Anything to Stop the Pain - BPD and Non-BPDs » Anything to Stop the Pain – For Non-Borderlines and Loved Ones of People with BPD

Reinforcement and “Behaving Better”

Bon Dobbs — Wed, 27 Apr 2011 18:10:13 +0000

Reinforcement, especially positive reinforcement, is a powerful teaching tool. You could more accurately say “training” tool. You have probably used reinforcement in your life without even realizing it. Consider potty training. If you have ever potty-trained (or as many modern texts call it “toilet taught”) a toddler, you know how difficult that task can be. However, all kids eventually learn to use the potty – I don’t know of a case of a kid going into high school without knowing how to use the potty.

Potty training provides an excellent example of positive reinforcement and the ignoring of “backsliding.” That is the essence of this tool. When you teach a child to use the potty, you make a BIG positive deal about it when it is successful. The first time you see the poop in the potty, what happens? Typically, the parent praises the child, positively reinforcing the behavior in a way that is out-of-proportion with the accomplishment. You may say, “Yeah! You did it! That’s fantastic! Good Job!” and clap your hands and cheer. You also will tend to do it within seconds of the completed behavior. That is where positive reinforcement differs with general praise. Praise can be given much after the fact and can be bestowed for a number of reasons, including character traits. That is, you could say, “Wow, you are so smart” after your child receives a 100% grade on a math test. That is praise. (Although I’m not sure it is effective, but that is not the topic at hand). Positive reinforcement is for behaviors and should occur right when the behavior is completed. That is how animals are trained. The positive reinforcement (feeding, for example) occurs within seconds of the completed behavior so that the two can be connected in the mind of the animal.

If I return to potty training, you will notice that you also naturally ignore and don’t punish behaviors that don’t match the desired behavior. That is, if the child has an accident and poops in his/her pants (while not wearing a diaper) you don’t say, “You are a naughty little boy/girl!” No, that would be damaging to your child’s self-image. No, instead, you say, “Everyone has accidents at first. You can try again next time. It’s OK.” This is an accurate corollary to emotional regulation and reinforcement and punishment. Since the BP naturally has difficulties regulating her emotions, the idea of her “messing up” or “backsliding” is analogous to child pooping in her pants (even if this is more the “rule” than the “exception” in the BP’s life). It is not effective to punish her for behaviors that (at first) she can’t control. The behaviors are conditioned and the purpose of this tool is to help recondition a BP to behaviors that are more desired and effective. After conditioning, the child is able to control (or at least sense) when she has to go potty. After conditioning a BP is able to control (or at least sense) when she is becoming dysregulated.

- An excerpt from When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder. Available online in Print, eBook and Kindle
Editions

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Beyond Boundaries eBook now available on the Kindle!

Bon Dobbs — Fri, 22 Apr 2011 14:08:59 +0000

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Beyond Boundaries (Kindle Edition)

By (author) Bon Dobbs

List Price:	$7.99 USD
Release date April 19, 2011.

I am pleased to announce that my eBook Beyond Boundaries is now available on the Kindle (and other Kindle format devices/readers). The price has been dropped dramatically because I had to remove the graphs, pictures and change the format slightly to make the content make sense on the Kindle. Some information about Beyond Boundaries:

My new eBook needs some explaining I think… It is an attempt of mine to bring together the ideas that I presented in “When Hope is Not Enough” plus some new ideas with which I have been working. I adjusted my “model” of BPD slightly beyond that which was presented in “When Hope is Not Enough”. I also speak more to attachment, cheerleading, mentalizing and goal-directed behavior. “When Hope is Not Enough” is a book that is all about the person with BPD. It is to help them (the ESP/BPD/ERD person) feel better. My theory with that one was if they feel better, they won’t act out in order to attempt to feel better. While modeling and reinforcement are behavioral modification techniques that ARE presented in “When Hope is Not Enough”, I have found that once you have mastered what is in “When Hope is Not Enough”, you’re left with a feeling of “what about MY feelings?” because, although things are (sometimes markedly) better, calmer and easier, it still isn’t a 50/50 relationship. That can cause frustration.

I believe I have discovered how to make the relationship closer to 50/50, which was assembled in the new eBook “Beyond Boundaries”. I wanted to get something out there to help people move toward a more 50/50 situation.I believe that it is necessary to read “When Hope is Not Enough” to fully understand “Beyond Boundaries”. I think that many people who buy it might not read “When Hope is Not Enough” first, because of the title. It is amazing how nons get the impression that boundaries are the only “tool” for BPD relationships. I am also trying to debunk that.

I don’t think you can properly apply techniques that move toward a 50/50 relationship without first gaining the trust that comes through “When Hope is Not Enough” (and other books too). Even if you SAY your intent is not malicious, the other person will not believe you unless you have demonstrated benevolent intent that “When Hope is Not Enough” helps facilitate.

Beyond Boundaries is essentially a transitional book that can get you from a calm, but sort of one-way relationship (which can be developed through the skills in When Hope is Not Enough) to a more two-way relationship. It can help you on your path toward emotional skillfulness and mastery.

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Understanding Major Depression With Borderline Personality Disorder?

Bon Dobbs — Tue, 05 Apr 2011 16:22:20 +0000

The NIAAA study begins to spread out and spur on new views of the findings regarding BPD. Here is a study about Major Depressive Disorder and BPD.

Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?

Myrna M. Weissman, Ph.D.
Epidemiologic surveys have mapped the terrain of psychiatric disorders. Personality disorders have bedeviled the clinician’s practice. Rarely have these two been rearranged in a meaningful clinical dialogue. Using the largest psychiatric epidemiologic survey ever, the National Epidemiologic Survey on Alcoholism and Related Conditions, and among the few to venture into axis II disorders, Skodol et al. (1), in this issue of the Journal, give a community-based national view of a common clinical question: What is the effect of specific personality disorder comorbidity on the course of major depression?

The original sample included over 40,000 adults, and 2,422 met criteria for DSM-IV current major depressive disorder. Three years later, 1,996 of the original currently depressed subjects were available for reinterviewing, which makes both a respectable sample size and response rate for generalizability. However, some caution is needed, since the sample was over-represented with Caucasian, college-educated, and married respondents. Fifteen percent of participants had persistent major depressive disorder, and 7.3% of those who remitted had a recurrence over the follow-up period. These figures are within the range of longitudinal studies of patients with major depressive disorder (2). While the presence of any personality disorder elevated the risk for persistence of major depressive disorder, when all axis I and II disorders, age of onset of major depressive disorder, number of previous episodes, family history, treatment, and duration of illness were controlled, borderline personality disorder remained the most robust predictor of major depressive disorder persistence. Neither personality disorders nor other clinical variables predicted recurrence of major depressive disorder. Thus, an epidemiologic survey yielded a practical jewel. The finding, undoubtedly, does not surprise the clinician but is now confirmed nationally. As the authors conclude, borderline personality disorder should be assessed in all depressed patients and considered in prognosis and addressed in treatment.

One can raise a number of methodologic issues about this study, including the use of lay interviewers or the instrument for assessing axis II disorders. The diagnostic interview, the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-IV version (3), was developed for this survey. The personality disorders included were adapted from items in the Structured Clinical Interview for DSM-IV Personality Disorders. The test-retest and internal consistency results reported for all personality disorders are fair to good, not great. However, the agreement with clinician interviews for borderline personality disorder (kappa=0.71) is about as good as it gets (4). The only other national survey to venture into assessing all axis II disorders was the National Comorbidity Survey Replication (5), which used the International Personality Disorder Examination. The investigators carried out a clinical reappraisal in a sample of 214 subjects using clinically trained interviewers to follow up screened, positive subjects and reported excellent predictions of classification. They also noted that the International Personality Disorder Examination is commonly regarded as a conservative diagnostic assessment of axis II disorders. The community rate they generated for any personality disorder in the United States was 11%, and in the World Health Organization World Mental Health Surveys (6), involving 13 countries, the rate was 6.1%. These rates seem to be lower than those reported in the National Epidemiologic Survey on Alcoholism and Related Conditions, but different presentations make it difficult to directly compare rates between studies. No articles from the National Epidemiologic Survey on Alcoholism and Related Conditions reporting overall rates of axis II disorders could be found. Unfortunately, given the findings in the Skodol et al. article, not all personality disorders were included in the first wave of the survey, and borderline personality disorder was added in the second wave. Both of these landmark studies used state-of-the-art measures. While they are imperfect, these are the best available. It is too bad they could not share the same methods.

