befrienders and their contact details are 95, Jalan Templer, Petaling Jaya 46990 (Telephone: 03 7956 8144 or 03 7956 8145; email: sam@befrienders.org.my)

If you do not like the idea of talking to someone on a helpline, you can talk to a family member, trusted friend, doctor or religious leader. You should also consult your doctor, who can prescribe treatment for mental health conditions.

> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

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Being blamed for everything is tiring to say the least. Coupled with the BP’s inability to take responsibility (and blame) for his/her own actions, this aspect of BPD is maddening. It is impossible for one person to shoulder all the blame for everything in a relationship. One of my therapist friends once told me, “If you are responsible for everything, you are responsible for nothing.” I truly believe that it is impossible for anyone to take all the responsibility and blame in a relationship.

Why does a person with BPD seem so fixated on blame-finding? (Which I like to call “blame-storming” in a nod to “brain-storming”). Why does he/she go to great lengths to assign blame to anyone else (including God, the world, everyone, etc.) other than his/herself? The reason seems to be similar to that of the inability to take responsibility for his/her actions. He/She does not want to be seen as the “cause” of problems or of pain. This would again make him/her “all-bad” and in being “all-bad” he/she deserves nothing less than death. It is easier to find someone else (or something else, like karma or life itself) that is a more acceptable cause of his/her pain and problems. Some books call this “projection,” but I don’t think it is projection per se. It is more the fear of rejection, ridicule and emotional pain if he/she is at fault. It confirms his/her shame and that he/she can do nothing right. Through black-and-white thinking, if he/she is a bit at fault, he/she is doomed.

Sometimes I will hear my wife say that she “hates everyone” or that she feels “everyone is out to get her.” Clearly, these statements can be seen as paranoid or misanthropic, but ultimately she is expressing her belief that forces outside herself are to be blamed for how she feels.

Adapted from When Hope is Not Enough

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1. Why you should NEVER let a person with BPD have access to a gun
2. BPD: What’s in a Name and How does it feel to be that person?
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Rage burns and burns

In the support groups, rage is one of the most talked about aspects of BPD. Why? Because it is one of the most difficult for the Non-BPD to endure. Many people ask themselves, why is this person so angry (with me)? It seems to make no sense. A person with BPD will fly into a rage about seemingly nothing. The smallest thing that is out of place or not done the way that this person expects causes sometimes hours of anger and raging, yelling and screaming and sometimes physical violence. Again, many Nons ask: “what’s up with that?”

Anger and rage are usually secondary emotions to other primary ones. Sensitivity to judgment plays a major role in the triggering of rage. The symptoms and feelings associated with BPD interact and, at times, feed each other. In the case of rage, I believe that it is fed by two other symptoms: shame and sensitivity to judgment (which is also fed by shame).

When someone with BPD feels shameful and when you (as a “Non”) criticize or judge her behavior as “bad” or “negative,” the trigger for rage is pulled within the person with BPD. Why? Because your judgment reflects her shameful feelings and resonates deeply into her core beliefs about herself. She panics that you are “finding out” that she is a bad person. She has to (at all costs) defend her “goodness.” What I have found with my own borderline is that this is the point at which she will rage and introduce the “what about you?” argument. The “what about you?” argument is a way to rage at the Non and release anxiety about the Non finding out about her shameful “badness.” Some people in the support community like to call this “projection” or “denial.” I personally don’t believe it is actually projection or denial (although there are times in which projection is clearly there). It is a form of misdirection to try to take the focus off their inner shame and refocus the discussion on you and your faults.

Nobody is perfect, not even you. When a person with BPD rages against you, you often feel very imperfect – especially if she uses the “what about you?” attack. When someone with BPD uses the “what about you?” technique she is usually deflecting blame and judgment on you. However, you experience the rage as hurtful to your very self. You find that the rage “forces” you to defend yourself against her. That is what the “what about you?” attack/rage does best. That is its intention; it puts you on the defensive and shifts focus away from her and her behavior. As I said, it is form of redirection away from the person with BPD’s shame.

One interesting thing about raging is that once the anger and raging is done, it is usually over. Sometimes the person with BPD will be exhausted after the rage and will just collapse and go to sleep. The same is the case with tired children. Sometimes a tired child will have a temper tantrum (which is a form of rage) and then, once the emotions are released, she will either go to sleep or sit placidly in your arms. The inner agitation has been released and she is done.

Adapted from the FAQ from When Hope is Not Enough

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Why discuss emotions when we are talking about a personality disorder? Well, most researchers agree that the main component of BPD is emotional dysregulation. If you understand the function of emotions and how they play a part in BPD, you can understand the relationship better and interact more effectively with someone with BPD.

A threat or not?

Emotions involve both the body and the mind. Each emotion has a physical and mental configuration. [Dr. Paul Ekman has shown that for “universal emotions” (he cites seven of them: anger, sadness, joy, disgust, contempt, surprise and fear) the person feeling the emotion also will display the emotion on their face. It is impossible to suppress this emotional display inside of 1/25th of a second. Ekman calls those expressions that are quickly suppressed (but not completely suppressed) “micro-expressions” and has developed a tool for recognizing those within other people. I highly recommend Ekman’s tools for learning to read emotions as displayed on other people’s faces.] What we see is that, once the emotional system becomes engaged, the body reacts automatically and reacts in a way that is “hard-wired” in our brains and bodies. We may feel a knot in the stomach, sweaty palms, a loss of blood to the extremities, a rise in blood pressure or other automatic physical reactions.

The emotions triggered are in line with the interpretation of the event. Sometimes the interpretation is “misaligned” with reality, yet the emotions are real and felt nonetheless. An example I use in When Hope is Not Enough, is that of an ancient Hindu parable. In this parable, a person sees a rope as a snake and jumps away with fear. The fear is real to the person seeing the “snake.” The fear only dissipates when the person realizes that it is a rope and not a snake, and perhaps the person will feel foolish that they jumped away in fear from something that was harmless. Still, the person feels the fear and has the natural physical and emotional feelings run through their body and mind. Also, this person behaves in the natural way as a reaction to fear: they jump away from the “threat.”

What I realized about this story after I published that book was that humans get more utility from a “false positive” (thinking a rope is a snake) than a “false negative” (thinking a snake is a rope). It allows us to better survive in a threatening world. Considering the “false alarms” (positives) that a person with BPD experiences, this threat-awareness, for whatever reason, seems to be on a hair trigger for someone with BPD.

Emotions play a huge role in our lives and in our decision-making. Many people believe that a person can’t make sound decisions if they are “too emotional.” Most people place value in being rational (as opposed to rash). However, studies have shown that every decision – from buying ice cream to hiring an employee − has an emotional component. We just don’t notice the emotional component often because it is so built-in that it just seems natural, unless the emotions are expressed for everyone to see. We usually only notice the emotions of people that “wear their heart on their sleeve.” Yet, everyone has emotions. When something just doesn’t “feel right,” that is your emotional system contributing to a decision.

Typically, people do the natural thing when responding to their emotions. This natural thing is built-in. In Emotions Revealed, Dr. Paul Ekman tells us that there are seven universal, built-in emotions.

So, when your loved one reacts in the “reflex” way to the  emotions, he/she is reacting naturally. Whether the “trigger” is appropriate for the situation remains to be determined, but the reaction is typically the normal one.

These emotions are “reflexive” emotions and can save a person’s life. However, if the reflexive emotion is not aligned with reality, it can cause problems. One skill  is how to turn reflexive emotions into “reflective” emotions. Reflective emotions can encourage wise choices.

Adapted from “Beyond Boundaries” by Bon Dobbs

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Here is a list of what could be called the top 10 emotional needs of children, in alphabetical order.

1. Accepted
2. Believed in
3. Cared about
4. Forgiven
5. Loved
6. Safe
7. Supported
8. Trusted
9. Understood
10. Valued

We believe that if parents adequately fill all of these needs, the child’s or teen’s behavior will take care of itself. We also believe that feelings predict behavior, so if children have positive feelings, positive behavior will naturally follow.

From eqi.com.

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… from an insightful blog post by Sonia Neale. Here is the text of the post:

Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance

By SONIA NEALE

Sometimes, the smallest things in life can cause the greatest pain and physical reaction.  A bee’s sting is almost invisible to the naked eye and yet can easily kill someone when they have an allergic reaction.  A mere critical stinging comment can just as easily send a person suffering Borderline Personality Disorder into “emotional anaphylactic shock.”

When a person has a life-threatening reaction to the poison from a bee sting, an ambulance is called and the person is taken to hospital where they receive treatment for their illness as well as respect and dignity but when someone suffering an emotional reaction to life circumstances presents at emergency, they are sometimes treated with rejection, intolerance and disdain.  People can die from a bee sting and Borderlines can “die” from their own personal rage and self-hatred.  If you present at emergency with a swollen face and throat unable to breathe with all your body organs shutting down, is some doctor or nurse going to say, “OMG, it’s a tiny bee sting, how bad can that be, look at you, get over yourself,” like they sometimes do when Borderlines present at hospital with similar symptoms.

Yet both types of people are in much pain and danger.  One is considered entirely physical and the other is considered entirely emotional.  Or is it entirely emotional?  When a sensitive person with a history of trauma has an emotional “bee-sting” reaction to someone’s criticism there is a definite physical reaction.
Borderlines tend to be hypervigilant, which means they live with permanent muscle tension and a certain excess of adrenaline pumping round their system at any given time.  So when criticism hits, the body goes into an emotional anaphylactic state where cortisol floods the brain and body system and a type of blackout occurs where nothing anyone says or does registers.  Your body has gone into “shock.”  When I used to get into such a state someone could have cut my arm off and I would not have noticed.

Things are said during this time that are simply appalling.  I have used language I would not use in normal everyday life.  I have said things that are deeply hurtful and as my husband has said, “you can mend a vase but the cracks are always there for those to see.” My therapist says it is best to repair those cracks with gold. Her favourite quote, by Barbara Bloom is “When the Japanese mend broken objects they aggrandize the damage by filling the cracks with gold, because they believe that when something’s suffered damage and has a history it becomes more beautiful.”  I prefer her take on this matter.

Therapy has taught me that my perception of events and criticism is usually erroneous.  Even if people are critical and disrespectful, it is about them and not me.  If my ideas get criticized it is not because I am a loser and I deserve to die, it is because we both have a different belief system and ways of handling situations.  There is no right or wrong, just opinions.

I have criticized my therapist on many occasions including recently when she raised her colleagues’ fees in the light of almost certain public benefit cuts.  Her reply was that her practice survived before the benefits were given and hopefully will survive after the benefits are cut.  She raised her fees because she valued herself and her colleagues.  She did not feel the need to get upset or question herself or her actions because she believed that what she was doing was the right thing to do.

It is this sort of self-valuing that is empowering to people like myself who always feel others are more valuable and powerful than I will ever be.  When we assert ourselves and say, “No, I don’t like that because….” we can start to realize that it is ok not to people-please all the time.  I said no to unpaid overtime because I value myself as a worker otherwise I will feel undervalued and get resentful.  Like my therapist I am worth it.

Mindfulness and radical acceptance of people and situations as in Dialectical Behaviour Therapy is the key to, well, if not happiness, then a more content and peaceful self.  It is the road to what Abraham Maslow calls self-actualisation – autonomy, independence, few but deep friendships, a philosophical sense of humour, resistance to outside pressures and transcendence of the environment.  These are the things I strive for and have spent much time in therapy trying to get a good grasp of.

A great book, which promotes self-actualization that I am reading at the moment, is “The Art of Happiness” by the Dalai Lama.  While I may not quite reach the emotional plateaus that His Holiness is capable of, I can certainly learn how best to inoculate myself when swarms of emotionally stinging bees are trying to infiltrate my brain and body system.

See larger image The Art of Happiness, 10th Anniversary Edition: A Handbook for Living (Hardcover) By (author) Dalai Lama List Price: $25.95 USD New From: $14.48 In Stock Used from: $6.97 In Stock Release date October 1, 2009.

