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People with BPD are in a great deal of emotional pain. Since emotions are immediate and primal, emotional pain is also immediate and primal. As I have said, emotions represent a land-bridge between the body and the mind. Emotional pain manifests itself in both mental and physical ways. If you have ever been depressed or “fraught with grief” over the loss of something or someone important to you, you will know what I am saying in this regard.
Depression and grief can be a trying experience for anyone. You feel pain in every area of your body and mind. Sometimes you will just want to retreat to your bedroom and go to sleep for hours, just to get some relief from the physical and mental anguish you feel. The sleep represents a distraction of both the mind and the body from the experience of complete pain. You might also use alcohol to relieve the pain by “turning off your mind.” Many people “drink themselves into a stupor” and, in doing so, extinguish the pain for a short period. Pain-killers, whether over-the-counter or prescription, can also remove pain by working on the pain at its source (in the brain where pain is actually felt). Once, when I was asked by one of my daughters about how the Tylenol knew to go to her foot (which was in pain), rather than to her head (because she’d taken it for headaches before), I explained that it acts in the brain where she feels the pain, not where the pain actually “is.” In the case of emotional pain, the pain seems to be both in the body and in the mind, but the pain-feeling area of the brain is where these drugs act. See below about substance abuse.
People with BPD are likely to feel emotional pain many times a day every day. Since these emotions are basic (like fear, sadness and anger) the reactions to them are both physical and mental. These emotional pain-states are powerful and have the ability to overpower rational thinking. When you are in pain, regardless of the source, the main reaction of the body and mind is to get out of or to relieve the pain as soon as possible and by whatever means necessary. I used the example of someone who is literally on fire. This person will try to douse the flames in any way, without thinking about the people around her and what harm may come to others if the flames spread. This situation is analogous to a person in deep emotional pain. The person will do anything to stop the pain, which is why my Internet site and Internet list are called “anything to stop the pain” (ATSTP). This “anything” includes self-destructive and relationship-damaging behaviors. Continue reading Ask Bon: Why does my loved one with BPD do such dangerous things? (like cutting, drugs, etc.) →
With a debt of u-opiods and over active u-opiod receptors, could this be the first medication for BPD? I am not a doctor yet when I saw this on twitter I immediately thought of Borderline Personality Disorder:
Extended-Release Opioid Gets FDA OK
By Emily P. Walker, Washington Correspondent, MedPage Today
Reviewed by August 26, 2011 Review
WASHINGTON — The FDA has approved tapentadol (Nucynta), an extended-release oral opioid, to treat severe chronic pain.
The agency first approved the drug for relief of moderate to severe acute pain in 2008. Friday’s approval is for an extended-release pill that chronic pain patients can take twice daily.
The approval is based on a randomized, double-blind, controlled phase III study that tested tapentadol as a treatment for moderate to severe low-back pain and diabetic peripheral neuropathy.
Safety was evaluated in 1,100 patients with moderate to severe chronic pain over a one-year period. The drug was found to be safe and effective, according to the company that makes tapentadol, Janssen Pharmaceuticals, a unit of Johnson & Johnson.
Tapentadol was also well-tolerated, the company said. Opioids can cause a number of side effects, including constipation, that may cause patients to discontinue their use.
A 2010 phase III study comparing the drug to oxycodone in patients with painful knee osteoarthritis found that tapentadol provided effective pain relief with fewer of the gastrointestinal side effects seen with oxycodone.
“Chronic pain is difficult to manage, and even with the treatments available today, it can be a challenge to balance pain relief with a patient’s ability to tolerate the medicine,” Sunil Panchal, MD, president of National Institute of Pain, said in a press release from Janssen. “People with chronic pain will continue to need additional options, so an approval like this is welcome news for this community and the people who suffer from this often debilitating condition.”
The approval also comes with a Risk Evaluation and Mitigation Strategy (REMS), similar those approved for other opioids, meant to educate prescribers about the potential of abuse, misuse, overdose, and addiction with extended-release tapentadol.
The CDC estimates that 42 million Americans over the age of 20 suffer from chronic pain.