The major issue now is not a debate about the methods of personality disorder assessment but about the future of personality disorders. The DSM-5 committee is working on the next version of psychiatric classification (7). In parallel, the National Institute of Mental Health is working on moving diagnosis away from clinical presentations to understanding of syndromes based on pathophysiology in a new project called Research Domain Criteria (8). These efforts will certainly effect how personality disorders are described, classified, or reimbursed in the future.

DSM-5 raises issues about the categorical conceptualization of personality disorders because of the high concurrence among disorders, both within and across axes, and the difficulty in differentiating normal from pathological. How dimensions will solve the problem of a lack of understanding of the pathophysiology underlying the disorders is unclear. Some cutoff along the dimension will need to be established for clinical practice.

The Skodol et al. study, based on an epidemiologic survey, may add light to the issue or, at least, generate a hypothesis about diagnosis that can be translated into a more experimental approach. Borderline personality disorder, defined categorically, and not the other axis II disorders explained the persistence of major depressive disorder over 3 years. Other axis I disorders may map out to different axis II disorders. The National Epidemiologic Survey on Alcoholism and Related Conditions, because of its large sample, could be mined for these clues about the relationship between specific axis I and II disorders.

The Research Domain Criteria project, in the long run, may offer more enlightenment for personality disorders if its goals can be achieved. The primary focus is on neural circuitry, with levels of analysis progressing from measures of circuitry function to clinically relevant variation or downward to the genetic and molecular cellular function (8). In the final analysis, the new molecular and neurobiological parameters will need to predict prognosis or treatment response. They will need to do as well as borderline personality disorder in predicting major depressive disorder persistence. If the Research Domain Criteria approach is successful, more than prediction of prognosis might be achieved, including a deeper understanding of the biological mechanism underlying the joined symptoms.

The epidemiologic finding that borderline personality disorder contributes to poor prognosis of major depressive disorder might be viewed as a hypothesis that can be translated into methods in the neurosciences to understand the mechanism behind this association. The features of borderline personality disorder, particularly the pervasive instability of the regulation of emotions and impulse control, would seem ripe for the Research Domain Criteria approach. When these symptoms occur in conjunction with major depressive disorder, a different syndrome may be present. Further experimental work may test how the symptoms of borderline personality disorder contribute to the prognosis of major depressive disorder. But what about the persistence of borderline personality disorder without major depressive disorder? Can the epidemiologic data provide any clues? In the meantime, the clinician treating major depressive disorder would be wise to assess for borderline personality disorder, even as currently defined.

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Don’t Defend: Should it be “Don’t Dexify?”

Bon Dobbs — Thu, 24 Mar 2011 18:23:40 +0000

In my book “When Hope is Not Enough”, I recommend to Non-BPD folks that they “Don’t Defend”. This advice has caused many a member of the ATSTP Goggle Group Support List to be concerned and to struggle with the idea of defending oneself against day-to-day accusations. Some times this “defending” is actually “justification or explaining”. Sometimes it is even done pro-actively – heading off criticism or misinterpretation ahead of time. Well, recently, a member of the group pointed us to a posting from Russell Bishop entitled “Why You Should Never Defend, Explain or Justify”. I think it captures the spirit and nature of my directive: Don’t Defend.

Here is the text of the article, as seen on the Huffington Post:

Russell Bishop Author, Consultant, Executive Coach
Posted: March 7, 2011 06:10 AM
Why You Should Never Defend, Explain or Justify

Why do some people seem to be forever defending, explaining or justifying themselves? Do you enjoy being around this person? Are you one yourself?

Quite the opposite from the critics who have been the subject of recent articles on complaints and criticism, this person becomes tiresome not because of a string of complaints, but more because of the somewhat toxic nature of self-defense.

Years ago, as the personal transformation wave was cresting via large group seminars, several of us started using a made-up word to highlight the toxic nature of self-defense and explanation: dexify. The word even seems to connote something toxic all by itself.

Certainly, someone who engages in dexification (there’s another use that may suggest something kind of dark) seems to be sliding down a spiraling path of negativity. What’s so negative about defending yourself, you might ask?

On the one hand, nothing really, especially if there’s something there to defend. However, I am not referring to the kind of self-defense you might need when wrongly accused of something, especially something heinous or criminal. However, there’s a difference between that kind of self-defense and the more common defend-explain-justify behavior that many of us seem to engage in almost daily.

To be fair, I know I have certainly done my fair share of dexification. The main problem in day-to-day life is that when you choose to dexify, you almost always sound guilty-as-charged. I know that when I find myself in justification mode, there’s almost always some part of me that feels insecure about the area, perhaps even wondering-fearing-believing that it must be true.

There may well be several moving parts here, but allow me to underscore a critical aspect that may be operative and why dexification is usually not all that helpful. The worst possible scenario might be that the criticism is accurate and I’m simply digging myself a deeper hole by dexifying.

Some time ago, I wrote an article on this subject, citing a lesson learned from Bucky Fuller about how we can benefit from our perceived enemies. The gist of the story: after a wonderful lecture on the value of seeking to understand and be understood, Bucky took questions from the audience. One gentleman took the microphone and proceeded to tell Bucky that he was full of beans, didn’t know what he was talking about, and had no basis for his point of view. Bucky considered the comment, and replied, “Thank you.”

After a couple of more rounds of this kind of exchange-attack, wherein the gentleman kept going after Bucky, trying to provoke a reaction, Bucky taught us all a great lesson in self-awareness by saying something like this:

Did you not notice that each time I paused to consider what you had to say? I looked inside myself to see if some part of me was reacting to what you had said about me, particularly if some part of me were upset, prone to counterattack, or otherwise affected. I have found that when I am in that kind of reaction, there is typically something there for me to learn about myself, something for which I need to improve. In this instance, I found no reaction. Thus, you were simply sharing your opinion to which you are fully entitled and with which I have no argument. Therefore, “Thank you” seemed most appropriate.
Indeed, Bucky Fuller demonstrated considerable self-awareness and personal integrity throughout his life, and this little exchange has been a guiding light for me for years. Learning to see the reaction inside myself as feedback about me, pointing out areas of growth, not something to be defended, has been both expansive and liberating for me.

I have learned that when I feel the need to dexify myself, some part of me is almost always of the opinion that they must be right and I must be wrong. The defending, explaining and justifying never seems to change anything and, instead, tends to anchor me more deeply in the issue that needs to be addressed.

If you recognize this tendency in yourself, here’s a little tip that I have found personally useful whenever I have the courage to use it. Courage, by the way, is an interesting word that typically means something about physical or mental strength or bravery. Its roots, however, go to the Latin and French words for “heart.” I have heard it said that the suffix of the word, “age,” means something like “wisdom.” If you put the two together, you get “the wisdom of the heart.”

The next time you find yourself under attack and are about to resort to dexification, consider the wisdom of your own heart. Look inside yourself to your own reactions. If, like Bucky, you find yourself in reaction mode, consider that there might be a kernel of truth here for you, perhaps an entire bushel-full. If there is something there, then draw a bit more on that source of heartfelt wisdom and dive into the question even further, perhaps saying something like, “That’s very interesting. Can you say some more about what you see or how you see this playing out in my behavior?”

I know that for many this seems somewhere between silly and incomprehensible. Why on earth would you invite even more criticism, especially in an area where you might already feel uncomfortable?

