Anything to Stop the Pain - BPD and Non-BPs

I believe there are several basic motivations to lie when you have BPD. There are also two types of lies: by admission (by telling) and by omission (by not telling). Both types are a problem with someone with BPD. The motivations for telling a lie (or omitting truth) by someone with BPD are as follows:

1.    When it is more painful to admit or tell the truth.
2.    When she wants the other person to think “better” of her than she thinks of herself.
3.    To avoid the judgment of the other person or judgment of herself.
4.    When she can’t see the “truth” because of emotional reasoning brought on by the refractory period of the emotion felt. In other words, when feelings = facts.

The first three of these factors play a role in the lies of someone with BPD and they are often inter-related. If the person to whom the lie is told is likely to judge the person with BPD as “bad” or “deficient,” the expectation of disapproval triggers first rejection sensitivity and then shame, because the person with BPD actually feels deep inside that, if she admits the truth, the other person will “find out” that she is a “bad person” and reject her fully. The last motivation is “emotional reasoning.”

I bring up these motivations not to “let liars off the hook” but to point out something: a person with BPD does not live in the same “reality” as you (the Non) do. Your truth is informed by what you see, hear, experience and what you believe about those inputs. A person with BPD is most often informed by her feelings about the experiences. These feelings can be misaligned with the facts and, as Paul Ekman notes in Emotions Revealed, a person overcome with strong emotions “cannot incorporate information that does not fit, maintain or justify the emotion.” In effect the original lies can be motivated by the inability to see information that doesn’t support the feelings. When someone is emotionally dysregulated, she just can’t see the truth if it doesn’t match what she is feeling.

In effect, she is not really “lying,” but merely pointing out “facts” (or generating them) that support her overwhelming emotion about the situation. The subsequent lies, which are used to “cover up” or support the emotional reasoning, are typically done for one of the first three motivations, particularly the idea that you would think of her as less of a person (and deservedly so) if it was revealed that she lied in the first place. I think there can be some argument about whether deep-down a person with BPD really believes the original lie (or any of those generated by motivation number four) when she exits the prolonged refractory period. My suspicion is that deep down a person with BPD is more concerned with the pain and shame the revelation of the lie will cause her than with repairing, rather than repeating, the lie.

While it is useful to know the motivations behind the lies, it still doesn’t make the lies any less hurtful. Being lied to is a painful and hateful experience for the Non. It destroys trust and personal integrity and leads to suspicion and paranoia. When someone specifically lies to you (by admission) or is secretive (by omission), you end up feeling angry, saddened and disconnected from your loved one with BPD. It is a confusing, embarrassing and painful experience.

Each of the motivations can be removed by:
Number 1: Pain management, distress tolerance (when the pain can’t be removed) and self-soothing
Number 2: Self-acceptance*
Number 3: Self-acceptance and developing the ability to tolerate judgment
Number 4: Emotional modulation

* a quick note on Number 2. I have known at least 3 borderlines rather well in my life. I have also known about 3 more peripherally (and of the 6 - not including my wife - 5 are female). But the 3 that I have known well (2 women and 1 man), ALL of them used motivation #2 to generate seemingly outlandish lies. Sometimes, each of them would have to “own up” to the lies and that was a painful experience I’m sure. I know if I every have to own up to lies, it is painful for me. I can only imagine how painful it is for someone with as much shame as a borderline feels.

Bon Dobbs :: May.14.2008 :: Pain, Shame, Emotions, Lying, Borderline Personality Disorder :: 2 Comments »

I found this Bill of Rights for People Who Self-Harm on the Internet. Copyright is as follows:

© 1998-2001 Deb Martinson. Reprint permission granted with proper credit to author.

So, it is rather old, but I think it still applies…

Bill of Rights for People Who Self-Harm

Preamble

An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike. Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm

1. The right to caring, humane medical treatment.
   Self-injurers should receive the same level and quality of care that a person presenting with an identical but accidental injury would receive. Procedures should be done as gently as they would be for others. If stitches are required, local anesthesia should be used. Treatment of accidental injury and self-inflicted injury should be identical.
2. The right to participate fully in decisions about emergency psychiatric treatment (so long as no one’s life is in immediate danger).
   When a person presents at the emergency room with a self-inflicted injury, his or her opinion about the need for a psychological assessment should be considered. If the person is not in obvious distress and is not suicidal, he or she should not be subjected to an arduous psych evaluation. Doctors should be trained to assess suicidality/homicidality and should realize that although referral for outpatient follow-up may be advisable, hospitalization for self-injurious behavior alone is rarely warranted.
3. The right to body privacy.
   Visual examinations to determine the extent and frequency of self-inflicted injury should be performed only when absolutely necessary and done in a way that maintains the patient’s dignity. Many who SI have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of future self-injury while making the person subject to the searches look for better ways to hide the marks.
4. The right to have the feelings behind the SI validated.
   Self-injury doesn’t occur in a vacuum. The person who self-injures usually does so in response to distressing feelings, and those feelings should be recognized and validated. Although the care provider might not understand why a particular situation is extremely upsetting, she or he can at least understand that it *is* distressing and respect the self-injurer’s right to be upset about it.
5. The right to disclose to whom they choose only what they choose.
   No care provider should disclose to others that injuries are self-inflicted without obtaining the permission of the person involved. Exceptions can be made in the case of team-based hospital treatment or other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. Patients should be notified when others are told about their SI and as always, gossiping about any patient is unprofessional.
6. The right to choose what coping mechanisms they will use.
   No person should be forced to choose between self-injury and treatment. Outpatient therapists should never demand that clients sign a no-harm contract; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. No client should feel they must lie about SI or be kicked out of outpatient therapy. Exceptions to this may be made in hospital or ER treatment, when a contract may be required by hospital legal policies.
7. The right to have care providers who do not allow their feelings about SI to distort the therapy.
   Those who work with clients who self-injure should keep their own fear, revulsion, anger, and anxiety out of the therapeutic setting. This is crucial for basic medical care of self-inflicted wounds but holds for therapists as well. A person who is struggling with self-injury has enough baggage without taking on the prejudices and biases of their care providers.
8. The right to have the role SI has played as a coping mechanism validated.
   No one should be shamed, admonished, or chastised for having self-injured. Self-injury works as a coping mechanism, sometimes for people who have no other way to cope. They may use SI as a last-ditch effort to avoid suicide. The self-injurer should be taught to honor the positive things that self-injury has done for him/her as well as to recognize that the negatives of SI far outweigh those positives and that it is possible to learn methods of coping that aren’t as destructive and life-interfering.
9. The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
   No one should be put in restraints or locked in a treatment room in an emergency room solely because his or her injuries are self-inflicted. No one should ever be involuntarily committed simply because of SI; physicians should make the decision to commit based on the presence of psychosis, suicidality, or homicidality.
10. The right to have self-injury regarded as an attempt to communicate, not manipulate.
    Most people who hurt themselves are trying to express things they can say in no other way. Although sometimes these attempts to communicate seem manipulative, treating them as manipulation only makes the situation worse. Providers should respect the communicative function of SI and assume it is not manipulative behavior until there is clear evidence to the contrary.

Bon Dobbs :: May.13.2008 :: Odds and Ends, Pain, Self-Injury :: No Comments »

An article about self-harm increasing in Britain:

Self harm by children on increase

The number of children admitted to hospital due to self harm has risen by a third in five years, according to National Health Service figures.

There were 11,891 in 2002/3, and 15,955 in 2006/7. In both periods, there were more than three times as many admissions of girls than boys.

Liberal Democrat health spokesman Norman Lamb, who requested the figures, said they were “shocking”.

He blamed a lack of specialist mental health treatment for children.

Gender differences

Admissions of children aged 10 to 18 following some kind of self harm rose by 34% between 2002 and 2007.

There was also an increase in children under 10 hurting themselves deliberately, from 157 to 169 admissions in the same period.

Triggers can be exam stress, bullying and feeling isolated and alone Sue Minto, ChildLine

Among under 10s committing self harm, boys outnumbered girls, unlike in older age groups.

In the 10 to 18-year-old category, there were 12,346 admissions of girls in 2006/7, compared with 3,440 boys.

In total, there were more than 70,000 admissions of young people to hospital for self-harm in the five year period.

Mr Lamb also requested NHS figures on the number of children admitted to hospital suffering from eating disorders.

The total figure was nearly 4,000, with cases having risen by nearly 10% in the five-year period.

‘Relieving distress’

Sue Minto, from ChildLine, said: “The rise in numbers of children and young people who have eating disorders or are self-harming is deeply worrying.

“Young people with eating problems or those who are self-harming are often trying to cope with other problems. Triggers can be exam stress, bullying and feeling isolated and alone with no one to talk to.

“Self-harm can be an attempt to relieve distress.”

Many children are languishing on long waiting lists or not getting treatment that meets their specific needs Norman Lamb Lib Dem health spokesman

The forms of self harm recorded by hospitals included drugs overdoses, attempted hanging and deliberate injury with a sharp object such as a knife.

Mr Lamb said: “These shocking figures are just the tip of the iceberg as most young people suffering from these illnesses will never make it to hospital.