Here is a quote from Infinite Jest about “depression” or the “Great White Shark of Pain”. I think it helps illustrate the difference between the chronically depressed and those in emotional agony. I see that people with borderline personality disorder are more likely to be in the second category. I have bolded some key points here. The “suicide contract” is exactly the same as a “behavior contract”. With a person in this much pain, it ain’t gonna work.
That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this depression clinical depression or involuntary depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton’s melancholia or Yevtuschenko’s more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.
It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.
It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain [(the big reason why people in pain are so self-absorbed and unpleasant to be around)], a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.
The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnosis can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it’s a closed circuit: the current is both applied and received from within.
The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death suddenly seems more appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who jump from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.
But and so the idea of a person in the grip of It being bound by a ‘Suicide Contract’ some well-meaning Substance-abuse halfway house makes her sign is simply absurd. Because such a contract will constrain such a person only until the exact psychic circumstances that made the contract necessary in the first place assert themselves, invisibly and indescribably. That the well-meaning halfway house Staff does not understand Its overriding terror will only make the depressed resident feel more alone.
By (author) David Foster Wallace
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Article about a University of Missouri swimmer who committed suicide. She had BPD. Sad, sad.
Missouri swimmer’s suicide might draw attention to disorder
By DAVID BRIGGS
Sunday, July 3, 2011
Sasha Menu Courey loved college life at Missouri.
She was a swimmer with Olympic ambitions but rarely missed a chance to set free a laugh so booming that it seemed to rattle the ceiling of teammates a floor below at Johnston Hall. The sophomore greeted friends — everybody counted as one — as if they were just the person she was hoping to see.
“It was always, ‘Heyyy!’ ” said MU swimmer Caitlin Connor, who met Menu Courey before a home football game their freshman year when she and her roommate from 233 Johnston searched out the source of the bursting cheer in Room 333. “She would talk to you like she had known you her whole life.”
In the classroom, Menu Courey earned a 4.0 GPA her first semester and was already planning for graduate school. The aspiring psychologist had lined up a prestigious internship this summer researching treatment for alcoholism.
“Everything she touched,” said her mother, Lynn Courey, “she was doing great.”
But this spring, Menu Courey fell into the grip of an illness she had kept hidden from the world.
Menu Courey committed suicide June 17 in a suburban Boston hospital. She was 20.
When a series of events one friend described as the “perfect storm” reached a crest, she slipped into a deep depression from which she would never escape.
Menu Courey left the team on March 21. She spent the next 10 days under watch and treatment at the MU Psychiatric Center, where her parents said she was diagnosed with borderline personality disorder, an illness characterized by extreme emotional instability.
Lynn flew in from the family’s Toronto home to be with her daughter when she was released. By then, however, she said she no longer recognized Sasha. Though Sasha often put on a cheerful front to keep friends and family from worrying, she bore an emotional pain too great to endure.
“We have difficulty understanding, as well, what happened,” Lynn said. “My daughter really had a great will to live, and suddenly she had a will to die.”
Now, Menu Courey’s family is celebrating a life that brought joy to so many while searching for answers and striving to raise awareness of a disorder they knew little about until it was too late. Continue reading Missouri swimmer’s suicide might draw attention to disorder →
In the post “When Your Partner Says They Are In Pain, Validate” Kate Theda of the “Partners in Wellness” blog specifically used my I-AM-MAD communication skill to teach her readers about validation. Here is the intro for the log post:
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.
A few days ago, I saw some confirmation of “it’s all about his/her feelings” come across the ATSTP Email Support List. A woman who has been a member for a while posted this about her husband with BPD:
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.
As you can see, there are two interesting notes in that post – one that it’s all about his feelings (IAAHF) and secondly that she didn’t want to accept that it was not about her feelings. Tough thing to face, but at some point, it’s more effective to accept that the motivation is IAAHF and, more so, that that’s the motivation that will have the biggest impact on an emotionally sensitive person.
I coined the phrase “It’s All About His/Her Feelings” (IAAHF) as a mentalization tool to understand the MOTIVATION behind much of the confusing behavior of those with BPD. Last week, I got the first search engine search on IAAHF. See below:
 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).