It’s simple, really. You just might learn something that will liberate you. You may find yourself growing in confidence and inner strength as you choose inquiry over dexification. You might also wind up closing a gap between you and the other person. After all, it does take great courage to step closer in the face of criticism, and your sincere inquiry may melt away something that prevents you from being even more effective.

***
Please leave a comment here or drop Russell an e-mail at Russell@russellbishop.com.

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Book Review: Overcoming Borderline Personality Disorder

Bon Dobbs — Wed, 23 Feb 2011 18:16:59 +0000

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Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change (Paperback)

By (author) Valerie Porr

List Price:	$24.95 USD
New From:	$15.03 In Stock
Used from:	$11.49 In Stock

Overcoming Borderline Personality Disorder by Valerie Porr is perhaps the most up-to-date and complete book for family members of people with BPD published to date. When I read the book, I couldn’t help but think that Ms. Porr had the therapists and mental health professional more in mind than the family members. It appears as though she is trying to dispel many myths about BPD that exist not only in the family environment but also in the mental health community. This book is steeped in scientific research, including research involving the biological under-pinnings of BPD. It includes many skills for family members from both DBT and mentalization based therapy (MBT). Clearly Ms. Porr is highly respected by the clinical community since many of the leading experts in research and practice in BPD treatment have written blurbs for this book. The book is quite dense and a must read for family members of those with BPD. Yet it might not be the best book to start with because of the complexity of the scientific research, the psychoeducational aspects and the technical details about the various therapies for those with BPD. Still, I highly recommend Overcoming Borderline Personality Disorder.

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Cleaned up links on ATSTP

Bon Dobbs — Sat, 23 Oct 2010 15:34:28 +0000

Hello all,

Today I cleaned up the links on ATSTP. I found that several of the links were dead and the directory links were linking out to spammy sites. I will have to check those more frequently. It’s been a while since I did a manual check of them. I think they are cleaner now. Enjoy!

A disturbing purchase from an ATSTP Link

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Shared my First Presentation on Slide Share

Bon Dobbs — Thu, 05 Aug 2010 18:57:40 +0000

I decided to share my video in slide form on slide share. Here is the 4 X 4 presentation that I used for the video on slide share.

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:

I am-mad emotional validation skill

View more presentations from bondobbs.

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An exercise in validation

Bon Dobbs — Fri, 16 Jul 2010 17:38:07 +0000

Validation (or emotional validation) is an extremely powerful tool when it comes to emotional situations. It is complex and multi-stepped and it takes a lot of practice to master. On my Internet list, I talk a great deal about validation because it is essential to managing a relationship with someone with BPD. If you learn to master validation, you can see a marked change in the way your loved one with BPD interacts with you.

Validation is a tool that verifies that the other person’s feelings are valid, but doesn’t necessarily condone or agree with their behavior. Remember, the behaviors come from feelings, beliefs and “action impulses” so they can be separated from behaviors. You are not “giving into” the person with BPD if you learn to validate their feelings. And, if you master validation, you might eventually receive validation back from your BP, which is a remarkable improvement over IAAHF (“it’s all about his/her feelings”). Don’t expect it right way, but after some time, it can happen.

With validation, you are basically saying, “Your feelings matter. It is OK to feel that way. It is normal to feel that way.” The way in which you validate someone else’s feelings is important. Many people believe that saying “It’s OK. I love you” or “You are safe with me” is a form of validation, but it is not. Those statements are about your attitudes toward the other person, not about his/her feelings. Validation is always about the OTHER person’s feelings, not about our own feelings. In some ways, this can get frustrating for us, because everything always seems to be about the other person’s feelings – and in the beginning, that is true. There are other tools that get your feelings on the table, but for now we need to focus on the other person’s feelings and how to validate them.

Validation is not giving advice. In fact, if you do give advice when the other person is emotional, they are likely to get angry with you. People don’t like to feel that they are being told what to do about an emotional situation – that is quite invalidating. It feels like you are telling them how they should feel and they can’t control the emotions.

This is where things get interesting. You see, I believe that since BPD is a very relationship-oriented disorder, changing the way in which you interact with the person with BPD will in turn change them. Mostly, the point is to make your life easier. If you learn and apply emotional tools, you will have less raging, less acting out and more peace in your life.

Exercise in validation

I sometimes like to assign homework assignments for my list members. I don’t do it very often, but I think it’s easy to learn from one another’s experience if you are all having a very similar experience. One of the exercises we worked on last year was one to help us learn the benefits of validating another person. My suggestion to the group was to make a validating statement to someone with whom you have a temporary interaction. This person could be a server at a restaurant, a clerk at the grocery store or an acquaintance at work. Here is an example conversation that I had with a co-worker who I knew by sight, but with whom had never really had a conversation on an elevator. She was about 8 months pregnant and it was the middle of the summer. She looked hot and stressed. I said that it must be frustrating and painful to be pregnant in the height of the summer. She immediately brightened up and talked to me about her feelings and her family.

My suggestion to you is that your emotionally validate someone in your life today. Test it out on someone with whom you have a passing contact. Remember validation is about their feelings, not about you. Just validate and listen and see what happens. If you don’t know how to validate, you can read all about it in When Hope is Not Enough.

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New Free Tool from ATSTP

Bon Dobbs — Tue, 13 Jul 2010 16:17:07 +0000

What should I do?

Today, I have uploaded a new free tool for you to use when making decisions. The purpose of the tool is to help you make more informed decisions and help to combat impulsiveness. The tool is a “decision matrix” where you can map out the advantages and disadvantages of doing something (or not doing it). Here is a link to the tool (instructions are on the second page of the tool):

ATSTP Decision Matrix Tool

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An exercise in being Non-judgmental

Bon Dobbs — Mon, 12 Jul 2010 21:10:52 +0000

I have been working on a second edition of When Hope is Not Enough, in which I am adding some exercises as well as some new tools and perspectives to make the book even more effective. One of the exercises is in learning how to be mindful of one’s judgmental attitudes. I often say that people with BPD are almost allergic to judgment. I find that this can be tracked back to shame which in turn can be tracked back to an unstable sense of self. Here is the first draft of the exercise:

One way to become non-judgmental is to become aware of your (often) unconscious and conditioned judgments. I often hear Non-BP’s say, “My BP is acting crazy” or some such. The labeling of anyone’s behavior as “crazy” is a judgmental label. The behavior that anyone does makes sense (even if it is emotional sense) to the person at the time they are doing those actions. Certainly, a person with BPD might perform certain actions that someone without BPD would find objectionable or “crazy.” However, because of a number of symptoms of BPD, especially shame and fear of judgment, labeling another person’s actions as invalid or crazy can undermine the trust that you are trying to build.

In this exercise, I would encourage you to take a specific time-frame – it could be an hour, two hours or a full day – and identify your judgments of other people’s actions, attitudes and interactions. In other words, if you find yourself thinking about another person (whether with BPD or not), “that person is an idiot,” that is a judgment and should be counted as one. Continue to practice this exercise such that you can become more aware of the judgments about others and about life that you make, even if those judgments are ingrained and unconscious. By making the unconscious biases conscious, you can more easily slip their grasps and become less judgmental of others, including your loved one with BPD.

Keep and mental or written tally of these judgments to see if, after time, the number of judgmental thoughts is reduced.

An exercise in validation

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Read my free eBook

Bon Dobbs — Wed, 30 Sep 2009 17:21:20 +0000

Here is one of my free eBooks (actually more of a free “white paper”). You can read it here from Scribd.

Read online by clicking on more…

Five Common Mistakes Made by Supporters of People with Borderline Personality Disorder BPD

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Trade Words and thinking about yourself differently

Bon Dobbs — Tue, 29 Sep 2009 15:36:02 +0000

Non-BPDs and self-image

I have starting thinking about the concept of “trade” words. What that means is that we nons “trade” certain words for other words. The purpose behind this is to re-make our ways of thinking – it helps to combat black-and-white thinking, shame and fear in ourselves. One of the concepts that I expound on in “When Hope is Not Enough” is the idea that one’s own language shapes one’s thoughts. While in that section of the book, I focus on the non-bp’s thoughts and words in relation to the person with BPD, here I am interested in how a non-BP thinks about his/herself.