“The underlying problem is the lack of specialist mental health treatment.

“The government has allowed child and adolescent mental health services to suffer drastic cuts over recent years. This means that many children are languishing on long waiting lists or not getting treatment that meets their specific needs.”

Mr Lamb requested the figures in a written parliamentary question.

A spokesman for the Department of Health denied that the government was not doing enough.

He said: “We are fully committed to improving Child and Adolescent Mental Health Services (CAMHS) and the actual reported spend on CAMHS has increased from £322m in 2003/4 to £461m in 2005/6.”

The spokesman also said that the majority of children did not have to wait more than four weeks for mental health care.

“As a matter of fact, services in some Special Health Authorities were able to respond to demand for hospital care quickly and lengthy waits of over six months were very rare.”

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/7379901.stm

Bon Dobbs :: May.13.2008 :: Pain, Self-Injury :: No Comments »

I have created a new version of my book, which fixes some typos and clarifies some points. I also was able to drop the price! It’s now $19.95, instead of $20.95. Since it got 3 pages shorter, I will be able to make a decent profit at the lower price. That price anticipates the cost it will have to be when I get it on Amazon (shortly).

Anyway, I suggest you check out the preview, and pick up a copy (shameless self-promotion). You can see the preview or buy the printed or downloadable version of When Love is Not Enough at Lulu.com.

If you are one of my readers with BPD, I would suggest getting a copy for anyone with whom you’d like to have an on-going relationship. Why? Because this book teaches a “Non-BP” the attitudes and tools to be more effective and more validating toward someone with BPD. The purpose is to rebuild the lines of communication. Like I said in a previous post (or comment), if I can quote myself here:

The BP/Non-BP relationship seems to me to be one of misunderstanding and miscommunication. I hope that I can help each learn the language of the other. And I agree most public awareness is important - BUT it has to be the right kind of awareness - not the “stay away from these people” or “these people are evil” kind.

Enjoy!

Bon Dobbs :: May.13.2008 :: Pain, Treatment, Boundaries, DBT-FST, Resources, Impulsiveness, Suicide, Shame, Mindfulness, Validation, Lying, Manipulation, Self-Injury, Emotions, Substance Abuse, Parenting, DBT :: No Comments »

At long last (about six months of work and 2 1/2 years of research, experimentation and practice), my first book When Love is Not Enough (WLINE) has been published!

This book is a quick-start, how-to guide for Non-BPs. It spells out step-by-step WHAT to do in your relationship with someone with Borderline Personality Disorder (or BPD traits) and HOW to do it. Unlike other books on this subject (you guys probably know which ones I’m talking about), WLINE tells EXACTLY what to do. Through the use of attitudes and tools, WLINE can help you build mastery over your relationship, regain control of your life and develop a deeper understanding of your BP loved one. I highly recommend it (if I do say so myself).

Although WLINE is fairly short (about 185 pages), it is packed full insights, advice and practical skills to help you understand your BP and to reestablish the lines of communication. If you are a Non-BP, WLINE is an essential resource. If you have BPD, I would recommend that you recommend WLINE to your family members, partners and friends (that is, if they are aware of your disorder). WLINE helps to build the bridge of understanding, serenity and effective communication between Nons and BPs.

It could be the most effective $20.95 you’ve ever spent.

If you’d like to buy a printed or eBook copy of WLINE, I am selling the book through Lulu:

Buy the Book!

A note on the title… I kicked around a number of titles before settling on this one. It is my feeling that most Nons don’t understand that, in addition to love, they have to develop ATTITUDES and SKILLS to be effective in their relationship with a BP. WLINE actually innumerates these attitudes and skills and provides detailed examples of how to apply them. With a commitment to the relationship, application of the concepts in the book and PRACTICE, a Non can learn what IS enough in their relationship with a BP.

Bon Dobbs :: May.09.2008 :: Pain, Treatment, Boundaries, Shame, DBT-FST, Blame, Best of, Impulsiveness, Suicide, Resources, Mindfulness, Biology, Validation, Lying, Manipulation, DBT, Self-Injury, Anger, Substance Abuse, Parenting, Emotions, Borderline Personality Disorder :: No Comments »

Here is an excellent article about shame and BPD:

http://www.soulselfhelp.on.ca/drm10shame.html

The Role of Shame in BPD
© Dr. Richard Moskovitz

Can you discuss shame? Is shame not one of the most significant core wounds that must be healed in order to recover from BPD?