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A: This is an excellent question and one that I have grappled with for years. My wife’s behavior before I started down the path to effectiveness was off-the-charts and was affecting my children’s feelings of safety in our household. Numerous times I felt the only solution to protecting my children was to leave my wife and apply for full custody of our children. When my wife was “acting out” and/or in a rage around the children, I would take the kids to the library or to events around town. I worried that they would associate going to the library (a nice quiet place) with my wife’s raging. However, once I understood the reason for her raging, I also understood that there was a more effective solution to my wife’s behavior. The reason my wife was raging was because she had dysregulated emotional states that were painful for her, yet out-of-line with the evidence of the world around her. Still, these emotional states seemed quite real and justified to her. All of her life she has felt that her very being is under threat from those around her. This situation causes fear in her, but the fear quickly turns to rage and no-holds-barred behavior toward others, even those she supposedly loved. In fact, this dangerous and confusing behavior was worse with the immediate family. The reason is that she felt that her emotional states were not understood, not accepted and judged by those with whom she had the most at stake. If your immediate family doesn’t accept you, who will? This judgment and rejection was seen as a prelude to abandonment, rejection and confirmation of her shame. This situation made her frightened, desperate and angry. The anger then translated into rage from which much of the emotional abuse arises.

Behavior is most often conditioned and based on previous beliefs, reactions and conditions. I found that if you, as a loved one of someone with BPD, change the conditions, the behavior will change. If the emotions are accepted and validated, they don’t typically spiral out of control and trigger dangerous abusive behavior. It is not a question of right and wrong, like many people believe it is. It is a question of effective reactions and behavior on your part versus continuing to react ineffectively and, essentially, throwing gasoline on a raging fire. Better to put out the fire with water, which is a soothing elixir. Punishing a person for their feelings becomes translated into more shame since “all feelings all the time” is how they “are”. Rejection confirms that to the borderline that he/she is a bad person, which, in turn, causes more and more rage. Remember, however, that emotions and behavior are not synonymous. You can validate emotions without condoning the resultant behavior.

What about past abusive behavior? When will my borderline take responsibility for that? Should I let that go?

If I’ve learned anything about borderlines in the past five years, it’s that they generally know what they’ve done “wrong” in life, whether or not they will admit it to you. The shame component causes a “deepest, darkest” reflection about who they really are. When a borderline identifies with a particular role in life – such as being a mother – anything that threatens that identity is usually met with fire. Yet, on the flip-side of the defense of their very being, there’s shame, unworthiness and self-flagellation. It is most likely that your borderline will punish herself for the discretions she has committed. Of course, sometimes, the emotion-fueled behavior is not even remembered. It’s sometimes an emotional vomit session to get all the bad feelings out, to purge the nasty sickness of the painful emotions – of course,  those around them can get spewed on. When I said that it might not be remembered some time ago on the ATSTP list, I got a response from a recovered borderline that went “oh, we remember it. We just can’t run to the toilet when it is occurring. And we almost always see the mess that has been made and feel bad about it afterwards.”

My suggestion about “balance” between validation and protecting the children from emotional abuse boils down to the belief that, if the borderline doesn’t let the emotions run away with them, the abusive behavior will (almost) cease entirely. I still get raging from my wife every once in a while – maybe once every 4-6 months. It used to be once every 2-3 days, then it was 2-3 weeks, then once a month and so on. What I changed was the environment for my wife’s emotional expression. I stopped judging her. I validated her when she felt bad. I built a safe, accepting environment for her emotional life. One that she has never experienced before. It was not my “fault” that she felt that way – it was merely how is actually was in her life. I had to accept the reality of the situation and do what I could do to change it.

Several members of the ATSTP list have reported that once they “turned their mind” (and behavior/reactions) toward what I purpose in WHINE, the raging in their borderlines ceased. The Buddha said of dependent origination: “When this exists, that comes to be. With the arising of this, that arises. When this does not exist, that does not come to be. With the cessation of this, that ceases.” My suggestion to each of you is to cause the “ceasing of this” (the non-accepting, judgmental, invalidating environment) to insure that “that ceases” (the abusive, dysregulated behavior).

NOTE “Ask Bon” is a new category within this blog in which Bon answers burning questions about being a non-BPD from his perspective and with the skills an attitudes with which he was able to rebuild his relationship with his borderline wife. The opinions are Bon’s alone.

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Sometimes Love Hurts

Emotional independence is gained through a change in the way we approach loving others and loving ourselves. Children are naturally and understandably emotional dependent on their parents, because all of their emotional needs are (at first) supplied by their parents – and their siblings, peers, teachers, other family members and others in society. They have little ability to supply needs on their own. If you continue this pattern when you grow up, you’re going to continue to be emotionally dependent on others to supply validation, etc. Even competition with others is a form of negative validation for your emotional needs. Eros-type love of partners is rooted in desire and sees loves as an exchange of emotional needs. Love is this way is a transaction, in which each individual expects the other to fulfill their needs (and even to anticipate them) and the person is upset and (in some cases) feels like less of a person or judges the other person for failing to fulfill their emotional needs (or both). This type of romantic (Eros) love is a dependent type of love in which there’s an idea of possession of the other person, and that possession also breeds more dependence. Even hatred of another individual can be the flip side of the same transaction-based and, when our desires and expectations are not met (or we don’t win or we don’t get revenge or whatever that requires the other person to be in relation to us to meet our emotional needs), we suffer. Our heart hurts because we are expecting something that we can’t control. We are basing our contentment and peace of mind (and of heart) on the behaviors, emotions, words, and intentions of the other person. The problem really comes into play when you start to realize that there’s no end to suffering. No other person can live up to all of your desires, because your desires are a fire that constantly has to be fed, pacified and stoked. This is the way of black-and-white thinking and is a reason that when a person (BPD or not, although BPD people live this way a lot, because of the inability to self-regulate and looking to others to be that self-regulator) approaches relationships that way, they suffer. You may not suffer in the “good times” but those good times are bound to go away (at least in certain moments) because you can’t control 1/2 of the equation – the other person. This way of approaching love relationships is childish and emotionally immature – I’m not judging anyone, I’m saying that it is a child’s way of approaching relationships because they have little self-efficacy.

A while ago I wrote something on Eros v. Agape love in the ATSTP List. I think that the Agape way of approaching love is all accepting and all appreciating for others in the way they actually are, rather than for what they can supply to us to keep the fires of passion burning. It is dispassionate and detached in the same way you might appreciate a beautiful sunset for what it is. You ask nothing of the sunset. It is as it is. People can’t be controlled. If you combine this way of loving and appreciating others with compassion, in which you can deeply relate to other’s suffering, then IMO you have a formula for emotional independence. It requires (again IMO) radical acceptance of others and compassion for other’s suffering. It also requires an acceptance of your own worth (core value). How do you get there? I guess that will have to be talked about in another post

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It is most important to be effective (rather than right all the time)

This particular attitude is one that has been the most controversial in my Internet group. Many people in life pride themselves on their morals and ability to discern right from wrong. Many people try to do the “right” thing in any given situation. Sometimes people will do what they think is right, even if that hurts another person that is close to them.

People are typically very judgmental. Before I started down this path, I also was very judgmental. Sometimes I can still be judgmental. When I talk about judgmental, I am talking about judging whether other’s behavior is “right” or “wrong” in your eyes. It is the act of labeling other people’s behavior as “good” or “bad.” The problem with being judgmental when dealing with someone with BPD is two-fold. First, because of the shame involved in BPD, when a person’s behavior is judged as wrong or bad, the person will expand that judgment to his or her feelings and further expand it to his or her self. Therefore, a judgment of the other person’s behavior is essentially a judgment of the other person’s self. Secondly, the person is acting on their feelings and doing something that has, at one time in their life, been used to assuage negative feelings. They are acting in a way in which they will feel better. They are acting in a way that they have used to adapt to strong negative feelings in the past. While the behavior may be maladaptive, it is understandable behavior based on how the person feels. You might not behave in the same fashion, but if you had their history, thought like them, had strong negative feelings as they do; chances are you would behave in the very same way. Thus, judging their behavior as “wrong” or “bad” is missing the objective of the behavior. Yes, the behavior may be self-destructive or nasty, but the behavior is a tool for adapting to how that person feels.

One of the biggest problems with being judgmental toward someone with BPD is that it denigrates their feelings and creates the “invalidating environment” that I spoke about earlier. If you judge another person’s feelings (by way of their behavior) as bad, you are judging them as bad – at least for a highly emotional person.

It is extremely difficult to drop the judgmental attitudes that you have. It takes time and practice. Being judgmental is taught to us from a very young age and it seeps into our language. In some respects, we are taught that being judgmental is a positive thing, a moral attitude. We are taught not to accept others and their behavior because their behavior is bad or wrong. This attitude helps keep us within our social group and helps keep us from risk. However, in interpersonal relationships, particularly with a highly emotional person, it is corrosive. If someone feels they can’t be accepted “as is” and “for what they are,” that person will be either shameful or will fly into rage against the judge (or a combination of the two).

A sure sign of being judgmental is name-calling and labeling. If you find yourself, internally or externally (meaning to yourself or to others) labeling someone, you are likely being judgmental. I will talk about how to be less judgmental shortly.

I say, “It is most important to be effective.” What does it mean to be effective? Before I could talk about effectiveness, I had to dismiss being judgmental, because it is a roadblock to effectiveness. Being effective is doing whatever is necessary to gain a positive outcome in any given moment. In the case of emotions, it is doing what is necessary to feel better in any given moment. The major difference between effectiveness and mere adaptive behavior (as mentioned above) is that effectiveness takes into account the consequences that are associated with a given behavior, not just the immediate effects. That is where the idea of “positive” outcome comes into play.

In the case of emotional situations, sometimes the most “conditioned behavioral” response is not the most effective one. An example of this is self-harm. Most often, self-harm – such as cutting, burning oneself or pulling at one’s own hair – functions to reduce pain, not to inflict it. In other words, it is an adaptive response to internal (usually emotional) pain. While you might not think that the behavior is “right,” it is a valid response to internal pain, because it works to reduce pain. Although it is adaptive and “works,” it is not effective, because of the significant negative consequences involved. It can lead to embarrassment, injury, infection or death. The potential negative consequences outweigh the effectiveness of the behavior.

So, doing what “works” is not always the most effective solution to a problem. Learning to identify the most effective solution is a skill itself, and I will discuss it at length later. The point of bringing it up here is that one must adopt an attitude of doing the most effective action in any given situation. You have to be dedicated to being effective.

Now you might ask (as many of the people on my list ask), what if the most effective thing goes against my values? What if being effective is “wrong” in a particular situation? Well, my response to that is that emotions trump values. Emotions are immediate and primal, whereas values have been developed over time (sometimes over generations) and are more abstract than emotions. Again, this is not a case of “if it feels good, do it.” This is the accumulation of the first few attitudes I have directed you to take. If emotions are important (attitude #1), not all people think the way you do (#2), no one has a corner on the truth (#3) and some things have to be accepted (#4), what we arrive at is the attitude that your values and judgments are not necessarily valid for other people. If someone is overcome with powerful negative emotions, we find that: 1) it is important to them; 2) they are not thinking the same way you might; 3) your version of the truth in this situation does not match theirs; and 4) the fact that they are in this state is a truth and must be accepted. Once those attitudes are applied to an emotional situation, you can start to be effective, even if being effective goes against the grain of what you deem is “right” or “good.” I know this might be a difficult concept for you to understand at this point. It was extremely difficult for me to come to terms with it as well. However, in the case of emotional situations, it is essential.