Here are some examples of “trade” words and phrase that I have either discovered or developed:

Old Word: Must
Trade Word: Prefer, would like to

Old Word: Should
Trade Word: Choose to

(from now on the old word/phrase will appear first, the trade word next – just so I don’t have to type “Old Word:” “Trade Word:” over and over again…)

Can’t
Choose not to

Have to
Want to

Ought
Had better

All
Many or most

Always
Often or typically

Can’t stand
Don’t like

Awful
Undesirable

Bad Person
Bad Behavior

I am a failure
I failed at

Anxious
Concerned

Depressed
Sad

Angry
Annoyed or frustrated

Hurt
Disappointed

Guilt
Remorse about

Jealous
Concerned about the relationship

Never
Not often

is
seems like

is
feels like

I am certainly open to more suggestions. Here are some examples when thinking about yourself:

“I must do well” = “I want (or wish) to do well”
“I shouldn’t do that” = “I prefer not to do that”
“I am a bad person” = “I did a negative thing”
“I need love” = “I want love, but not need it to live”
“I can’t stand this” = “I don’t like this”
“I am a loser” = “I lost (or failed) at a task”

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The great tree of behavior modification

Bon Dobbs — Wed, 29 Jul 2009 17:50:13 +0000

Where are you on the tree?

When I talk to Nons, either in person or virtually, I find that they have the biggest problems with the behaviors of their loved ones with BPD. In When Hope is Not Enough, I outline a way to work on behavior modification and help the person with BPD change problem behaviors. The tool of reinforcement is number eight out of a tool of eleven tools. It rests on the foundation built through the application of other tools (mostly emotional ones) and attitudes presented in When Hope is Not Enough. In other words, behavior modification through reinforcement, which is usually called “shaping,” is not possible without first understanding, implementing and mastering the tools and attitudes presented before the eighth tool. That said, today I’d like to talk about another problem with using behavior modification techniques with someone with BPD: that problem is the scale at which many nons try to make the change. I have come up with a brief “model” that can help you figure out if you are operating at the right scale. This model uses a tree as a metaphor. The largest scale is presented first, with me gradually winnowing it down to the smallest and most effective scale.

In the sky:

She is selfish.
She is lazy.
She’s a chicken.
He’s a bully.
She’s a liar.
He’s too rigid.
He’s closed-minded.
She’s so dramatic.
She’s immature.
He always has to be right.

In the leaves:

Her up-bringing made her that way, so she can never change.
He doesn’t care about anyone.
She needs to be more rational and not freak out all the time.
She was spoiled by her dad.
She was abused.
He thinks he’s better than everyone else.
She doesn’t care about my feelings.

In the branches:

He lacks empathy.
She doesn’t know how to communicate.
He’s got to listen more.
She screws up all the time.
He doesn’t spend enough time with the kids.
He rages at me for nothing.
She needs to learn to cope.

On the trunk:

He needs to come home earlier.
She needs to learn how to do it herself.
He should be on time more.
She has to stop making so many commitments.
He has to be more polite to my friends.
She has to stop finishing things halfway through.
He has to be less critical of my family.

On the ground:

I’d like for him to spend Saturday afternoons with the kids.
I’d like for her to pay the phone bill.
I’d like for her to send a thank you note to my mother.
I’d like for him to say hello to my friend when she comes over.
I’d like for her to work on the kitchen project we agreed to do.
I’d like for him to arrive home at 6PM on Tuesdays.

What I have found is that many nons come to support forums with a basket full of problems at various scales along the tree. Some are character traits, some are psychological explanations, some are wide behavior patterns, etc. The problem with this approach is that a non can’t solve (or work with the BPD to solve) all the problems at once. Secondly, large, general problems are not solvable in a support forum. One has to solve, through behavior modification (and the use of the other tools in When Hope is Not Enough) specific problems with specific outcomes. Once you are at ground level, you can actually get something worked out, because if the specific positive behavior is observed, you can reinforce that specific behavior. That is the “one small step at a time” approach to behavioral change. It is the only one that actually works.

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Prices Rising on my eBooks

Bon Dobbs — Wed, 29 Jul 2009 16:44:51 +0000

All, because of the change in Google Checkout’s commission formula – I have to raise the price of my eBooks by $1.00. The cost of the eBook for When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder is now $7.00 (USD). The cost of But I Love You: a primer for understanding a loved one with Borderline Personality Disorder has risen to $5.00 (USD). The upside of this change is that now that Google Checkout has implemented digital-goods delivery, you can get your eBook moments after you order it!

Here are the new Google Checkout buttons for these two eBooks:

When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder ($7.00 USD)

But I Love You: a primer for understanding a loved one with Borderline Personality Disorder ($5.00 USD)

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New Free “White Paper”: 5 Common Mistakes by Non-BPs

Bon Dobbs — Tue, 21 Jul 2009 20:02:17 +0000

Today I completed a new “white paper” (a small eBook basically) that explains the five common mistakes made by supporters of people with Borderline Personality Disorder (BPD). It is available for download at no cost by clicking on the link below:

Five-common-mistakes-by-non-bpd

Enjoy and feel free to share with others.

Related posts: Read my free eBook Bon’s Free eBook Downloaded 6,000 Times Last Year Remission Common in BPD, but functioning still a problem

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It’s the emotions stupid

Bon Dobbs — Mon, 13 Jul 2009 18:09:12 +0000

In “When Hope is Not Enough” I quote renown Buddhist monk Thich Nhat Hanh about anger. Here is the quote:

Anger is an unpleasant feeling. It is like a blazing flame that burns up our self-control and causes us to say and do things that we regret later. When someone is angry, we can see clearly that he or she is abiding in hell. Anger and hatred are the materials from which hell is made. A mind without anger is cool, fresh and sane. The absence of anger is the basis of real happiness, the basis of love and compassion.

…

When we are angry, we are not usually inclined to return to ourselves. We want to think about the person who is making us angry, to think about his hateful aspects – his rudeness, dishonesty, cruelty, maliciousness, and so on. The more we think about him, listen to him, or look at him, the more our anger flares. His dishonesty and hatefulness may be real, imaginary, or exaggerated, but, in fact, the root of the problem is the anger itself, and we have to come back and look first of all inside ourselves. It is best if we do not listen to or look at the person who is the cause of our anger. Like a fireman, we have to pour water on the blaze first and not waste time looking for the one who set the house on fire..

The thing is that many people, when overcome with emotions, have a tendency to focus on the situation and causes of the anger (who set the fire) vs. the anger itself. This reason is why I try to refocus non-borderlines on the emotions, not the “offense.” People typically defend against the accusations, rather than focus on the anger. Many skills can be applied to cool the anger, but defending is not one of them. Defending just fuels the flames.

Putting out the fire of anger

Instead of defending, I encourage non-borderlines to use the I-AM-MAD communication skill. It’s been a while since I elaborated on that skill, so here it is in a nutshell:

I-AM-MAD

1. Identify the emotions.

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

Examples: “I see that you are frustrated.”

“You sound aggravated.”

“You look really upset.”

2. Ask a validating question. Immediately – combine with step 1 to be most effective.

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

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

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

“Want to talk about it?”

3. Make a validating statement about their emotion.

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

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

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

“Yeah, that’s really disappointing.”

4. Make a normalizing statement about their emotion.

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

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

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

“I can see why you feel that way.”

5. Analyze the consequences of their behavior.

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

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

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

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

6. Don’t solve the problem for them.

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

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

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

“Is there anything I can do to help?”

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

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What is your goal for your relationship?