Excellent article about what BPD feels like:
What BPD Feels like
A lot of friends and family members want to understand what the BPD sufferer is going through, but they don’t have a proper understanding of what is actually happening. For the BPD sufferer it is hard to explain what it feels like when honestly, they don’t know exactly what it is that isn’t “normal”. People around the BPD sufferer know that something isn’t right with the person, but quite often the sufferer does not know there is anything wrong, which is why they can attack you when you suggest there may be.
As a BP sufferer myself, I can say that there are definitely times when you can “cope” better than others. But then there are times when it is all you can do to get out of bed. Your emotions can be that out of control that you suffer an emotional pain that is similar to the experience one feels when a loved-one has died, but it doesn’t get better and there is no reason for it. Some people deal with emotional pain in various ways, such as drinking, using drugs, crying all of the time, or becoming angry. It can affect BPD sufferers in different ways, depending on how they usually deal with stressful situations. I know for me I have a strong belief in being non-violent as I know that if I don’t keep my anger in check it can verge on being out of control, so I work extra hard to avoid that. Unfortunately that means that I will do things like drink or drugs to distract myself, and so I have had addiction problems in the past that I have also had to deal with. This is quite common in BPD personalities, as they try to do whatever it takes to find a way to distract themselves, or ease their pain, for a little while. If they find something that works, even if it is for a little while, then they will latch onto it in the hope that if they do it all of the time the pain will go. This obviously doesn’t work, and provides the BPD sufferer one more thing they need to fix in their life.
At my worst, the ability to think clearly or to make rational decisions is completely gone, and it is almost an impossible task. You can try your hardest to take your time to think about things to make the right choice, but this doesn’t happen. It is unclear whether this is a response to the overload of emotions on the brain or another cause due to this illness, but it is a fact.
Then there is also the other part of BPD which can cause depersonalisation, which can cause huge problems in a person’s life. Depersonalization is when the person experiences a sense of detachment from the self. It is often associated with sleep deprivation or “recreational” drug use. It may be accompanied by “derealization” (where objects in an environment appear altered). Patients sometimes describe depersonalization as feeling like a robot or watching themselves from the outside. It may also involve feelings of numbness or loss of emotional “aliveness.” When I have experienced this it is almost like I have been tricked into thinking I have no feelings for certain things. For example, a few years ago I went through this phase of depersonalization in which I was convinced that I had no feelings (almost overnight) for my partner. Whilst in hospital after a suicide attempt I met someone there, and thought that because I felt something for them that my relationship with my partner must be over, so I split up with my partner. A few weeks later my feelings for my partner kicked back in and I realized that I had made a huge mistake. Luckily for me my partner took me back after this indiscretion, but I know it is the only chance I have. I now understand from this experience that I can’t always trust my emotions, because for me, as a BPD sufferer, they are not all real.
BPD sufferers can also experience bouts of dissociation, which can lead to dissociative amnesia. This means that they will have no memory of what happens when they are in a dissociative state. Dissociation is the state in which, on some level or another, one becomes somewhat removed from “reality”, whether this be daydreaming, performing actions without being fully connected to their performance (“running on automatic”), or other, more disconnected actions. This can be a lot more serious than the usual “automatic pilot” that most people will experience, and can be as a result of depersonalization as well.
Family members and friends say that BPD sufferers have extreme mood swings for no reason, and while this is true to outsiders, the BP sufferer always thinks they have good reasons. They feel like they are only reacting to what the people around them are doing, but this is only because their view of what is happening around them is skewed. Because of the extreme emotional reaction they have to normal events, what may seem small to other people becomes a huge thing in the mind of a BPD sufferer. For example, if my partner looks at me in a weird way, it could mean absolutely nothing on their end, yet I may blow up at my partner because in my mind it means that they are angry at me. The mind of the BPD sufferer makes these kinds of assumptions all of the time – they believe that they are experts in reading people and body language, when in fact they are the exact opposite. And it is when they make these errors in judgment that they react wrongly and overly emotionally, and the friend, partner or family member has no idea why. In our mind it all makes sense, as we tell ourselves we know what is truly going on, when in fact we have no idea.