OK, well there it is a long quote from When Hope is Not Enough. The reason I am posting it today is that I have come to understand more fully how this attitude conflicts with many strongly-held beliefs of my readers. It takes a LOT of time to understand and “grok” this approach to life and to your relationships with a person with BPD or any emotionally sensitive person. Once, I was asked what qualities do I dislike the most about other people and I answered: contempt, sanctimoniousness and judgmentalism. I feel that all of these qualities are those that hurt relationships with other people and they all center on the idea that person A (with those qualities) is RIGHT and person B is wrong, for whatever reason. That reason could be that person B is disordered, like have Borderline Personality Disorder. However, person B is no BPD, person B is a person first and can be respected as a person. I read recently an introduction written by the Dalai Lama to a book. His first words were “Every person wants to be happy.” I agree. A person with BPD wants to be happy. The nons want to be happy as well. Yet one stumbling block to happiness is the desire to be right and lord it over the other person. Relationships are not competitions in which one person is right and the other wrong. That’s my belief anyway. When you’re ineffective, what you’re really doing is “winning a battle but losing the war” by gaining points on a particular situation yet hurting the relationship in the longer run.

Related posts:

1. An exercise in being Non-judgmental
2. Tough Love is not an effective approach to BPD

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Diane Schuler’s Story Is One Of Isolation, Denial, And Rage
Anna North

One of the saddest news stories of the summer just got sadder — the husband of Diane Schuler, whose wrong-way drunk-driving crash killed her and seven others, tells New York Magazine he still believes his wife was essentially perfect.

New York’s Steve Fishman tells a depressing tale of denial and rage. On one side is the bereaved Schuler, struggling to go on after the death of his wife and daughter, and on the other is the Bastardi family, two of whose members were killed when Diane Schuler’s Winstar struck their TrailBlazer. Mike Bastardi lost his father, Michael Sr., and his brother Guy, and is angry at the whole Schuler family for what he sees as their role in the accident. He says, “They make like it was not even their fault. I think they knew she was drunk and stoned.” Bastardi’s wife Jeanne is even harsher. She says, “Not even a second have I felt sorry for Danny. This becomes a man you can’t hate enough.”

Part of the reason the Bastardis are so angry with Schuler is that he won’t own up to his wife’s guilt. After the crash, he said at a press conference, “She did not drink. She is not an alcoholic. My heart is rested every night. Something medically had to have happened.” He’s stuck to this story ever since, hiring a private investigator and a lawyer who speculated that a small stroke or abscess might have caused her to suddenly lose judgment and down ten shots of vodka before getting behind the wheel. Not only was his wife not an addict, he says, she was nearly flawless. Though he spoke to the investigator about “ups and downs” in his marriage,” he told Fishman, “There were never any downs. Up for twelve years.” He says they were “perfect” for each other, she was an “outstanding” mom, and, tellingly, “She never complained. I do; she doesn’t.”

Diane Schuler’s friends also portray her as keeping her feelings — especially negative ones — to herself. One says, “I’ve never seen her mad or angry,” another, “she infrequently talked about personal feelings.” She never talked about her parents’ divorce, and refused to speak to her mother — some friends even thought her mother was dead. When Fishman asked Danny “how well he really knew” his wife, Danny answered, “She’d talk to me if things came up.” His examples: “The house needs painting, the gutters need to be cleaned.”

To hear Fishman tell it, the Schulers’ story seemed like a long, drawn-out, and bloody example of the consequences of secrets in a marriage. Did Diane Schuler feel pressured to be the perfect mom — Danny mentions her expertise with birthday cards and holiday decorations — and thus keep her substance problems to herself? Did she feel she couldn’t confide in her husband because their work schedules meant they were rarely home at the same time? Did her parents’ divorce make her feel she couldn’t rock the boat in her own marriage? Why didn’t her friends know more about her troubles? Probably these questions will never be answered, but if there’s a tragic flaw in the whole Schuler saga, it’s isolation.

Despite her supposedly close-knit family, Diane Schuler apparently kept herself hidden from everyone. This led not only to her death and the deaths of seven others — it also plunged her husband into denial and the surviving Bastardi’s into fruitless anger. They won’t be satisfied until he admits guilt; he won’t be satisfied until he proves his wife was blameless. It’s hard to know how much of this cycle of despair was caused by Diane Schuler’s own particular pathology, and how much by an American idea of marriage that often positions the spouse as sole confidant even when, as was the case with the Schulers, that spouse may be physically unavailable. Only one thing is clear: if Schuler had felt able to open up about her own life, she might have avoided destroying countless others.

Related posts:

1. Mindfulness and Acceptance
2. Emotional Validation with Honesty
3. Ask Bon: How do I balance validating somebody’s feelings with protecting myself or my children from emotional abuse?

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10 Signs That You’re An HSP (Highly Sensitive Person)

By Zoë Kessler, BA, B.Ed.

Many people with ADHD (myself included) identify with being an HSP (Highly Sensitive Person), so I thought I’d revisit this topic in today’s blog post.

I’m not saying that non-HSP’s don’t experience these traits, but it’s much more common amongst the 15 to 20% of the population who carry the gene for sensitivity (yes, research backs up its genetic origin).

Sensitivities can manifest as physical characteristics, in social situations, and at work.

I’ve created the Chick A-D-D P.O.S. System to categorize these common 10 HSP characteristics.

P= Physical sensitivities
O = Occupational sensitivities
S = Social sensitivities

See if you can find your POSition through these 10 Signs That You’re An HSP.

1 ) Loud Movie Soundtracks (P)

non-HSP: Wow!
HSP: Ow!

I remember seeing Star Wars when it first came out (yes, I’m that old). I think I actually put my hands over my ears (which, come to think of it, did make me feel like a little old lady although I was only 18 at the time). The entire soundtrack was like having the Imperial Stormtroopers’ E-11 blaster rifles shooting directly into my ears.

2 ) Big, Excited Crowds (S)

non-HSP: Fun!
HSP: Run!

I’ve had the heebie-jeebies in crowds since a young age. I can get downright claustrophobic shoulder-to-shoulder at a large fireworks display, parade, or crowded bar (at least in a bar I can anesthetize myself with a few vodka coolers).

3 ) Delicate Or Subtle Smells, Art, Flavours (P/S)

non-HSP: Miss
HSP: Bliss

Two examples of this from my life are 1) I’ve been known to sit, mesmerized, in front of a painting for over three hours at a stretch and 2) the subtleties of East Indian cuisine intrigue and delight me, with delicate nuances and undercurrents of sauteed-’til-popping-mustard-seeds, cumin and cardamom.

4 ) Crude Sexual Innuendo (S)

non-HSP: Bad-ass
HSP: Simply Crass

An example of this can be found in what I refer to as the X-rated section of a card shop:

Cover of the card – “ You know you’re getting older when your underwear creeps up on you …”

Inside of card: “… and you kinda enjoy it.”

Actually, wedgies can also fall under the P (Physical) category. Ew.

5 ) Brassiere (P)

non-HSP: Wearable
HSP: Unbearable

In about 3 nanoseconds of wearing a brassiere, I want to rip the damn thing off and run screaming back to my closet for a top that will disguise that I’m no longer wearing it. I only wear one under duress (i.e. when décorum demands it. At work, for example). Straps, underwire, the whole contraption smacks to me of bondage (I know, I know; this feature is actually an attraction to some of you, but this post isn’t the place to discuss that).

For you male HSPs, I wonder if the jockstrap is the bra-torture equivalent? Fortunately, it’s highly unlikely that a male HSP would be a jock, so it’s probably not an issue.

6 ) Unkind Remarks at Work (O)

non-HSP: no big issue
HSP: get out the tissues

HSPs are known to be highly emotionally reactive. Ok, we’re drama queens (aka “emotionally labile” in psychology-speak). The same insensitive remark would affect an HSP and non-HSP very differently. I’ve been known to break into tears at work for careless and uncalled-for remarks on more than one occasion (especially when off my ADHD meds).

7 ) Violent Films (S)

non-HSP: bring on the action!
HSP: emotional reaction

Although I love film, I have to be very selective about what I watch. I’ve missed some excellent films because of this. I just can’t expose myself to graphic violence, or even to movies where someone dies at the end. (Whatever possessed me to go to the film Titanic, I’ll never know. I think I was secretly hoping that everyone would be rescued at the end. Duh! Failure to foresee consequences is a frequent ADHD symptom, so I might have an out for that little oversight…)

8 ) Circus In Town (S)

non-HSP: fun and magnificent
HSP: torture of the innocent

Just hearing the radio ad, “the horses and elephants will entertain you,” makes me physically ill and bawl my eyes out.

9 ) Tags In Clothes (P)

non-HSP: laundering navigation
HSP: endless irritation

Ever heard of, The Princess and the Pea? – that’s me.

10 ) Being Evaluated (Watched) at Work (O)

non-HSP: doing my best
HSP: make a big mess

If you want to see me walk into furniture; develop a sudden case of Parkinson’s, dropping things randomly on the floor; giggle maniacally for no reason while cracking nonsensical and non-humorous jokes, tell me I’m being scrutinized at work. The mere concept of a “Probation Period” sends me into near-panic.

How about you? HSP too?

So – how’d you do? If you found out that you’re an HSP, no worries. Just like ADHD, there are ways to cope, and even – yes – ways to turn your challenges into strengths.

Want to find out more? Read Elaine N. Aron’s excellent book, The Highly Sensitive Person.

 

Related posts:

1. Why you should NEVER let a person with BPD have access to a gun
2. British Personality Survey shows 77% show signs of PD
3. BPD: What’s in a Name and How does it feel to be that person?

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After a period of dealing with a partner’s mental illness, compassion fatigue can set in. Yes, you still love your partner. Yes, you still care that they are not feeling well. But it can become difficult to empathize after a while, and you begin to wonder, “When is this going to end?”

While I can’t give you an answer on when–or if–the illness will abate, what I can tell you is that it is essential that if your partner says they are in pain, believe them. The pain could be emotional or physical, and either way, it is valid.

I could not agree more with that statement. Pain hurts even if he seems to you (the partner) as if it shouldn’t.

I wanted to thank Ms. Theda for sharing my tool with her readers. I’d encourage my readers to read her post. I’d also encourage you to check out the Emotional Validation Spotlight.

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1. I-AM-MAD communication skill
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Emotional Dysregulation and BPD

What is important for Non-BPDs to realize about BPD-like conditions and disorders is that they have a core component in common, which is called emotional dysregulation. A disturbance to one’s emotional regulation system can exhibit itself in a number of ways, and the behavior of the borderline (a person with BPD) and the feelings of the Non-BPD are generally confused and misunderstood unless seen through a lens of emotional dysregulation. Emotional dysregulation is not a “grand excuse” to remove responsibility from a disordered person. No, it’s a “grand explanation” to explain the reflexive (yet often confusing) behavior of a disordered person. It’s a way of understanding the motivations (reflexive behavior to stop powerful emotions – which is what IAAHF means) and the intent (to get out of pain).

I put the words emotional dysregulation in bold because that concept is vital for the Non-BPD to understand what BPD is all about. What upsets the Non-BPDs most about the disorder is the behaviors associated with BPD – raging, lying, substance abuse, unfaithfulness, dangerous risk-taking and others. The Non-BPDs feel put-upon and under siege, yet what motivates the behaviors of the borderline is that they are awash with negative emotional states. They have a reduced capacity to regulate their emotions.

Dr. Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), states it this way:

The components of emotion vulnerability are sensitivity to emotional stimuli, emotional intensity, and slow return to emotional baseline. “High sensitivity” refers to the tendency to pick up emotional cues, especially negative cues, react quickly, and have a low threshold for emotional reaction. In other words, it does not take much to provoke an emotional reaction. “Emotional intensity” refers to extreme reactions to emotional stimuli, which frequently disrupt cognitive processing and the ability to self soothe. “Slow return to baseline” refers to reactions being long lasting, which in turn leads to narrowing of attention towards mood-congruent aspects of the environment, biased memory, and biased interpretations, all of which contribute to maintaining the original mood state and a heightened state of arousal.