Bon Dobbs — Tue, 16 Jun 2009 18:25:31 +0000

What is your goal?

I have recently made a realization about the other Non-BP writers and myself. I realized that our goals are completely different. When reading other books about being a loved one of a person with Borderline Personality Disorder (mainly those written by lay people, as opposed to professionals), I have found that essentially we fall into three categories. These categories are:

Those that are chiefly concerned with stopping the emotional abuse doled out by the person with BPD. This category is the largest of the three. Most books written about being a loved one of someone with BPD fall into this category. These books include: “Tears and Healing”, “Stop Walking on Eggshells”, “The Essential Family Guide”, “The Siren’s Song”, “Loving and Loathing”, “One Way Ticket to Kansas” and others. Typically these are written by ex-spouses as guides to getting out of emotionally abusive situations and protecting oneself from emotional abuse. Most of these have an emphasis on boundaries or limits, tough love and abusive dynamics (such as the victim-rescuer-perpetrator triangle or Stockholm Syndrome). If your goal is to stop the abuse directed at you from your loved one with BPD, I believe reading these books can help you do that; however, I don’t think you should expect to keep the relationship and, if you do keep the relationship, I wouldn’t expect that it would grow to be a close, loving relationship. The tools and techniques in these books will not help you build such a relationship with someone with BPD.

Those that are written by people who have recovered from BPD and wish to promote a better understanding of the disorder. These books include those by Rachel Reiland, A.J. Mahari, Tami Green and others. I find these books to be helpful for the intended purpose. It certainly helps a loved one understand what it feels like to have the disorder. However, I also find that many of these books are short on what a loved one can do to build a loving relationship with a person with BPD. These books are inspirational for people who want to recover from BPD, but I don’t feel they provide the complete picture when it comes to the loved ones.

Those that promote an effective, skillful path to building a loving relationship with someone with BPD. As far as I can tell, I am the only “lay person” in this category. There are some professional books, such as “New Hope for BPD,” which attempt to achieve this goal, but no other first-hand experience books that I have found other than my two books, “When Hope is Not Enough” and “But I Love You”. If your goal is staying with your loved one with BPD and building a loving, compassionate relationship, I think I am your only choice.

I implore you to consider your goals and choose your path accordingly.

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Walking on Eggshells Quiz

Bon Dobbs — Thu, 11 Jun 2009 19:08:33 +0000

A quiz to find out if you’re “walking on eggshells” around your partner:

The Walking on Eggshells Quiz

If you find that you are, and think that your partner has Borderline Personality Disorder traits. I suggest you check out the resources that I provide on this site – that is, if you want to stay with your partner and want to learn how to make things easier and better. “Stop Walking on Eggshells” is a great title for a book; however, the book itself will not teach you the skills necessary to stay in the relationship effectively. I have found that the skills in that book (commonly known as SWOE) actually breed resentment and further division in a partner relationship. I know because I tried those skills, and they made things much worse.

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Success and the Path to Effectiveness

Bon Dobbs — Wed, 20 May 2009 19:15:32 +0000

Path to Effectiveness

Over the past two days on the ATSTP Google Group, I have been happy to see some success exhibited. Many people on the Internet and on Internet email supports lists for Non-BPs will tell you that there is no hope of having a relationship with someone with BPD. Often I have seen that the only “advice” given to Nons is: RUN AWAY! Even on the “staying” sites and sub-sites, many people think that it will never get better EVER – which to me is a form of black-and-white thinking that Nons engage in.

While hope may not be enough, the BP/Non-BP partner relationship is not without hope at all. This week I received two messages from the ATSTP Google Group that gave me some hope. One was from a long-time member of the group (he’s been a member for about 2 years) and it goes like this:

I truly consider myself still part of the ATSTP community even tho I’m less deeply immersed in it now. And the reason I’m less deeply immersed now… is because I’ve learned the lessons I needed to and moved on. If this is my alma mater… consider it mission accomplished in preparing me for “college” or even the “job field” of succeeding with a BP. I arrived at grade-school level. I’m now at high-school-grad level… I recognize you, Bon, at the college-masters-instructor level. And I’m so grateful, that you have been here for me! So, thank you… keep up the spectacular work! You benefit not only your family, but so many of us out here in the world! You have made THE DIFFERENCE, in my life! I thank you profusely, and ask that you keep me ‘in the loop’ in areas which I might be able to help in or find interest in. Thanks SO MUCH, Bon! Thank you ATSTP! You’ve helped me learn and grow SO much!

It’s wonderful to hear that someone has truly benefited from the sharing, caring and skills teaching that go on at ATSTP. One success story (out of so many failures on other boards) really warms my heart.

Now as for the other message that I received – this one is from a “newbie” to the list. She joined on May 8th and has read my book “When Hope is Not Enough”. She just started applying the skills with her husband. Here’s her message:

This s#$t really works. (sorry to use that word but I wanted to express my excitement!) I used some validating words (the ones I could remember at the moment) and helped my husband calm down twice this weekend. I liked the results and am looking forward to finishing “When Hope is Not Enough”

So, here we have on person that is near the end of the path toward effectiveness and one that is at the very beginning. I’m just gratified that the methods that are provided in “When Hope is Not Enough,” on this blog and, most importantly, in the ATSTP Group are actually helping people get a handle on their relationship with their loved one with BPD.

Study Shows Success in Treatment for BPD

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A new book from Bon

Bon Dobbs — Mon, 11 May 2009 17:31:10 +0000

Today, I published a new book called “But I Love You: A Primer for Understanding a Loved One with Borderline Personality Disorder.” This book is a even quicker quick-start guide to BPD and being a Non-BP than my other book “When Hope is Not Enough.”

“When Hope is Not Enough” is 185 pages and packed with examples, conversations and frequently asked questions about BPD. “But I Love You” is only 50 pages and represents a distilling and reorganization of the material presented in “When Hope is Not Enough”. Basically, what happened was that one of my list members (of the ATSTP Google list) found that my first book was frustrating her. She has an adult daughter with BPD and found that she and her husband found the way in which I present a model of BPD in “When Hope…” was frustrating. The reason is that they wanted to know immediately about the behavior associated with BPD (such as lying, manipulation, running away, burning bridges, etc.) FIRST, rather than how I present it in “When Hope…” – where I present those symptoms LAST. I do that because I try and re-frame the Non’s understanding of BPD in “When Hope…” This approach just wasn’t working for the member of my list.

She decided to reorganize and summarize my work in “When Hope…” and did so without my prompting. She did so to help herself and her husband understand their adult daughter’s behaviors. So, she sent me a copy of her work and I edited it for accuracy, reformatted it and added some additional material that I didn’t put into “When Hope…”

The book is such a slim one (like I said 50 pages), that I don’t plan on selling it through Amazon or any other such retailer. Instead you can get either an electronic copy (for $4.00) or a printed copy ($9.95) from Lulu, which is who I use to self-publish my material. Soon, I will set up a google checkout for an electronic copy of this book, like I have with “When Hope is Not Enough” but first things first.

If you haven’t read “When Hope is Not Enough” and want a primer/orientation to how you can make your life calmer and easier with someone with BPD. You can try “But I Love You: a Primer for understanding a loved one with Borderline Personality Disorder” – and yes, it probably has a few typos, sorry. And yes, I’m sharing profits with the member.

But I Love You

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Article in Time about the DSM

Bon Dobbs — Sun, 22 Mar 2009 03:40:45 +0000

Here’s an article about the DSM…

Wednesday, Mar. 11, 2009

Redefining Crazy: Researchers Revise the DSM

By John Cloud

If you wanted to make a list of important books you should read, what would you choose? Anna Karenina, maybe? The Bible? How about the Diagnostic and Statistical Manual of Mental Disorders?

It may not be at the top of your list, but the DSM, as it’s usually called, is one of the most important books in the world. It attempts to categorize, describe and give a code number to literally every problem that can occur in your mind, from schizophrenia to borderline personality disorder to something called mathematics disorder, which is essentially being so bad at math that it amounts to a mental problem.