Shame is fundamental to the experience of anyone with BPD and is the most crucial emotion that must be addressed if recovery is to occur. Shame is often confused with guilt, but these emotions have very different meanings. Shame is about who we are, while guilt is about what we do. Shame therefore reflects more lasting beliefs about the self than guilt. When we feel guilt, we expect retribution for what we’ve done. When we feel shame, we expect contempt from others and feel contempt for ourselves.

Shame is connected with a wealth of negative self-beliefs that may include fundamental assumptions of defectiveness, the belief that one is helpless to survive alone, beliefs about physical defectiveness (”I am fat, deformed, repulsive to others), mental defectiveness (I am stupid, incompetent, inarticulate), or sexual defectiveness, and the belief that one is unworthy of the love and attention of others.

We feel shame about anything about ourselves that we would prefer others not to see. The body language of shame is about being invisible or not acknowledging being seen by others. We become small in posture by slouching or turning away. We avert our gaze from that of others, which is reminiscent of a baby covering its own eyes and imagining that it has become invisible to others. As adults, however, failing to meet another’s gaze is also a sign of submission.

We also feel shame whenever we fall short of our own expectations of ourselves, however unrealistic they may be. Impossible goals, such as the total eradication of body fat, inevitably lead to deepening shame, which in turn may be reflected in an increasingly distorted self or body image. This is the cycle of shame that fuels the compulsive self-starvation of anorexia nervosa. Shame is therefore connected with the fantasy of how we imagine we are supposed to be and obstructs our vision of who we really are.

While shame has many roots, it is a natural consequence of abuse and neglect. What all forms of abuse have in common is the contempt that an abuser has for a victim. The deeper pain of being abused is the shame that derives from being an object of contempt. Many abusers show their contempt explicitly in the form of degrading words, but all abusers show contempt by their assumption that their victim’s primary role is as an instrument for their gratification. Shame in turn results in submissiveness that tends to perpetuate the cycle of abuse.

Dr. Donald Nathanson has pioneered the study of shame and its relationship to the psychotherapeutic process. He defines four categories of learned responses to shame, which he visualizes as the four points on a compass. On one axis lies “Withdrawal” at one pole and “Avoidance” at the other. On the other axis lie “Attack self” and “Attack others.”

“Withdrawal” behaviors include various forms of hiding from others, ranging from averting ones eyes and maintaining silence in the presence of others to reclusiveness and flight. Withdrawal can lead to isolation and feelings of abandonment, confirming the belief that we are unworthy of the company of others and therefore reinforcing shame.

“Attacking self” includes a repertoire of behaviors that are designed to protect us from abandonment at all costs. These are self-negating, submissive gestures that acknowledge the superior power of another, whose presence has become important to us. This can also contribute to the cycle of abuse.

“Avoidance” includes all the behaviors that are designed to keep from feeling the shame. This ranges from the use of drugs and alcohol to obliterate feeling to the distractions of sexual indulgence, materialism, and vanity. Avoidant behaviors include a variety of things we do to cover up the defects that we imagine others see in us. They are often cosmetic in quality and serve to distract both ourselves and others from these defects.

“Attacking others” includes a repertoire of desperate behaviors that serve to belittle others as a last ditch attempt to rescue self-esteem by feeling bigger at another’s expense. The attacks may come in words or actions. These behaviors inevitably distance us from others, again raising the threat of abandonment. These behaviors also result in shaming others and pass the wounds along.

These four kinds of responses to shame are all intricately interrelated, are self-defeating, and therefore perpetuate the cycle of shame. They are behind the many impulses with which people with BPD must struggle. They are connected with the terror of abandonment that characterizes BPD as well as with the difficulty that people with BPD have in achieving intimacy.

Bon Dobbs :: Apr.02.2008 :: Pain, Shame, Anger, Borderline Personality Disorder :: 2 Comments »

A link between chronic pain and BPD/PTSD:

Over the years in treating BPD or PTSD I have observed a syndrome that my fellow clinicians now refer to as the “”Bellman Syndrome”" a title I modestly [accepted]. It is simply stated thus; chronic pain and medication addiction are directly associated with BPD or PTSD in a complex interaction.

bon :: Jan.08.2006 :: Pain, Borderline Personality Disorder :: No Comments »

Interesting article from a former sufferer of borderline personality disorder on healing versus stopping the pain. A quick blurb:

So, in healing, it is necessary to face the pain of your past, the pain that you are currently in and the pain that you will come to know when you can see how the choices you’ve made to protect yourself have effected not only your life but the lives of those around you, especially the lives of those who tried to care, to love and to help you. There is a profound grief that must be waded through in the quest for one’s authentic self.

http://www.borderlinepersonality.ca/borderhealing.htm

bon :: Jan.06.2006 :: Pain :: No Comments »