Essentially what you’re dealing with is someone who reacts strongly and emotionally to the slightest provocation, who will dwell on those intense emotional reactions for periods longer than you might. A person with BPD-like traits heats up quickly and cools down slowly. I’m sure that if you have been dealing with such a person for an extended period of time, you will have noticed that she seems to fly off the handle at the slightest comment or action, no matter how unintended the “offense.”

Someone with BPD will be more sensitive to emotional cues and triggers from the environment, will react more intensely to these cues, and will take longer to “return to baseline,” or will be under the effects of strong emotions for longer than other, less emotionally-reactive people. Many times, because of the low tolerance for emotional cues or triggers, the person with BPD will react with alarm even though their emotional reaction does not match the reality of the environment.

We all have emotions and react emotionally to events in our lives. That’s one of the things that makes us human and that we all share – disordered or not. What separates us is our emotional profile. A person with BPD gets into powerful emotional states more easily than other people, and her reactive period lasts longer than with other people. A person with BPD is like a cork floating on a stormy sea of negative emotions and her emotional profile is like a volcano. Yet, one has to understand that the emotions feel as real as any other emotional reaction even if the intensity is high. A person reacting to emotional states will, for the most part or until they train themselves to do otherwise, react in the natural fashion that anyone would react to strong emotions: attack with anger, flee with fear, withdrawal with sadness and rejoice with joy.

(adapted from When Hope is Not Enough)

Related posts:

1. BPD: Emotional Dysregulation and MRI/fMRI
2. Sounds like Childhood Borderline: new diagnostic category called disruptive mood dysregulation disorder, or DMDD
3. Emotions and Borderline Personality Disorder

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Mind Reading: Psychologist Simon Baron-Cohen on Empathy and the Science of Evil
By MAIA SZALAVITZ Monday, May 30, 2011

Cambridge psychology professor and leading autism expert Simon Baron-Cohen is best known for studying the theory that a key problem in autistic disorders is “mind blindness,” difficulty understanding the thoughts, feelings and intentions of others. He’s also known for positing the “extreme male brain” concept of autism, which suggests that exposure to high levels of testosterone in the womb can cause the brain to focus on systematic knowledge and patterns more than on emotions and connection with others. (Oh, and yes, he’s also the cousin of British comedian Sacha “Borat” Baron Cohen.)

Baron-Cohen’s new book, The Science of Evil: On Empathy and the Origins of Cruelty, examines the role of empathy, the ability to understand and care about the emotions of others, not only in autism but in conditions like psychopathy in which lack of care for others leads to antisocial and destructive behavior.

What do you mean when you write about “zero negative” empathy?

Zero empathy refers to people at the extremely low end of the scale. They tend to be people with personality disorders, particularly antisocial personality disorder (ASPD). I focus quite a lot on psychopathy [the extreme form of ASPD] and also on two other personality disorders, borderline personality disorder and narcissistic personality disorder.

The ‘negative’ is meant to be shorthand for this being negative for the individual but also for the people around them. It’s meant to contrast with what I call ‘zero positive’ empathy, which effectively describes the autistic spectrum.

[Autistic people] struggle with empathy just like zero negatives but it seems to be for very different reasons. I’m arguing that their low empathy is a result of a particular cognitive style, which is attentive to details and patterns or rules, which in shorthand, I call systemizing.

If we think about the autism spectrum as involving a very strong drive to systemize, that can have very positive consequences for the individual and for society. The downside is that when you try to systemize certain parts of the world like people and emotions, those sorts of phenomena are less lawful and harder to systemize. That can lead to having low empathy, almost like a byproduct of strong systemizing.

How do you account for people who are both highly empathetic and highly systematic, such as some of those with Asperger’s who are actually oversensitive to the emotions of others?

I’ve certainly come across subgroups like that. There are people with Asperger’s whom I’ve met who certainly would be very upset to learn they’d hurt another person’s feelings. They often have very strong moral consciences and moral codes. They care about not hurting people. They may not always be aware [that they've said something rude or hurtful], but if it’s pointed out, they would want to do something about it.

The other side of their moral sense is that they often have a strong sense of justice or fairness. They may have arrived at it through looking for logical patterns rather than necessarily because they can easily identify with someone, however.

People often think that autistic people are dangerous, like psychopaths, when they hear this idea that they have “no empathy.”

In a way, that was one of my motivations for writing the book. Low empathy is a characteristic of many different conditions or disorders. Often books are written where they either focus on psychopathy or autism but [not both].

We have to look at them side by side, and when we do that, we see that they are very different and it’s important to bring that out.

Is it the case, then, that autistic people are not good at the “mind reading” part of empathy, in terms of predicting people’s behavior and feelings, while psychopaths are able to do that but are not able to care?

I think the contrast between these two conditions provides some evidence for that dissociation within empathy. People with psychopathy are very good at reading the minds of their victims. That’s probably most clearly seen in deception. You have to be good at mind reading before it would even occur to you want [to deceive someone]. So you can see the cognitive part of empathy as functioning very well, but the fact that they don’t have the appropriate emotional response to someone else’s state of mind, the feeling of wanting to alleviate distress if someone’s in pain, [that suggests that] the affective part of empathy is not functioning normally.

What stunts the development of empathy in personality disorders?

In the book, I explore both early environmental factors and biological and genetic factors. I think it’s particularly clear in borderline personality disorder (BPD) that there’s a strong association between early environmental deprivation and neglect and abuse and later outcome of BPD. There’s an association [with abuse and trauma early in life] in psychopathy, but it’s not strong as in BPD.

What defines borderline personality disorder?

There seems to be quite a lot of difficulty in self-regulation, in the regulation of their own emotional state. A lot of people with BPD also have depression. Many are suicidal. Many have had a history of feeling attacked or uncared for’ they are almost hypersensitive to possible threats from others.

They react almost with a hair trigger — if they perceive they are being attacked, they go on the attack. People with BPD can be so preoccupied by their own sense of not being cared for and not being understood that they can become blind to the impact of their own behavior on others.

So how would you address increasing empathy in these conditions?

There are interesting and imaginative new approaches to treatment for empathy. Some are medications like oxytocin. Some are psychological treatments like Peter Fonagy’s work on mentalization therapy. I haven’t ever watched it done but the idea is to encourage the patient to stop and think about others’ thoughts and feelings. It’s particularly useful for BPD. When someone with that condition is mostly focusing on themselves, the therapist prompts them to take other people’s perspectives. And just through repetition and practice, people get better and better.

I don’t see how that would work with psychopaths.

People are doing some clinical approaches with psychopaths too, like getting them to meet their victims. That’s obviously got lots of traumatic risk attached to it [for the victim], but again, it’s an exercise in perspective-taking.

I think if we take seriously the idea that behavior is the result of the brain — that having low empathy [is] the result of the way the empathy circuit is functioning or has developed — it does raise moral questions. When someone is acting with low empathy, why do we judge them as bad and punish them? It does shift the locus of where [they should be treated] philosophically, from the criminal justice system to health care.

Don’t you think there are people who are actually evil, who know what they’re doing is wrong and harmful but choose to do it anyway?

I argue in the book that I don’t find the term evil very useful. Once you are down at zero degrees of empathy, all kinds of behavior become possible. I don’t find it scientifically useful to use that term. Empathy is a scientific term in a way that evil isn’t. You can try to localize it in the brain; you can look for which part of brain is activated. It’s normative behavior. Evil is kind of the opposite of good, I guess, but empathy, as we were talking earlier, is quantifiable and normal. You can measure it and look for it, whereas you don’t see evil in the brain.

It’s argued that humans were able to evolve cooperation and altruism only by having a way to detect and punish those who didn’t cooperate.

I could see an evolutionary benefit for both empathy and lack of empathy too. Low empathy allows you to act selfishly, which could be in your interest, but high empathy fosters social cohesion and it’s good for the individual to end up as part of a social network.

I speculate that maybe most people end up in the middle, which may be the optimal position. It’s good to have some empathy, so at the very least you avoid offending or inadvertently hurting someone, but too much empathy might mean never completing your own projects.

How does your cousin Sacha Baron Cohen, creator of Borat, rate on empathy? His work can really make you cringe, but he must be excellent at mind reading to do it.

First of all, he and I have a family agreement that we don’t talk about each other. I respect his work. I think that sometimes that kind of comedy can create what you called a “cringe reaction,” cringing with embarrassment, but that has a purpose.

Why does empathy seem especially lacking in the teen years?

It’s kind of interesting that parents comment on adolescence as being a low point in empathy. But there’s still quite a lot of maturation going on in the part of the brain that involves empathy during that period. There could also be hormonal factors, particularly in males with the increase in testosterone. That could change empathy levels.

I’m struck that if you look at the “terrible two’s,” kids who have tantrums when they don’t get their way, and teens, at one level it looks like very little development has gone on. There’s a transition at around age four to becoming able to apprehend that others have different perspectives. You would imagine that empathy would almost reach a peak in early childhood, but it seems to have a long protracted development.

It seems to me that the terrible twos and adolescence are both the most intense periods of brain development. Could that be why empathy is impaired then?

That’s really interesting. I think brain maturation is one thing and also just the experience of relationships. I think that empathy has to have an environment in which to work, and that environment is relationships. Making mistakes in relationships is all part of learning to empathize.

There was an interesting study I was part of. Women who took extra testosterone were given the ‘reading the mind in eyes test.’ [The test measures how well people can read others' emotions by looking at their eyes.] A dose of testosterone lowered scores on this test. It was one of the first demonstrations that changing testosterone levels affects your empathy.

If you’re taking an evolutionary approach, it might be very adaptive if you have to use aggression for self-defense. You’d be more effective if you didn’t have empathy getting in the way.

A U.S. doctor tried to treat autism by lowering testosterone levels, citing your work as justification, although he actually didn’t get the research right. He just lost his license because he was using a “chemical castration” drug on kids to do this.

We haven’t considering [lowering testosterone] as a treatment to study for autism. I’m not comfortable with it ethically in terms of side effects. They misquoted [our research], and cited it as evidence that there was elevated testosterone in autism when, in fact, we haven’t shown that. They presented it as if we’re endorsing it, which I’m certainly not.

See more of Healthland’s “Mind Reading” series.

Find this article at:

http://healthland.time.com/2011/05/30/mind-reading-psychologist-simon-baron-cohen-on-empathy-and-the-science-of-evil/

You can buy to book here:

See larger image The Science of Evil: On Empathy and the Origins of Cruelty (Hardcover) By (author) Simon Baron-Cohen List Price: $25.99 USD New From: $13.92 In Stock Used from: $9.88 In Stock

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When I asked my H why he thinks he would never fall back on his old ‘opiate’ (other women) he said this:  “because I realized it only made me feel sh*ttier about myself and fall into a dark and self-loathing place, feeling that way is the ugliest experience I’ve ever had – and I felt that way for too long.”

I didn’t like that answer at first.  I wanted to hear “because it was heinous of me to betray you – *you* didn’t deserve that, how could I be such a self-centered so and so…” any combination of that – was what I wanted – I wanted it to be about *me*.  Inevitably that stuff came out – but his main and true motivator is himself.  And that is what keeps him in an ‘effective behavior’ stance.

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I believe that there is no right or wrong way to approach human emotions – there’s an effective way and an ineffective way and there are shades of grey in between those “polar” opposites. The effective way gets a positive outcome. That positive outcome is typically the return to baseline of the borderline and the establishment of a modicum of trust with others. One of the most important issues with borderlines seems to be the idea that they believe no one understands them (they feel “strange” – I said “broken” in WHINE, but I think that it was [a recovered borderline on the list] who clarified that it’s more like a “not feeling ‘normal’ and ‘fitting in’ feeling”), they can’t trust anyone with their emotions because many people have invalidated their feelings throughout their life and this leads to “silent desperation” and the inability to communicate effectively how they feel. If, through the use of my tools, you are able to gradually establish an environment in which your wife feels that she can safely express her emotions, which will go a long way toward establishing trust.