The DSM is important not only because it is wildly ambitious but also because mental-health professionals around the world have adopted its classification system. In the U.S., it is virtually impossible to get reimbursed by an insurance company for treatment unless a mental-health professional identifies your condition by a DSM code number. (The number for mathematics disorder, if you were wondering, is 315.1. The code for Tourette’s syndrome is 307.23; the code for sexual sadism is 302.84. As I said, the DSM tries to cover everything.) (See the top 10 medical breakthroughs of 2008.)

The American Psychiatric Association (APA), which owns the DSM, is in the process of rewriting the book, which was first published in 1952. The DSM-V, as the fifth edition will be called, is set to be published in 2012. But the process of researching it began way back in 1999 — five years after the publication of the last major revision, the DSM-IV — meaning the new book’s production will take 13 years overall. (Read about how we get labeled by the DSM.)

Why so long? Last week, a research organization called the American Psychopathological Association (which goes by the acronym APPA, to distinguish it from the APA) brought many of the key players in the development of the DSM-V to a conference in New York City to discuss some of the reasons the writing of the book is so complicated.

One obvious reason is that so many people have a stake in what the world defines as crazy and what it calls normal. Famously, homosexuality was listed as a DSM condition until a 1974 vote among APA members removed it. Other groups of mental-health professionals and patients want certain disorders to be added (and covered by insurance): sexual compulsivity, for instance, is not in the DSM, even though “sexual aversion disorder” (302.79) — the persistent and distressing avoidance of genital contact not explained by another disorder like depression — is included. (Read an interview with an author who has bipolar disorder.)

Debates about what should and shouldn’t be in the DSM are fascinating and often bitter, and as I have pointed out before, the book makes at least one fundamental error in the way it conceives of mental problems: it ignores causes almost entirely. If you feel sad and tired for a couple of months, have trouble sleeping and making decisions, and gain weight, you can be given a DSM diagnosis of depression (296.31 or 296.32, mild or moderate, recurrent) and prescribed drugs for it — even if the reason for your funk is that you just lost your job. Such physiological responses as insomnia are evolutionarily natural (and sometimes helpful, in a jump-starting sort of way) when you suffer a trauma like losing your job. But according to the DSM, only perfect is considered normal. Another basic problem with the DSM: it tries to reduce the vastly complex experiences of your mind to a single number.

At last week’s conference, there were tantalizing hints that the DSM-V might fix some of these problems. Dr. Steven Hyman, provost of Harvard, a former psychiatry professor at its medical school and a former director of the National Institute of Mental Health, agitated at the meeting for a new DSM framework that would stop trying to divide mental problems into discrete all-or-nothing categories. That method is appropriate for some medical problems — you either have leukemia or you don’t — but depression, for instance, doesn’t work like that. (Read “Why Do the Mentally Ill Die Younger?”)

Rather, Hyman argued that many mental illnesses are problems that lie along a continuum from normal and functioning to disordered and tragic. To the annoyance of some old-fashioned DSM defenders, he made the case that the DSM should regard mental illness as “continuous with normal”: less like leukemia and more like hypertension. You don’t get diagnosed with hypertension until you meet a cutoff point for high blood pressure that takes into account other extenuating factors: your age, for instance, or the conditions under which the blood-pressure reading is taken. Depression should be the same: if you are sad because you just got divorced, the DSM shouldn’t necessarily consider you to have an illness.

Such a diagnostic model wouldn’t be simple, though, which is one reason the DSM is taking 13 years to rewrite. And in the meantime, the book still has to be useful to everyday clinicians seeing patients who need a code number for insurance companies. “It’s like wondering how you repair the airport while the planes are still flying,” Hyman said at the conference.

Hyman noted that medical problems, whether in the mind or in the body or both, are usually caused by some combination of genes, environment, behavior and chance. Despite the comforting modern notion that severe psychological illnesses are simply due to an unfortunate genetic inheritance, it is the exceedingly rare mental condition that is caused only by genes. (Rett syndrome is one example.) Rather, if you take something like generalized anxiety disorder (300.02), there may be a variety of causes that set it off: genes that cause excessive activity in the fear-producing part of the brain called the amygdala, a stressful job that stimulates that activity, engaging in dumb behavior like having an affair that exacerbates your anxiety, then randomly getting into an anxiety-heightening situation like a car accident. The DSM has to try to account for all of that complexity — causes, effects, unintended consequences — and still be definitive.

Hyman said in an interview that one way the DSM currently handles this complexity is to have what he described as a “wastebasket” diagnosis — called “not otherwise specified” (NOS) — that captures just about anything that doesn’t easily fit the categorical model. One major problem with the NOS diagnosis: pretty much anyone can qualify for a diagnosis that, by definition, is not specified. A 2005 American Journal of Psychiatry paper found that nearly half of a group of 859 people who sought psychological help in Rhode Island could be considered to have a DSM personality disorder if diagnosticians were allowed to include the NOS option. Another problem: how do you adequately treat patients whose illness is unspecified?

A continuum model like the one Hyman proposes could help solve this problem by recognizing that people aren’t always one thing or another. They’re sometimes just a little depressed or a little anxious. To avoid medicalizing normal stress, the DSM-V would set a cutoff point within the spectrum. Of course, determining the right cutoff point for the DSM’s 350 illnesses would take an enormous research effort, one that has begun for some disorders like depression but probably hasn’t even been thought about for rare problems like sexual sadism.

Other attendees at the APPA conference indicated that the new DSM will almost certainly adopt a continuum model for mental illnesses. But don’t be surprised if the book doesn’t come out as scheduled in 2012. If the three-day conference came to any solid conclusion, it was that toting up all the ways our minds can fail is a lot harder than, say, explaining why your appendix might burst.

Read “Tallying Mental Illness’s Costs.”

Read “I’m O.K. You’re O.K. We’re Not O.K.”

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Ekman and Emotional Profiles

Bon Dobbs — Sun, 15 Mar 2009 21:37:03 +0000

I was reading the book “Emotional Awareness” which is a transcript of a conversation between the Dalai Lama and Dr. Paul Ekman (two of my favorites!). On pages 45-47, Ekman talks about the idea of “emotional profiles.” He says he has spent many decades of his career identifying the similarities between people in their emotional lives and now, through emotional profiles, is identifying differences in people’s emotional lives. I noticed when reading the book is that there are a number of factors that seem to affect a person’s emotional profile. Ekman says a bit about it, yet when I researched and thought about writing “When Hope is Not Enough” I found that there are five factors that affect someone’s emotional profile. Those are:

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.

A primer on Emotional Dysregulation and its role in Borderline Personality Disorder

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Mentalization and BPD

Bon Dobbs — Sun, 15 Mar 2009 18:40:42 +0000

I am learning mentalization and it shows great promise! Here is a link to Anthony Bateman’s website with info on this technique….

http://www.ucl.ac.uk/psychoanalysis/unit-staff/anthony.htm

Related posts: Mentalization Based Therapy Shows Promise with BPD How mentalization and attachment might explain “high-functioning” BPD Mentalization-Based Treatment Versus Structured Clinical Management for BPD

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Safety and Insecurity in BPD

Bon Dobbs — Sun, 15 Feb 2009 18:30:44 +0000

I have a list member who is a big fan of Al Turtle. Mr. Turtle (great name BTW) is a relationship consultant, not specifically dealing with BPD, but in relationships in general. What I found out through this list member is that Mr. Turtle and I came to the same conclusion about a certain experience. This experience is the “safe” and “unsafe” experience. While I deal with this on the BPD level, Mr. Turtle does so in general – and he calls the “lizard” of a person. The lizard is the emotional brain of an individual. Because it’s the primitive brain, it is lizard-like. I personally can’t go with the idea of the lizard – it’s just too cheesy for me. However, the idea of emotional safety is important to me. Mr. Turtle and I have come to the idea of safety versus insecurity to the same conclusion with different means. I have been considering this idea with respect to BPD. What I found was that, when feeling unsafe, a BP will be faced with four choices: run away, attack, submit or ruminate silently. What was pointed out to me was the opposite to the feeling of insecurity. That is the idea of safety. Most BP’s don’t feel safe most of the time… but sometimes they do. When they are feeling safe, they have four choices as well (thanks, Al Turtle and my list member!). Those choices are: mate, play, nurture and create.