The fear of abandonment is also a major issue in the life of a BPD sufferer, and this is what can cause most of the issues when it comes to personal relationships, either romantically or not. When starting a new romantic relationship, the BPD sufferer will usually test the potential partner to see whether they will stick around. If the partner passes this test, then the BPD sufferer will latch on and treat that person like they are a God/Goddess so that the other person will fall in love also. Once the BPD sufferer is comfortable with where the other person is at, they may then start to switch between intense bursts of love/hate that confuse the other person. This is not done consciously to torture the other person – in fact, the BPD sufferer has no idea that they are doing it. They are actually responding to perceived events in their own mind which causes them to act this way, even though these acts don’t exist. For example, there are times in my relationship where my mind makes the leap that my partner is cheating on me even when I know in reality that this is not the case. All it takes is for me to experience rejection one night when I make sexual advances, and my emotional response is out of control to try to figure out what the problem is. In my mind it couldn’t actually be that my partner is tired from work and our children – it has to be more than that. So I go into this emotional free-fall until it ends up in an argument where my partner has to defend themselves from something they haven’t even done.
It is extremely difficult for BPD sufferers to have successful relationships, and it is because of our reaction to the fear of abandonment which is the reason why a lot of non-BPD sufferers refuse to have relationships with us. I can certainly understand why, if my partner was always looking for the negative in our relationship instead of just being happy. I know for me if I have times where I recognize that I am happy, it will be quickly followed by me searching for a reason that things are bad as I can’t believe that things are as good as I think they are.
The BPD sufferer can not accept that things are good or happy or uncomplicated – they expect things to go wrong any second and are always searching for any sign of this occurring. It even gets to the point that if they can’t see one then they will make one up (sub consciously of course) so that they can prove themselves right. This can be very frustrating for those around them, as they constantly go through this dance of proving to their partner or loved one that they are not leaving. It eventually gets to the point where the BPD sufferer will push the other person that much that they will leave, and then the BPD sufferer is in some way validated for doubting the person in the first place. It is a no win situation.
Another area in which BPD affects my life is in maintaining focus on areas in my life. For example, I will develop an interest in religion, so I will then have to read books, watch documentaries, live, talk and breath religion until a few weeks later when suddenly this obsession will pass. It also happens in things like career choice. I have started University study four times as each time I start a course I am 100% sure that this is what I want to do, but as soon as I start studying I lose interest so I stop. I have sunk money into so many ridiculous career choices and money making schemes that I guarantee I will commit to, only to have given up when my focus changes to something else. I can get so excited by something only to give up on it after a month or so, and it is just as frustrating for me as it is for those around me.
A lot of BPD sufferers, including myself, have experienced episodes of self harm and suicide attempts. Luckily for me I have never been successful, but unfortunately 10% of all sufferers are. This number should indicate how hopeless, distraught and pained BPD sufferers are. Suicide is not something anyone takes lightly. I know for me, every time I have thought about it, it has been over a long period of time, until finally it gets to the point where it feels like I have no choice. It is not something I rush into. Suicide is only an option to sufferers because they are not thinking clearly, and are having inappropriate reactions (which they can’t control) to events and the environment around them.
To a lot of non-BPD sufferers it can seem like the BPd sufferer is using suicide attempts as a form of manipulation. From my experience, although I can’t speak for everyone, this was never my intention although I can see how it has been interpreted like this. Normally to get the point where suicide is considered the BPD sufferer is experiencing an episode of immense pain for a long time, although sometimes if they can feel one of these episodes coming on they may consider it as a way to stop the torture they are about to sink into. When I have got to the point of actually attempting suicide, for me it has been more about preventing other people from being hurt by me than trying to hurt them by committing suicide. As I have previously said, I can not say that this is true for all sufferers, but I know the majority would feel this way.
Episodes of self harm are also common for BPD sufferers. I have experienced these episodes on many occasions, but for me there is not always one reason as to why I do it. Sometimes it is because I feel so much emotional pain I want to let it out so I try to do it physically, other times it is because I am feeling absolutely no emotion that I want to feel pain so that I know I am still capable of feeling something. Some times it is even because I am almost in a psychotic state that for me it makes sense to cut myself if an angel tells me to. Whether this is what the doctors call true psychosis or not I am not sure, but it can seem real enough at the time. All I know is that the ability to think properly becomes that distorted that things that would normally seem stupid become really good and sensible ideas. You start believing things that could not possibly be true, and can even imagine conversations with people that don’t exist.