Secondly, you posted that you feel as through your feelings do not have a forum for airing and validation. Unfortunately for you, your wife sounds like a typical borderline. She is impulsive, she cuts, she abuses substances – especially painkillers. The divorce talk is probably born of either shame (“I will leave you before you leave me”) or of a feeling that she is being judged and/or disrespected (or not appreciated and accepted for whom she feels that she is). That leads to a certain mind-set that essentially makes her believe that, since no one has ever listened to her feelings before, she must dig in and hold on to her feelings as if she is the only person in the world. That is, “if I don’t fight for myself no one will”. This situation makes it difficult for you to express how you feel because she gets the message (even if it is not true): “YOU MADE me feel this way” because she thoroughly believes that about you. The reason she believes that you (and others, not just you) make her feel like she feels is that she is unable to self-regulate and looks to others to regulate her own emotionally states. When [a recovered borderline on the list] said something about her being more worried about what you think of her, she hit the nail on the head, because a borderline (and possibly for biological reasons) has a great deal of internal chaos and the usual strategy (also possibly biological) is to internalize other’s feelings and opinions about her self. It’s odd, yet I think that this dynamic is the one in which all the talk of not respecting boundaries arises. She feels at some level that you are actually a “part” of her, because she requires external validation. When that external validation turns to judgment, she has to cut you out of her mind. Sadly, she will continue to seek others (particularly men) to self-regulate until she can self-regulate.

As for IAAHF (“It’s all about his/her feelings”), one thing that many people read into that is that EVERY interpersonal situation is about her feelings and that she will not EVER be able to empathize with yours. This is neither the intent of IAAHF or the case. Borderlines are really empathetic (really no kidding they can be) but only when they are not on fire internally and emotionally. The intent of IAAHF is to EXPLAIN the “crazy” behavior, not to make a blanket statement about the relationship. When asked “why would she cut herself?” (for example) the answer is IAAHF. She’s in pain and the cutting helps alleviate that pain. Or asked “why is she raging at me over nothing?” (which happened to me the other night, presumably out of the blue). The answer is IAAHF.

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IAAHF

As you can see, I also get lots of searches on “famous people” or “celebrities” with BPD. I only post those types of articles to relate to those with BPD and their families that perhaps they are not alone in their struggles – perhaps (again it’s a maybe because the closest celebrity to actually come out and say he/she has BPD is Megan Fox – who speculated about it).

I’ve written a lot about IAAHF here. I also explain the concept and how it relates to validation skills in the I-AM-MAD communication skill. The concept of IAAHF is extremely important to fully understand if a non-BPD is going to understand what is going on in the emotionally dysregulated moments (EDMs). It takes some time to understand and to truly “get” it. For me, it was one to the most valuable perspectives on BPD and emotional dysregulation.

Sometimes, however, nons have a problem with this concept because they misinterpret it. Here is a brief note from “When Hope is Not Enough” (the second edition, on which I am working) about IAAHF:

I found that many people bristle at the idea that it’s “all about” the borderline’s feelings. Sometimes this formulation makes the Non-BPD’s ask: what about my feelings? (which, in a way, is a reformulation of “what about me?”). The intention of this concept is for you to understand the motivation of behavior, not the entire landscape of the relationship. There will be times in which the context of the relationship is about your feelings. Yet, when the “crazy” behavior takes place, it is most often motivated by dysregulated feelings and emotions. The purpose and intent of the behavior is to quell those feelings, even if it seems as if it’s your fault that those feelings exist. To understand and use this attitude properly, you have to remember that it’s (the behavior) is all about (motivated by) his/her feelings (dysregulated emotions that require calming/quelling of pain).

Related posts:

1. A Note about BPD and Boundaries And SWOE
2. A primer on Emotional Dysregulation and its role in Borderline Personality Disorder
3. Confirmation of IAAHF

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Clearly, the reviewer didn’t understand the idea of emotional dysregulation or the difference between motivation, intent, action and consequence. I attempted to separate and explain each concept in the book, but perhaps I did a poor job.

In “When Hope is Not Enough” I write about the concept of IAAHF (or “It’s all about his/her feelings”). That statement, which is an exploration of the idea “it’s not about you,” is a statement of intent and motivation, not a release from the consequences of someone’s actions. The “all about” statement concerns the motivations of a person with BPD’s actions – that is, rarely does someone with BPD intend to hurt the non-BPD, despite appearances. What the intention of this statement of intent seeks to do is release the non from the paranoia that their loved one with BPD is out to get them. This is typically not the case. Usually, the actions of a person with BPD are intended to reduce their own emotional pain (stemming from emotional dysregulation). Sometimes this emotional pain and emotional dysregulation is triggered by (what I call) perceptions that are “misaligned” with the situation. That is, the “attack” on the borderline is not intended by the non to be an attack at all and through a highly sensitive emotional profile and emotional dysregulation, the borderline will attack back as a way of defending their self from a perceived attack. But the real point here is that the motivation and intention of the borderline’s attack is actually to quell the painful feelings within herself, not to cause interpersonal strife or manipulate the non.

However, as I also say in “When Hope is Not Enough”, the action (or cause) sometimes has unintended consequences (or effects). When a borderline is emotionally dysregulated and overcome with feelings, the action that she takes is likely to be impulsive and the consequences of her actions are not taken into consideration. When behaving this way, the borderline will often behave in an “effect -> cause” way – meaning she will think “I feel bad, so you must have done something to specifically make me feel bad.” If a borderline is to consider the consequences, even the unintended ones, of her actions, she will need to approach the situation in a “cause -> effect” way. Intentions do not provide a free pass for consequences. As I have said on the ATSTP list, just because you didn’t intend to burn down the house while playing with matches, doesn’t bring the house back into existence when you express your intention. One thing that separates the understanding of consequences (that follow from a cause – and in this case the cause is the behavior of the borderline) from blame is that there is an analysis based on observation as opposed to judgment. If you feel that the borderline has done something “wrong,” then you are inserting your judgment, rather than understanding the observed consequences of the behavior. I tried to explain this fully in “When Hope is Not Enough”, but I suppose some people either are so caught up in fault-finding and blame-storming that they can’t separate judgmental thoughts from the understanding of consequences or I have expressed it poorly in the book. If a borderline can begin to understand the consequences of her actions (and especially powerful are those that go against her goals), then, in my mind, the borderline can become responsible for her actions and do so in an effective manner.

Related posts:

1. Are you pissed off at someone with BPD?
2. Radio Program: Understanding BPD
3. Understanding Major Depression With Borderline Personality Disorder?

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How much do feelings of emptiness matter in BPD?

Recently Rajkumar Kalapatapu, et al., released a report in which they hosted an Internet-based survey to ask people with BPD what they wanted to see in the next version of the DSM with respect to BPD. As many of you know, scores of people find BPD (Borderline Personality Disorder) stigmatizing and confusing, since the term “borderline” was adopted to indicate “on the border between neurosis and psychosis” (although some indicate that it refers to “borderline schizophrenia” – although no correlation between BPD and schizophrenia exists as far as I am aware) and “personality” often connotes a “character-flaw” or something that is immutable and incurable. The only part of the name that seem to be in agreement is “disorder” – although even that can be called into question given a spectrum emotional regulation, impulsivity and other factors that play a role in BPD. I mean, NAAA and Bridget Grant published an epidemiological study that showed a 5.9% lifetime occurrence of BPD. Is that possible? Or is there something else afoot here?

In the Internet survey/study, the researchers asked self-identified people with BPD their ideas on a name and criteria change for BPD. I was forwarded a copy of the study findings because ATSTP hosted a link to the study and encouraged our readers with BPD to fill it out. The most-mentioned alternative names for BPD included were (not surprisingly since the DBT community has been advocating some change like this for years) “emotion” (or emotional) and “regulation” (or dysregulation) with Emotional Regulation Disorder (or similar form) mentioned in 21.4% of the cases. Again, not surprising considering the idea has been in the DBT community for years. A total of 53.3% of accepted responses indicated that a name change is desired.

There were a couple of things that I noticed in this survey data that actually piqued my interest. One was the most common symptom (based on the current DSM criteria) mentioned was emptiness (92.9%), not emotional instability. While unstable relationships was very high on the list, even higher was the “self image” aspects of BPD – emptiness and questions of identity. Personally, as someone who has for several years paid devotion to the “altar” of DBT, those aspects are not as noted within the clinical framework that is DBT. In fact, the idea of “systems-level” issues (emotional system, impulse control system) seems to be the most common way of approaching BPD, once you get out of the psychoanalytic backwater and into the CBT/DBT state of the art. Yet, these self-reporting people with BPD report emptiness and questions of identity as the most common symptoms (at 92.9% and 91.8% respectively)  and relationship-based issues (fear of abandonment, unstable relationships) in a close second (each at 91.8%). I guess I am wondering then if a name change to “emotional regulation disorder”, while it is certain much less stigmatizing than BPD, would actually capture the crux of the issue? And what would instead? Frankly, I don’t really think the name matters all that much (if the stigma was expunged).

What further got me interested in this data was the biographical data. Of 646 included responses (1,186 were excluded), 88.5% of the population was female, 88.7% was Caucasian, the mean age was 36 (the median 35) and 45.2% of the respondents were single/never been married (with over 18% in the divorced or separated category). So what we have here is a group of white, 30-something women who are generally not married or not attached to another person – and almost half have NEVER been so attached, even though their biological clock is ticking (at 36). Plus, they feel empty and have unstable relationships and fear people will leave them. Granted, I am making assumptions based on this data and I am generalizing and “averaging the averages” at some level, but if this is the picture of a borderline person, it makes sense as to why she would be angry and fearful and shameful.

Recently, I started working with several men who want to get their BPD girlfriends back. And the picture of a thirty-something, white, never-before-married woman with BPD has arisen in several of these cases. That got me thinking about this person with BPD and how she must feel about her life. Here she is: empty, sad, distrusting, childless (when her friends probably have kids), unmarried (no one will truly love her), with a history of broken relationships thrown aside (if it doesn’t work out I’ll feel horrible, best to end it now). I rarely see a non-BPD man in a relationship with such a woman who actually thinks about how it must feel to be in her shoes. I think it would be quite beneficial to the men in the lives of these women with BPD to consider how it feels to be in that situation – empty, unmarried, childless, in your mid-30s, etc. I think if one were really to ponder and meditate on what that must feel like, the behavior might become less confusing and more compassion could flow into the relationship.

Related posts:

1. Why you should NEVER let a person with BPD have access to a gun
2. The power of “When you do this, I feel that”
3. 10 Signs you’re a highly sensitive person (HSP)

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I believe this feature is born of an unstable sense of self. A person with BPD has difficulty “locating herself in the world.”  While two of the other “core” features of BPD are “systems related” (meaning, those features are based on subsystems of the mind – the emotional regulation system, the impulsivity control system), shame and the preoccupation with interpersonal relationships are based more on a person with BPD’s view of herself. While it might seem that interpersonal relationships are outside of self, a more complex picture arises as we look more deeply into the mental configuration of BPD.

A recent study showed that the number one trigger of systems dysregulation (like wildly swinging emotions and impulsive behavior) is interpersonal distress. This interpersonal distress is more important as a trigger of dysregulated behavior than sweeping/major life changes – in fact major life changes, such as changing jobs, getting married, having a child – were ranked last of nine factors that trigger BPD distress. The interpersonal, moment-to-moment perception of the state of an important relationship is the most important trigger. That can be bad news for someone in a close relationship with someone with BPD. The person with BPD will be continuously scanning the interpersonal landscape for threats. Since shame is involved, people with BPD are likely to use others to regulate their internal systems and their self-view. In other words, a person with BPD uses others as a mirror to view their self.

Why is this so? I believe that a person with BPD’s lack of internal regulation causes her to internalize other people and use others to self-regulate. When someone has an inability to locate herself in the world, which very possibly arises from the emotional instability as a child, she seeks to have others locate her for her. She needs others to verify and validate that she’s “ok”. Unfortunately, because few of us are taught the language of emotional regulation, a person with BPD will likely learn that the interpersonal landscape is not safe; it is full of threats to their very self. It’s not an easy situation in which to live. If a person requires external validation and regulation, there develops a sense of a lack of control. Others are unpredictable, don’t understand how it feels and can damage the very core of her being.