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

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Tough Love Reconsidered with BPD

Bon Dobbs — Sun, 15 Feb 2009 16:13:05 +0000

Tough Love

Not too long ago I wrote an article on why tough love is not the answer for BPD. I still believe that ONLY tough love is not the answer; however, I have come to reconsider tough love and BPD.One of the reasons was that the TIME article said that DBT is a combination of emotional validation and tough love.

One of my list members has moved from the techniques that I provide in “When Hope is Not Enough” – which is basically a non-judgmental attitude plus validation and normalization – to a combination of those techniques plus “tough love.” What is tough love? In my opinion, tough love is the application of PERSONAL boundaries on a relationship. These personal boundaries need to be understood. Often, people don’t understand personal boundaries. Even popular books about BPD for Non-BPs (such as SWOE) get this concept wrong. In fact, even books that are ABOUT boundaries get this concept wrong. The other day I posted a link to a video of a part of the film “The Basketball Diaries” in which Jim Carroll’s mother (Jim Carroll is played by Leonardo DiCaprio BTW and the film is based on the book by Jim Carroll and is true) denies her son money for drugs (he is a heroin addict). She enforces her own boundary (I will not give my son money to buy drugs). She does not enforce a “rule” which is the way that someone tries to control the behavior of another person. Rules and boundaries differ significantly. With a rule, you try and control another person’s behavior – such as telling a child “you have to go to bed at 8:30 PM.” That is a rule, not a boundary, because it has to be enforced. Rules have to be enforced, boundaries do not (except on yourself).

Back to tough love… how does one use tough love with BPD? Well, first of all I have to say you can’t START with tough love, because first emotional trust has to be established. If you start with tough love and use ONLY tough love, that is a recipe for disaster with someone with BPD. The problem is that tough love hurts too much for them. They feel “different” and “broken” and tough love reinforces these feelings. However, tough love can be used once the trust is established. Tough love is something you can use FOR YOU to establish your own boundaries with someone with BPD. But you have to make sure that it’s your boundaries that are being applied and not rules for another person’s behavior.

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

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Kids of BPD – or kobies

Bon Dobbs — Fri, 09 Jan 2009 00:42:07 +0000

Recently, I noticed that one of my list members created kobies.org – which is a site dedicated to kids of Borderline Personality Disorder parents. My own kids represent part of this group. What I found was that his site was sending me about 3 times the traffic I was sending him. So, I wanted to highlight his site: www.kobies.org.

Enjoy! (ok, if you’re a kid of a BP you might not be enjoying, but hopefully it will help).

UPDATE: www.kobies.org seems to not longer be available. I don’t know why as of yet.

I haven’t bought/read it yet, but here’s a children’s book for kids with a BP mom

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Possible Genetic link in BPD?

Bon Dobbs — Mon, 22 Dec 2008 12:58:33 +0000

From Science Daily:

Possible Genetic Causes Of Borderline Personality Disorder Identified

ScienceDaily (Dec. 20, 2008) — According to the National Institute of Mental Health, borderline personality disorder (BPD) is more common than schizophrenia or bipolar disorder and is estimated to affect 2 percent of the population. In a new study, a University of Missouri researcher and Dutch team of research collaborators found that genetic material on chromosome nine was linked to BPD features, a disorder characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, and can lead to suicidal behavior, substance abuse and failed relationships.

“The results of this study hopefully will bring researchers closer to determining the genetic causes of BPD and may have important implications for treatment programs in the future,” said Timothy Trull, professor of psychology in the MU College of Arts and Science. “Localizing and identifying the genes that influence the development of BPD will not only be important for scientific purposes, but will also have clinical implications.”

In an ongoing study of the health and lifestyles of families with twins in the Netherlands, Trull and colleagues examined 711 pairs of siblings and 561 parents to identify the location of genetic traits that influences the manifestation of BPD. The researchers conducted a genetic linkage analysis of the families and identified chromosomal regions that could contain genes that influence the development of BPD. Trull found the strongest evidence for a genetic influence on BPD features on chromosome nine.

In a previous study, Trull and research colleagues examined data from 5,496 twins in the Netherlands, Belgium and Australia to assess the extent of genetic influence on the manifestation of BPD features. The research team found that 42 percent of variation in BPD features was attributable to genetic influences and 58 percent was attributable to environmental influences, and this was consistent across the three countries. In addition, Trull and colleagues found that there was no significant difference in heritability rates between men and women, and that young adults displayed more BPD features then older adults.

“We were able to provide precise estimates of the genetic influence on BPD features, test for differences between the sexes, and determine if our estimates were consistent across three different countries,” Trull said. “Our results suggest that genetic factors play a major role in individual differences of borderline personality disorder features in Western society.”

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Mindfulness for Anger

Bon Dobbs — Sat, 01 Nov 2008 15:19:50 +0000

Here is some quotes from a website that tells of anger and mindfulness:

All this material is from “Peace is Every Step” by Thich Nhat Hanh, a Vietnamese Buddhist monk who
is one of humanity’s greatest spiritual resources. He was, among other things, responsible for getting Martin Luther King to come out against the Vietnam War (a very controversial move for him at the time). King nominated him for the Nobel Peace Prize for his work (unfortunately futile) for peace in Vietnam. He is the author of *numerous* books, all of them lovely and wonderful, among them “Being Peace” and “The Miracle of Mindfulness”. Here’s some of what he has to say about anger:

“Anger is an unpleasant feeling. It is like a blazing flame
that burns up our self-control and causes us to say and do
things that we regret later. When someone is angry, we can see
clearly that he or she is abiding in hell. Anger and hatred
are the materials from which hell is made. A mind without
anger is cool, fresh and sane. The absence of anger is the
basis of real happiness, the basis of love and compassion.

When our anger is placed under the lamp of mindfulnes, it
immediately begins to lose some of its destructive nature. We
can say to ourselves, ‘Breathing in, I know that anger is in
me. Breathing out, I know that I am my anger.’ If we follow
our breathing closely while we identify and mindfully observe
our anger, it can no longer monopolize our consciousness.

Awareness can be called upon to be a companion for our
anger. Our awareness of our anger does not suppress it or
drive it out. It just looks after it. This is a very
important principle. Mindfulness is not a judge. it is more
like an older sister looking after and comforting her younger
sister in an affectionate and caring way. We can concentrate
on our breathing in order to maintain this mindfulness and
know ourselves fully.

When we are angry, we are not usually inclined to return to
ourselves. We want to think about the person who is making us
angry, to think about his hateful aspects – his rudeness,
dishonesty, cruelty, maliciousness, and so on. The more we
think about him, listen to him, or look at him, the more our
anger flares. His dishonesty and hatefulness may be real,
imaginary, or exaggerated, but, in fact, the root of the
problem is the anger itself, and we have to come back and look
first of all inside ourselves. It is best if we do not listen
to or look at the person who is the cause of our anger. Like
a fireman, we have to pour water on the blaze first and not
waste time looking for the one who set the house on fire…

When we are angry, our anger is our very self. To suppress
or chase it away is to suppress or chase away our self. When
we are joyful, we are the joy. When we are angry, we are the
anger. When anger is born in us, we can be aware that anger
is an energy in us, and we can accept that energy in order to
transform it into another kind of energy. When we have a
compost bin filled with organic material that is decomposing
and smelly, we know that we can transform the waste into
beautiful flowers… We need the insight and non-dual vision
of the organic gardener with respect to our anger. We need not
be afraid of it or reject it. We know that anger can be a
kind of compost, and that it is within its power to give birth
to something beautiful. We need anger the way an organic
gardener needs compost. If we know how to accept our anger, we
already have some peace and joy. Gradually we can transform
anger completely into peace, love and understanding.