BPD affects virtually every area of a sufferer’s life. It affects the decisions they make, how they respond to stimuli in their environment, how they behave towards themselves and other people, and their emotional reactions. I could not imagine anyone choosing to live this lifestyle, as it destroys virtually everything around them. Overcoming BPD is the biggest challenge a sufferer has, but it is possible with a lot of hard work. And to have any semblance of a normal life it is necessary.
Article that mentions BPD and Anna Nicole Smith….
Doctor: Anna Nicole Smith medication ‘overkill’
By LINDA DEUTSCH (AP) – 3 days ago
LOS ANGELES — A hospital psychiatrist testified Friday that medication given to Anna Nicole Smith by a doctor now on trial was “overkill” for the kind of pain she was describing.
Dr. Nathalie Maullin said she believed Smith had “a borderline personality disorder” and was addicted to prescription medications.
Maullin said she was on staff at Cedars-Sinai Medical Center in April 2006 when Smith was brought in pregnant and in withdrawal from anti-anxiety drug Xanax and the pain killer Methadone. The celebrity model told her she had gone “cold turkey,” discontinuing her medications all at once because she was concerned for the welfare of her expected baby.
By doing that, Maullin said, she had actually endangered the baby and herself. The doctor said she quickly resumed her medication with Methadone and began weaning her off Xanax, both of which had been prescribed by Dr. Sandeep Kapoor, a defendant in the drug conspiracy case.
“My thoughts were these were very hard core medications to be giving for the kind of pain she was demonstrating,” said Maullin. “She was on medication that seemed like overkill for the type of pain she was in.”
She said it was difficult to get a medical history from Smith because she was “putting on a show” and was deferring questions to her lawyer-boyfriend, Howard K. Stern, who was with her at all times.
Kapoor, Stern and Dr. Khristine Eroshevich have pleaded not guilty to conspiring to provide excessive opiates and sedatives to Smith. They are also charged with prescribing drugs to an addict, but are not charged with causing her 2007 overdose death.
Maullin said Stern told her Smith had been suffering from back pain for five years. She said the former Playboy model also complained of pain in her upper back and arm.
Another doctor who testified earlier this week said Smith suffered from chronic pain syndrome all over her body.
Maullin said she conferred with Kapoor by phone, gave him her plan for weaning Smith off Xanax and any drugs known as benzodiazopines which can be addictive. She said he agreed and told her he would leave the prescribing of Methadone to her.
“Did you see any pain that needed treatment with opiates?” asked the prosecutor.
“No,” Maullin said.
The problem was that Smith showed no enthusiasm for the plan, the doctor said.
“It was like pulling teeth to get some response from her,” she said. “She was compliant but not really interested. She was not wholehearted.”
Five days after Smith checked in to the hospital, Maullin said she received a page at midnight from a nurse that said Smith’s eyes had rolled back in her head.
That sounded like a drug reaction and a one-time dose of Benadryl was prescribed, Maullin said. However, the next day, she received another call saying Smith was having hallucinations.
“The nurse said that she was flossing her teeth with no floss and was out of it,” Maullin said. “This was a radical change.”
Under questioning by Deputy District Attorney David Barkhurst, Maullin said she did not consider this an emergency and she tended to other patients before going to see Smith five hours later.
“In psychiatry, we are used to seeing patients do strange things,” she said.
Upon her arrival, Stern told Maullin that Smith “was generally acting goofy.” Smith was angry and made no eye contact but seemed lucid, Maullin said.
The psychiatrist said she suggested that Smith go into an inpatient facility that deals with addicts. But Smith wasn’t interested and told Stern she wanted to leave the hospital.
Maullin said she informed Kapoor and he said he would go to her house.
“I thought that was unusual,” she said. “Physicians generally see patients in the office or the hospital. There was no reason she could not leave her home to come to see him. Just in terms of proper boundaries with patients, you see them in your office.
“She needed to participate in her care,” Maullin said. “It’s not a home delivery service.”
 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?
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