People with BPD have described this internal feeling of emptiness and lack of internal controls as feeling “dead inside,” which is in itself, tragic. Extending this feeling to others through this preoccupation with close interpersonal relationships leaves a person with BPD with the feeling that others contribute to this unpleasant internal feeling. In other words, “it’s your fault that I feel this way.”

Many Non-BPD’s ask me why their loved ones with BPD don’t seem to trust them. To me, this aspect of BPD is a significant factor, along with other biological factors.

All of that being said, let’s suffice it to say that interpersonal relationships play a huge role in BPD. Social connections and attachments, including parent/child attachments, are the focus point of a person with BPD’s sense of well being. When these trigger dysregulation and/or ineffective modes of thinking and behavior, a person with BPD is lost in the world, floating free in a threatening sea of feelings, thoughts and behaviors.

One must understand that in order for the interpersonal tools to work properly, they need to be understood and applied in a step-wise fashion. I have often said to my list members that “you can’t boil the ocean” which means that you can’t jump to the end before you walk the path. You can’t do everything all at once. Instead, you have to take one small step at a time in a longer journey. The goal of all of my tools, attitudes, skills and approaches is (in my mind) a compassionate, trusting, respectful and two-way relationship in which both parties feel known, heard, understood and worthy. Achieving that goal is hitting a grand slam so to speak. Yet, I feel that a person must be given the fundamentals and practice those fundamentals before you can hit one out of the park. Emotions which are the first layer to unravel peel back from the onion that is BPD. Understanding emotions in oneself and others is vital to having a two-way relationship with someone with BPD.

Related posts:

1. Distancing and Detachment as an Interpersonal Strategy

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Tough Love and BPD

Tough Love is not an effective approach with children and teenagers with Borderline Personality Disorder. Although some therapists and self-help authors recommend tough love as what should be done with BPD, it is ultimately detrimental to the borderline and to your relationship with the borderline. The problem comes in regarding the nature of the disorder. While behavioral therapies can work, those based on reinforcement and shaping, those therapies usually include acceptance strategies and non-judgmental approaches. The nature of BPD is that the individual with the disorder is in deep emotional pain because of the dysregulation of the emotional system. They are exquisitely sensitive to emotional experiences and many of these experiences are physical in nature, especially with children. There is intense physical pain and social rejection (to which borderlines are also intensely aware) causes more pain. The borderline will then seek to end the pain in any way they can, including substance abuse, casual sex, thrill-seeking and other dangerous methods. While these methods will stop the pain temporarily, the pain always comes back.

OK, now back to why tough love doesn’t work. A person with borderline personality disorder wants more than anything to communicate his/her pain with those with whom he/she has an attachment relationship. Understand that BPD is not just a case of the person “behaving badly”. The behavior has a function and generally that function is to either stop the pain or to communicate the pain. If you try to deal with behavior with tough love (rules, contracts, boundaries, punishments, etc.), the person with BPD will feel more rejected, more abandoned and unable to communicate the pain. This causes MORE pain and requires more pain-quelling behavior. It causes more of what made you start using tough love to begin with.

A little while ago, I was speaking with someone about a friend of my daughter’s. This girl probably has BPD. Her behavior was totally off the charts – drugs, turning tricks, running away, cutting herself, suicide attempts, etc. When the person I was speaking with expressed sympathy for the girl’s mother, I responded like this: “I think what happened with [girl’s name] was that she was in a lot of pain and didn’t know why. All she really wanted was for her mother to see her pain. All she ever wanted was for her mother to understand her and her pain. But her mother only saw bad behavior and tried to deal with that. So, the girl tried anything and everything to stop her pain.”

The word compassion actually means “to suffer alongside” (or co-suffering). If you’re a parent of a person with BPD, are you seeing and understanding their pain? Or are you fed-up with their “bad behavior”? Developing non-reactive compassion is the answer, not tough love. Tough love sends a message that the borderline can’t communicate their pain. Are you co-suffering? Or are you punishing the borderline for doing anything to stop the pain?

Related posts:

1. Tough Love is NOT the Answer with BPD
2. Being Right vs Being Effective
3. Confirmation of IAAHF

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http://www.slideshare.net/bondobbs/the-4-x-4-of-bpd

I am also sharing another presentation that talks about the I-AM-MAD emotional validation skill.

Here is the I-AM-MAD presentation:

No related posts.

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Moran: Inspiration through empathy: Living with mental illness

Published: July 22, 2010 6:00 PM
Updated: August 05, 2010 8:00 AM

For Lorelei Andrews (not her real name), volunteering to offer support to local individuals living with mental illness is cornerstone to her daily life.

I had a chance to talk with her about her story and the current state of services in Kelowna for individuals living with mental illness.

She has worked as a server, a wedding planner, a full-time student (earning two degrees), and a bridal consultant.

In fact, she started one bridal gallery in Vancouver that has now become the largest in Canada, which may even be the venue for an upcoming television reality show.

However, about five years into her whirlwind career, she began experiencing anxiety.

“I was used to delivering 100 per cent all the time, I required it of myself,” recalled Lorelei.

She came to the point that with so much pressure, she started to think of the sale instead of the client. As a very thoughtful and empathetic person, she felt her self-worth sliding.

What began as a dip in productivity ended up with her entering “self-preservation mode,” and being prescribed various medications to balance out—resulting in a near comatose state for several months.

Lorelei is living with a mental illness. As productive and successful as she was, it struck her where she least expected it. It can happen to anyone: the successful executive, the homeless man asking for change, the young woman serving your coffee.

In fact, one in three Canadians will experience some form of mental illness in their lifetime—one in five will experience it this year.

After several rounds with psychiatrists, hospitalization and group therapy sessions, Lorelei was diagnosed first with bipolar disorder, which involves extreme mood swings.

She has since been more correctly diagnosed with pervasive post-traumatic stress disorder with symptoms of borderline personality disorder.

Lorelei was lucky. She had the drive and motivation to pick herself up and learn about her illness.

After the incorrect diagnosis, she began to self-advocate and attend various meetings and courses regarding mental illness.

While in Vancouver, she was offered a position in providing wellness and recovery planning for individuals with mental illness. “I found I had a talent for translating the doctor talk to regular people” said Lorelei.

She is now living completely organic. With her newfound skill set, she came to Kelowna and started a peer support group session that occurs once a week at the Kelowna and District Branch of the Canadian Mental Health Association.

“Our group is passionate, loving and empathetic, and they are so good to each other. A lot of us are hypersensitive, and with that comes great responsibility to control and manage our emotions,” said Lorelei, who maintains a positive outlook.

“It keeps me well and grounded and balanced; if I’m not living what I’m teaching, things don’t go well.”

What makes this group unique is the focus on mental health, rather than mental illness, which is steeped in stigma. Peers learn how to self-soothe and tolerate stress, as well as about the impact of mental illness in living a happy, healthy life.

“I’m inspired by what I see when I help someone change their perspective about what’s been bothering them. It’s the same thing I used to see in a girl’s eyes when she realized she was wearing the dress she was getting married in.”

To learn more about living with mental illness, and to hear stories such as Lorelei’s, visit the CMHA Kelowna website at www.kelowna.cmha.bc.ca.

***

CMHA Kelowna, in partnership with Interior Health, is also holding a community forum regarding the state of mental health and addictions services, which occurs July 28, 5:30 p.m., at 504 Sutherland Ave.

For more information or to register, contact Charly Sinclair at 250-861-3644 or email charly.sinclair@cmha.bc.ca.

Watch for another story of another member of our community who is living with mental illness in Sunday’s edition of the Capital News and online at www.kelownacapnews.com. The Canadian Mental Health Association is a charitable association, which promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness.

Jamie Moran is the director of promotion and development for the Okanagan branch of the CMHA.

Related posts:

1. Impulsiveness Article
2. Must Read Article about BPD and “coming off the couch”
3. Validation Article from DBT’s perspective

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If your emotional well-being is dependent upon a loved one’s behavior, you’re in a difficult and painful situation – one in which you have  little control over. This leads to a feeling of helplessness because you have no ability to direct your emotional life since your feelings are dependent on another person’s words or actions. Instead, you can state: “My emotional well-being will be whatever it will be no matter what he/she does/says.” Easier said than done, I know, especially when the other person is telling you you’re a loser or a failure or whatever other insults that may have been foisted upon you. Ask yourself: Is my emotional well-being dependent on his/her behavior?

Here’s a quote about this subject from the I-Ching which a member of the ATSTP list posted on this subject:

Here the source of a man’s strength lies not in himself but in his relation to other people. No matter how close to them he may be, if his center of gravity depends on them, he is inevitably tossed to and fro between joy and sorrow. Rejoicing to high heaven, then sad unto death-this is the fate of those who depend upon an inner accord with other persons whom they love. Here we have only the statement of the law that this is so. Whether this condition is felt to be an affliction or the supreme happiness of love, is left to the subjective verdict of the person concerned.

Related posts:

1. BPD: Emotional Dysregulation and MRI/fMRI
2. Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance
3. Ask Bon: How do I balance validating somebody’s feelings with protecting myself or my children from emotional abuse?

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Each person has a unique emotional profile. This profile is based on five independent factors. When I say “independent” here, I am saying factors that can each be unique in each individual. The emotional profile factors are:

1. Tolerance. This is the sensitivity a person has to triggering events. Those with a high sense of threat awareness (like people with BPD) are likely to have this factor set at “hair trigger.”
2. Onset. This is how quickly the emotion gets to full intensity.
3. Intensity. This is how intense the emotion affects a particular person.
4. Duration. How long the emotion lasts and continues to affect the person’s thinking.
5. Return to baseline. How long it takes a person to “get over” the emotional reaction.

A person with BPD will likely have an emotional profile in which all five aspects are poorly regulated. That is, the tolerance will be low and they will react at the slightest provocation. The onset will be fast and they will react quickly to the trigger. The intensity will be high, and their experience and expression of the emotion is likely to be strong. The duration will be long and it will last a longer time at top intensity. Their “return to baseline” will take longer and they will be emotionally upset longer than others might. In other words, people with BPD are likely to be an emotional volcano, ready to erupt at any minute.

For this reason, a person will BPD can be difficult to deal with and to understand how they get upset at the most “trivial” of things. However, the experience of the emotions is valid and real. Just because something seems trival to you (i.e. below your tolerance) doesn’t mean it’s not perfectly real to the other person.

Related posts:

1. BPD: Emotional Dysregulation and MRI/fMRI
2. Ask Bon: Why do you emphasize emotional validation so much?
3. Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance

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Related posts:

1. BPD: What’s in a Name and How does it feel to be that person?

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Dialectical Behavior Therapy Validation Strategies for Parents
By Christy Matta, MA

How Do We Validate

Validation and active listening techniques are specific ways of approaching your child to increase cooperation and balance the change we are often asking for from our children.

1. Responsiveness: Addressing our children with interest in what they are saying, doing and understanding. Expressing concern about his or her wishes and needs.
2. Warm engagement: Approaching kids with warmth and friendliness. Active positive communication with our voice, tone and posture.
3. Self-Disclosure: Communicating our own attitudes, opinions, and emotional reactions to our children, as well as reactions to how they are behaving.
4. Genuineness: Being ourselves, rather than always acting as “parent” or “authority figure.”
5. Vulnerability: Empowering them, rather than having an exclusively high-power-low-power relationship.
6. Cheerleading: Cheerleading is helpful in validating the person’s inherent ability to overcome difficulties and learn new skills. It is believing in our children, assuming the best, providing encouragement, focusing on their capabilities, contradicting other people’s criticisms that are not accurate, and providing praise and reassurance.
7. Articulating their unverbalized emotions, thoughts, or behavior patterns. Children are often unaware of their own feelings and behaviors. It is validating for us to give voice to what they are thinking and feeling.

Remember: what each individual child finds validating is different. One child may respond to simply being listened to, while another may respond when you articulate and express understanding for how he or she feels. Our children are not the only ones who can benefit from understanding and active listening. Husbands, friends, family and yes, even we, ourselves, need it. We all have times when we’ve got an important problem, emotional pain, are having trouble with change or are feeling out-of-control. Validation can help us and our children make necessary changes and face challenges.

In my house, once I stop pushing everyone to ‘get things done,’ I find the solutions come fairly easily. My kids will pick up the toys if I assure them they can keep out their favorite. They’ll put their dishes in the dishwasher if we spend dinner talking about their day and I notice small attempts they’ve made to be helpful around the house. My family life is not a fairytale of cooperation and teamwork, but I do find that when I’m paying attention and listening to my kids, I feel less like I’m alone in the never ending battle against disarray.

See my March 31, 2010 post for more discussion of validation. Comment below to share how you create an atmosphere of cooperation in your family.

References:

Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.

Related posts:

1. Validation and DBT
2. An exercise in validation
3. Primary and Secondary Emotions

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Megan Fox and BPD

A little while ago, I wrote a piece on Megan Fox and her statements in an interview that she was considering the possibility that she had a “borderline” personality. I got several reactions that she probably didn’t know what she was talking about or that she was merely emulating/reflecting her “heroine” – Marilyn Monroe. (Fox has a tattoo of Marilyn Monroe on the right forearm).

I read the interview with Fox in “Rolling Stone” this month and found that, if she was being honest in the interview, there is a distinct possibility that she does have BPD. Here are some of the salient points…

In “When Hope is Not Enough,” I point to three features of BPD that I think are common to all people with the disorder. They are: emotional dysregulation, shame and impulsivity. So, let’s start there:

Emotional Dysregulation

Fox: “…But it doesn’t mean I don’t struggle. I am very vulnerable. But I can be aggressive, hurtful, domineering and selfish, too. I’m emotionally unpredictable and all over the place. I’m a control freak. My temper is ridiculously bad. I’ve destroyed my house.”

As a child she had, “panic attacks that manifested themselves as violent, rageful temper tantrums. Like I didn’t know how to control myself or what to do.”

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

Shame

Fox: “I’m really insecure about everything. Like what those reporters said about the movie, all I could think was, ‘They’re mocking me… I have a sick feeling of being mocked all the time. I have a lot of self-loathing.”

Impulsivity

Fox: “I go batshit. I’ve had to say to Brian (her boyfriend), ‘You have to go and stop talking to me, because I’m going to kill you. I’m going to stab you with something. Please leave.’ I’d never own a gun for that reason. I wouldn’t shoot to kill. But I’d shoot him in the leg, for sure.”

More evidence…

As a child, she started seeing a therapist because of her real “emotional problems,” but it didn’t seem to help.

She is sensitive about the environment. She can’t sleep with someone touching her. She requires a “cocoon” of pillows to make her feel safe. She can’t sleep in the quiet and dark. She doesn’t like to look in the mirror. She admits to drawing blood during sex, but doesn’t elaborate. She admits to self-injury, but doesn’t elaborate. She hints at an eating disorder, but doesn’t elaborate. She is a “bi-sexual.”

And more. If half of the things in the interview are honest and true, I think Megan Fox may have leaped over my other “celebs with possible BPD (but not for sure)” list.

Related posts:

1. Princess Di and Borderline Personality Disorder
2. New for May – Borderline Personality Disorder Awareness Month
3. Megan Fox, a new celeb on the BPD-o-meter

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Are you and your BP on the same team?

When someone is highly emotional, they need to know that they have an advocate and that someone is on “their side.” I often ask my consulting clients (especially partners of people with emotional regulation issues) if they feel that their partner and they are “on the same team.” Many times the answer is no. Why does someone have a desire to have someone on their side, even when the “sides” are not desired, intended or even clearly delineated? The answer in my mind comes down to shame and rejection sensitivity.

If a person has shame (or even low self-worth, which is similar), then the person is likely to have a high level of rejection sensitivity. Being rejected by others is painful, especially for emotional people. Having an advocate of their “side” of the issue, which is essentially answering, “I am on your side no matter what the situation,” is tantamount in these highly emotional, social interactions that involve rejection. One can be “on their side” emotionally without condoning whatever behavior that one doesn’t agree with.

There are teaching moments and there are times that one doesn’t teach. If you try and teach, punish or impart values during a period of emotional dysregulation, the relationship will be damaged and nothing effective will be accomplished. Instead, emotional validation and support can be used to cool the bonfire. Once it is cool, then a teaching moment can present itself.

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Obviously, my heart goes out to his victims more than to him. I just wonder how many other people are suffering out there in isolation and painful emotions. So many people require emotional skills. IMO most violence, included these horrible mass murders, are caused by painful emotions.

Related posts:

1. NIU Shooter and Self-Injury
2. Values vs. Emotions
3. Primary and Secondary Emotions

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Emotional validation strategies contrast with approaches that focus on the overreactivity of emotions or the distorted basis of their generation. Thus, they are more like the approach of Greenberg and Safran (1987), who make a distinction between primary or “authentic” emotions and secondary of “learned” emotions. The latter are reactions to primary cognitive appraisals and emotional responses; they are the end products of chains of feelings and thoughts. Dysfunctional and maladaptive emotions, according to Greenberg and Safran, are usually secondary emotions that block the experience and expression of primary emotions. These authors go on to suggest that “all primary affective emotions provides adaptive motivational information to the organism” (1987, p. 176). The important point here is the suggestion that dysfunctional and maladaptive responses to events are often connected or interwoven with “authentic” or valid responses to these events. Finding and amplifying these primary responses constitute the essence of emotional validation. The honesty of the therapist in applying these strategies cannot be overstressed. If emotional validation strategies are used as change strategies – that is, if lip service is given to validation in order to simply to calm the patient down for the “real work” – the therapist can expect the therapy to backfire. Such honesty, in turn, depends on the therapist’s belief that there is a substantial validity to be found, and that searching for it is therapeutically useful.

Cognitive-Behavioral Treatment of Borderline Personality Disorder

This idea is an important one for loved ones of those with BPD because it touches on several points:

• It acknowledges that emotional validation focuses on “normal” emotional reactions, not “the overreactivity of emotions or the distorted basis of their generation.” That is the way of emotional invalidation, i.e. “You’re overreacting to something trivial. Look at what really happened.” I see that expression from Non-BPs all the time.
• It points out the differences between primary and secondary emotions. This distinction is extreme useful for Non-BPs. Why? Because most often the anger and rage are secondary emotions (not always) and that is typically what Nons focus on. If the emotional validation is used for secondary emotions, then I interpret this as not therapeutic, because you are “validating the invalid.”
• Probing (gently and compassionately) for the primary emotions seems to be a more effective strategy and those are the emotions that can be validated effectively.
• One has to approach emotional validation as a tool unto itself – without using it as a “change strategy.” That is, “it is ok to feel that, but you have to change the way you feel to be ‘normal’.” That is, bound to backfire.
• If this distinction of primary and secondary emotions – the first being true and “authentic”, the second being dysfunctional and maladaptive – is applied to the concept of mentalization, then the idea within mentalization to use emotional validation to probe for further feelings begins to make more sense. One has to help the BP locate the primary emotion.

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Related posts:

1. Validation and DBT
2. Validation Article from DBT’s perspective
3. Shooter in PA and painful emotions

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Fear and Shame

The core idea here however, is that these two emotions, which motivate controlling behavior, are not about the person who is being “controlled.” No, these emotions are about the controller. I often say in my group (and in my book) that poor behavior in someone with BPD (or anyone in fact) is “not about you” (the recipient of the behavior) or, after rephrasing it: “it’s all about his/her feelings” One of the misunderstandings of that attitude in some of my readers is that some people read that and think “When is it about MY feelings?” That was never the intention of this approach. In fact, the idea was intended to be a way of elucidating the motivation of the behaviors to which Non-BPs object. You see, in my experience, the behaviors of a person with BPD (or anyone emotional) can be explained as being motivated by poorly regulated emotions. The behaviors serve a function which is to halt the negative and overpowering emotional states. Fear and shame are very painful emotions and any person will do anything to halt them (anything to stop the pain). So, while the behaviors seem to be directed at you (like my daughter’s boyfriends controlling behavior seems to be directed at her), in reality the function of the behaviors is to halt the pain. If the fear and shame were not present, the behaviors would cease to exist. That is why I encourage people to act on the emotions directly, rather than on the behaviors directly. This is possible through the application of emotional skills both within one’s own mind and within the context of the relationship.

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1. Role of Shame in BPD
2. Shame and BPD
3. Blast from the Past – BPD, Shame and Self-Image

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“Sam and Lindsay are speaking,” the source tells PEOPLE. “But Sam has begged Lindsay to get help.”

“Lindsay, despite appearances, is insecure and has relied on Samantha and their relationship to build her up,” explains the pal. “Lindsay barely sleeps, which explains a lot of her behavior. She’s exhausted. She can’t even sit down for a minute without pacing around the room. It’s really sad.”

Sam is begging Lindsay to get help? For what? Well, perhaps we know.  Looking at Lindsay’s case, I can’t help but see Borderline Personality Disorder (BPD). She is erractic, emotional and sexually confused. She has all the classic signs of an untreated person with BPD. I hope she gets help – and I hope that, if she is diagnosed with BPD, she would come out publically and say so – to reduce the stigma of the disorder.

Lindsay Lohan and BPD?

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Celebrity Searches on ATSTP

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Celebrities’ bad behavior is rooted in mental illness, according to “Dr. Drew” Pinsky, who is best known as the host of Celebrity Rehab and Loveline — a nationally syndicated radio show that invites listeners to call in with questions about sex and drugs.

In his latest book, The Mirror Effect (on bookstore shelves Tuesday), he spells out a theory that stars are predisposed to narcissistic personality disorder long before they become famous. Their dysfunctional behavior is rewarded by Hollywood and portrayed as normal by the press.

“As reporting on celebrity behavior becomes even more ruthless and mean-spirited, I am struck by this disconnect between how a
celebrity’s behavior is portrayed in the media, and the very real problems that underlie their actions,” wrote Pinsky.

He argues that the media fails to acknowledge that celebrities are mentally ill when holding them up as role models, so everyday people have begun to emulate their unhealthy behavior.

In 2006, Pinsky and his co-author Mark Young published the first systematic study of celebrity psychology in the Journal of Research in Personality. The new book explains that research and how it fits into the larger context of our culture, which they argue has been soiled by shameless producers, agents and paparazzi.

The first three chapters read like a history textbook, recapping famous celebrity mishaps and an era when those unfortunate episodes were carefully hidden from the public. It gives readers a glimpse of just how conservative Pinsky really is. He seems to prefer the  good old days when movie studios were able to keep Rock Hudson in the closet.

The celebrity doctor is not a fan of MySpace or Facebook either, because they allow people to seek attention by acting out like celebrities — posting provocative pictures and personal stories about irresponsible behavior.

“Without appropriate monitoring, these social networking platforms are subject to abuse by those who are most vulnerable to the endless feedback loop they create,” wrote Pinsky. “This is known as an urge/compulsion/reinforcement cycle, and it’s very similar to what happens to those who crave drugs or other addictive substances.”

After that rather stiff introduction, the book becomes a psychology lesson with celebrities as examples.

Pinsky seems fond of interpreting behavior in the light of evolution, and gave this explanation for the asinine stunts performed by Johnny Knoxville and Steve-O on the show Jackass.

“Some have speculated that such acting out may be deeply rooted in our genes, as a way to display genetic prowess and adaptability,” wrote Pinsky. “In this theory, males (in particular) who survive dangerous stunts are displaying their biological capacity to survive in adversity.”

In their 2006 study, Pinsky and Young found that celebrities from reality television score the highest on the Narcissistic Personality Inventory. Pinsky is convinced that the producers of those shows carefully select contestants with psychological problems, because they will bring extra drama to each show.

“Having served as a consultant to several reality shows, I know what the producers are looking for in contestants,” wrote Pinsky. “The standards regarding mental health are extremely fluid.”

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2. Amy Winehouse Crops Up Again
3. Four reasons bipolar disorder is accepted and borderline personality disorder is not

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• Tolerance – the sensitivity to being triggered
• Uptick speed – how quickly someone gets to maximum emotional intensity
• Intensity – how “high” and intense the emotion goes
• Length of time at maximum intensity – how long one can maintain maximum intensity
• Down hill speed – how quickly the emotion peters out

I have to think more about this idea and maybe more will come. Unfortunately, Ekman’s work on this will not be published until later this year.

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Isolation

Mother I tried please belief me
I’m doing the best that I can
I’m ashamed of the things I’ve been put through
I’m ashamed of the person I am
Isolation, isolation, isolation

New Dawn Fades

Different colours, different shades
Over each mistakes were made
I took the blame
Directionless so plain to see
A loaded gun won’t set you free
So you say

Passover

Forgive and forget’s what they teach
Or pass through the desserts and wastelands once more
And watch as they drop by the beach
This is the crisis I knew had to come
Destroying the balance I’d kept
Turning around to the next set of lives
Wondering what will come next.

Atmosphere

Your confusion
My illusion
Worn like a mask of self-hate
Confronts and then dies
Don’t walk away

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1. Celebrities with Borderline Personality Disorder (possibly, not for sure)
2. Kurt Cobain and Borderline Personality Disorder (BPD)
3. New for May – Borderline Personality Disorder Awareness Month

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Learned Helplessness and PTSD

Another concept that is new to this edition is the idea of learned helplessness and PTSD as Non-BP’s. Personally, I think this concept applies to both people with BPD and those who loved them. Not so long ago I was reading a “Non-BPD Staying” book (one that, as this book does, encourages the acquisition of certain skills to live with a BP). This book mentioned the idea of “Stockholm Syndrome” sometimes occurs within the Non-BP’s mind. Stockholm Syndrome is a condition in which a person who is abducted begins to feel sympathy for and identify with his or her abductor(s). It was coined following a six-day hostage crisis in 1973 in Stockholm, Sweden in which the captors began to feel emotionally attached to their abductors. This other “Non-BP” book likens the state of the mind of a Non-BP to those captors; that is, the abused person (the Non-BP) begins to develop an emotional attachment to the BP because of this dynamic. Stockholm Syndrome has also been used in the context of a weaker abused person (such as a child) bonding to a more powerful abuser. While it is not a professionally recognized diagnosis, several high-profile abduction and abuse cases have mentioned the syndrome in the popular press, including the high-profile case of Patty Hearst. I believe that application of Stockholm Syndrome to a BPD/Non-BP relationship is inaccurate in almost every case. While there may be certain cases in which this dynamic exists, of all of the individuals that I have met in person and online, I have yet to see any that could be properly described as Stockholm Syndrome.

One problem in my mind with the application of this label is that it creates a defined abuser/abused polar relationship and discounts the real affection one may have for the (supposed) love one in your life. Mistreatment certainly goes both way in any relationship and in the case of a BP/Non-BP relationship, that mistreatment can arise to the level of abuse. I don’t, however, think it can arise to the level of abductor, captor or terrorist on either part. It may feel that way at times, but relationships go through many changes during the course of months and years and to say that the overriding factor contributing to the relationship is only and solely one of abuse and mistreatment, that would indicate (to me at least) that the relationship is not based on love and one which might likely be better off terminated. However, if you are this person’s parent or child, it may not be possible to terminate such as relationship. Instead, you have to find ways to break the cycle of abuse. It is difficult, no doubt. Stockholm Syndrome is, in my mind, an extreme form of co-dependency.

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A more useful concept is that of learned helplessness. One of the major differences between Stockholm Syndrome and learned helplessness is that the former is psychodynamic or psychoanalytic (through attachment and/or object relationship explanations) and the later is behavioral. Before I began to research BPD and the “plight” of the Non-BP, I was never much of a behaviorist. Once I started to understand what actually worked with BPD, I have warmed up to the idea of behavioral therapies in general and to DBT specifically (because it is something of a hybrid approach to acceptance and change, whereas CBT is typical places more emphasis on change). There are several differences between the idea of learned helplessness and Stockholm Syndrome. First, I need to define learned helplessness such that you understand the concept and why it may apply to you (or your BP loved one).

Learned helplessness is a state in which a person (or an animal, which is a major difference because it operates at a lower brain level than does the psychoanalytic-derived object relations model that explains Stockholm Syndrome) discovers that no behavior can counteract the pain and suffering that that person is feeling. Here is a quote from the Wikipedia entry on learned helplessness:

Learned helplessness is a psychological condition in which a human being or an animal has learned to act or behave helpless in a particular situation, even when it has the power to change its unpleasant or even harmful circumstance. Learned helplessness theory is the view that clinical depression and related mental illnesses result from a perceived absence of control over the outcome of a situation (Seligman, 1975).

The idea of learned helplessness is derived from a behavioral experiment in by Seligman and Maier in 1967. These researchers took dogs and placed them in experimental conditions in which one group of dogs could stop shocks coming from a grid beneath their feet by pressing a lever. In other words, pressing the lever was the behavior that allowed them to escape pain. These dogs learned to press the level repeatedly to escape the suffering induced by the electric shocks. Another group of dogs also had the grid and the lever, but in their case pressing the lever did nothing to alleviate the painful shocks. The shocks did not increase or decrease by behaving in any particular fashion. The lever did nothing to stop the pain they were feeling. These dogs learned that they were completely helpless to lessen their pain. Eventually, these dogs merely “laid down on the gird” and accepted the shocks without attempting a behavior which might remove the shocks. This reaction is the essence of learned helplessness. If a person learns that no matter what they try nothing works to alleviate their pain, they eventually give up on trying and “lay down on the grid.”

I believe this idea better describes the dynamic between any other person (including the BP/Non-BP relationship) than does Stockholm Syndrome. I say this because unlike Stockholm Syndrome in which one party is deemed the abuser and the other the abused, learned helplessness is about pain avoidance – either on the BP or Non-BP side. If what you try, over and over, doesn’t work to alleviate pain, then you eventually learn that the pain is unavoidable and you “lie down on the grid” and accept the pain as unavoidable – or you go nuclear and terminate the relationship or commit suicide. If everything you do, even if you try the diametrically opposed action to the previous action and that doesn’t work, results in suffering and equal pain, eventually you are going to learn that you are helpless to the pain – this is what learned helplessness is all about. I don’t think this concept is only about the Non-BP (which the idea of Stockholm Syndrome assumes – that is, there is one abuser and one abused, which in a loving relationship seem ridiculous to me. I mean, after all, we are talking about “loved ones” and families are we not?), No, the idea of learned helplessness cuts both ways because both parties are using ineffective methods to remove pain and both parties end up banging their head up against to wall of ineffectiveness. If nothing works, despair rules and the only solution is to accept your fate and “lay down on the grid.”

The way out of learned helplessness is a reconditioning of one’s behavior in which the pain can be removed. That is another difference in the idea of Stockholm Syndrome and learned helplessness. The mechanics of Stockholm Syndrome are impossible to counteract (I suppose it’s years of psychoanalytic therapy or other ideas that this “Non-BP” book purports), while the mechanics of learned helplessness are difficult, yet possible, to counteract. What one has to do to counteract the condition of learned helplessness is find a behavior or technique that is not helpless. One has to find a technique or behavior that one can practice and be effective to alleviate the suffering of the condition in which one is currently helpless.

The reason that I included this section on learned helplessness in this section of the book is two-fold. While I have yet to talk about the tools to counteract this and other relationship issues that can arise from an ineffective BP/Non-BP relationship (I do that later in the book), I just wrote about conditioned behavior and I am about to write about emotional memory. Conditioned behavior and learned helplessness can happen in both humans and in animals. These two concepts are interrelated. I’m not sure about emotional memory and if it applies to animals. However, if whatever you try to reduce your pain doesn’t work, you eventually learn that nothing works – that is the state of learned helplessness. Within the framework of the BPD dynamic, if you find that your reactions and behaviors are ineffectual, these reactions and behaviors are ineffective at reducing your suffering and at fostering a calmer relationship. So, learned helplessness is related to conditioned behavior and learned helplessness can grow out of the BPD dynamic if you continue to perpetuate ineffective behavior.

Unlike Stockholm Syndrome, learned helplessness is born out of trust. Stockholm Syndrome is born out of abuse and/or hostage-taking. Your loved one is not (however it may feel at times) a kidnapper, terrorist or, intentionally, an abuser. They (and you) are trying to get needs met. The relationship generally is born out of trust and presumed love, whether romantic, familiar or friendly (or a combination of each). The basic premise of the nature of the relationship is a significant difference between Stockholm Syndrome and learned helplessness. It is not just the nature of the concepts academically (one is psychodynamic, the other behavioral), it is the foundation for the relationship that is divergent. The dogs in the learned helplessness experiments essentially trusted and relied upon their “owners” – they needed food and shelter provide by the experimenters (which in a way makes their case more tragic). In the case of Stockholm Syndrome, the initial state between subject and object is adversarial. The abusers or abductors are part of the initial part in the equation, as are the abused and the abducted. There is a clear perpetuator and a clear victim, but in my mind, no such clear lines between these categories exist in a BPD/Non-BP relationship. Certainly, Non-BP’s do feel embattled and, at times, overwhelmed, but, upon reflection, so do BP’s. Both groups are behaving in ways that are ineffective and ineffectual for reducing pain, for increasing understanding and for maintaining calm in the relationship.

One of the keys to understanding learned helplessness is to understand that no effective behavior can be found to escape pain. While BP’s might resort to “extreme” behavior to reduce their pain (such as cutting, risk-taking behavior, drug taking and others) Non-BP’s may be less likely to do so. I say “may be” less likely because I suspect that alcoholism and other such behavioral adaptations might be more prevalent in Non-BP’s than in the general population because these are behavioral adaptations that act on the pain directly, yet these adaptations are ineffective and may create other interpersonal and personal consequences. It is possible that (as in the dogs) there is no behavioral adaptation that has any effective impact on the suffering. You feel stuck and there’s no way out. That, in effect, requires that you “lie down on the grid” and accept your punishment. The trust and presumed love you felt in the beginning of the relationship is exposed as ineffective, and you feel trapped in pain. I think this is a mild form of PTSD. The point is, if you can’t do anything to get you out of pain, you’re stuck, helpless and hopeless. I called this book When Hope is Not Enough for a reason, and here’s where my intentions become clear: you can’t hope for a better and more effective solution when everything you have tried thus far doesn’t relieve the suffering and pain you feel. You stop pressing or depressing any lever because neither state relieves the pain; thus, you’re stuck in pain and suffering. However, unlike Stockholm Syndrome, I can offer you a way out of learned helplessness. The way out is through the application of tools that you can apply to the BPD dynamic that can break you out of hopelessness. And unlike psychodynamic explanations, which can take years, this escape window can take much less time. All one has to do is dedicate oneself and practice.

This form of PTSD or learned helplessness hurts and feels as if you are trapped in a cage of conditioned behavior. Yet, if you learn and apply the tools in this book, you can change the BPD dynamic and take your life back. My point is to try and introduce a new dynamic in which you can open the escape window. I have seen in this work in my life and, possibly more importantly, in the lives of the people on my list. There’s hope, but real hope only comes through the application of skills that can escape learned helplessness and PTSD forever.

Related posts:

1. Bellman’s Syndrome – BPD and Chronic Pain
2. What is your goal for your relationship?
3. Mentalization-Based Treatment Versus Structured Clinical Management for BPD

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