Expressing anger is not always the best way to deal with
it. In expressing anger we might be practicing or rehearsing
it, and making it stronger in the depth of our consciousness.
Expressing anger to the person we are angry at can cause a lot
of damage.

Some of us may prefer to go into our room, lock the door,
and punch a pillow. We call this “getting in touch with our
anger”. But I don’t think this is getting in touch with our
anger at all. In fact, I don’t think it is even getting in
touch with our pillow. If we are really in touch with our
pillow, we know what a pillow is and we won’t hit it. Still,
this technique may work temporarily because while pounding the
pillow we expend a lot of energy and after a while we are
exhausted and we feel better. But the roots of the anger are
still intact, and if we go out and eat some nourishing food,
our energy will be renewed. If the seeds of our anger are
watered again, our anger will be reborn and we will have to
pound the pillow again…

…In order to have real transformation, we have to deal
with the roots of our anger – looking deeply into its causes.
If we don’t, the seeds of anger will grow again. If we
practice mindful living, planting new, healthy, wholesome
seeds, they will take care of our anger, and they may
transform it without our asking them to do so.”

So here is Thich Nhat Hanh’s anger meditation:

“When anger arises, we may wish to go outside to practice
walking meditation. The fresh air, green trees and plants will
help us greatly. We can practice like this:

Breathing in, I know that anger is here.
Breathing out, I know that the anger is in me.
Breathing in, I know that anger is unpleasant.
Breathing out, I know this feeling will pass.
Breathing in, I am calm.
Breathing out, I am strong enough to take care of this
anger.

To lessen the unpleasant feeling brought about by the anger,
we give our whole heart and mind to the practice of walking
meditation, combining our breath with our steps and giving
full attention to the contact between the soles of our feet
and the earth…After a while, our anger will subside and we
will feel stronger. Then we can begin to observe the anger
directly and try to understand it.

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Cheerleading as an effective relationship skill

Bon Dobbs — Wed, 22 Oct 2008 16:58:29 +0000

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

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

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

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

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

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

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

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

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

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

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

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

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I-AM-MAD communication skill

Bon Dobbs — Tue, 14 Oct 2008 15:46:44 +0000

I AM MAD Communication Skill

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

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

I-AM-MAD

1. Identify the emotions.

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

Examples: “I see that you are frustrated.”

“You sound aggravated.”

“You look really upset.”

2. Ask a validating question.

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

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

“Want to talk about it?”

3. Make a validating statement about their emotion.

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

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

“Yeah, that’s really disappointing.”

4. Make a normalizing statement about their emotion.

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

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

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

“I can see why you feel that way.”

5. Analyze the consequences of their behavior.

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

6. Don’t solve the problem for them.

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

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

“Is there anything I can do to help?”

I AM MAD PDF Version

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Congress Adds Mental Health Parity Act to Bailout

Bon Dobbs — Mon, 06 Oct 2008 14:16:22 +0000

From Bloomberg…

Mental Health Coverage Expanded by Rescue Package (Update2)
By Aliza Marcus

Oct. 3 (Bloomberg) — Health insurers that provide mental- health benefits will be barred from providing less coverage than they do for other medical services under the $700 billion financial-markets rescue package approved by Congress.

The plan was backed by a 263-171 vote in the House of Representatives today and signed by President George W. Bush. The package incorporates a measure requiring so-called mental health parity for health plans enrolling more than 50 employees.

“Aren’t we all pleased across America that this legislation includes the mental health parity act?” House Speaker Nancy Pelosi, a California Democrat, said in a speech before the vote.

The mental-health measure was among provisions added to the financial rescue package to win support after the House initially rejected the bailout legislation. The Senate, which supported the expansion of mental health coverage benefits in tax legislation passed last month, approved the revised financial rescue plan on Oct. 1.

“It seemed like it was getting lost after the bailout issue arose, but now with this bill it’s just happened,” said Steve Vetzner, spokesman for the Mental Health America advocacy group in Alexandria, Virginia. “This has been a long struggle and long fight.”

The act is intended to eliminate what supporters call unequal access to care from insurers that set higher co-payments and other limitations on services such as mental health counseling compared with physical ailments.

$3.4 Billion

The House and Senate previously disagreed about how to cover the cost to the federal government of the expanded benefit, estimated at $3.4 billion over five years by the Congressional Budget Office in 2007.

The estimate is related to tax revenue that would be lost because employers would pay more for health insurance premiums, to cover the expanded benefits, instead of turning over some of this money as taxable wages to employees.

Health insurers and businesses worked with Congress on the measure, which built up wide support from stakeholders in the health-care field, said Aetna Inc. Chief Executive Officer Ronald Williams in a statement on Business Wire.

“They had a deal for a long time,” said Kim Monk, an analyst at Capital Alpha Partners, in Washington, in a telephone interview. “The challenge was how to off-set the cost,”

Employers will now be looking for well-managed mental health networks to help them reduce costs associated with implementing the legislation, Monk said. “Not all insurers have this, so they may have to beef it up.”

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net

Last Updated: October 3, 2008 15:26 EDT

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Mental Health Parity

Bon Dobbs — Wed, 01 Oct 2008 16:19:56 +0000

This is an editorial from the NY Times…

October 1, 2008

Editorial

Oh So Close to Mental Health Parity

Congress is within a whisker of passing a sound and fair-minded bill to require that group health insurance coverage for mental illness and substance abuse be provided on the same terms as coverage for physical illnesses. It would be a shame if the legislation, which caps more than a decade of struggle to achieve mental health parity in insurance coverage, were allowed to die while Congressional energies are focused on the all-consuming economic crisis.

The bill would not require employers or health plans to cover mental illness or drug or alcohol abuse. But if they do, the treatment limits and financial requirements could be no more restrictive than those that apply to medical or surgical benefits. A 1996 law had required parity in setting annual and lifetime spending limits, but insurers found ways to circumvent it. The new bill closes loopholes by requiring parity in deductibles, co-payments and out-of-pocket expenses — and in setting treatment limitations, such as the maximum number of doctor visits and days of coverage allowed.

The bill is endorsed by President Bush, business groups, insurance companies, the medical community and mental health advocates. Both the House, in a stand-alone bill, and the Senate, as part of a broader tax relief bill, have approved it by large margins. But it requires a final shove because the measure is snarled in a broader legislative struggle over how to pay for tax revenues that would be reduced by this measure and others. Is there a statesman who can push this worthy parity legislation through to final passage before adjournment?

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Some resources on the web

Bon Dobbs — Wed, 17 Sep 2008 16:46:50 +0000

I have discovered some resources on the web that may help those with BPD (and those nons who are in a relationship with someone with BPD). These resources are:

Mass General Hospital Mood Charting (thanks to Tides…)

DBT Skills Help:

Emotional Regulation Skills… from dbtselfhelp.com … from Borderline Personality From the Inside Out

Mindfulness Skills… from dbtselfhelp.com

Distress Tolerance Skills… from dbtselfhelp.com

Interpersonal Effectiveness Skills… from dbtselfhelp.com

DBT Family Skills Training… from middle-path.org

You can gain access to more DBT resources, to other pertinent files, and to advice from me and other group members by joining the ATSTP (Anything to Stop the Pain) Google Email List.

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When Tools Become Triggers

Bon Dobbs — Thu, 07 Aug 2008 18:05:48 +0000

Why boundaries and detaching can make things worse….

I decided to write this post because I have seen many non-BPs frustrated over the fact that when they try to use the tools in certain books with their BP, the tools seem to cause more rage and emotional dysregulation. The two “tools” that I have found that cause the most problems are boundaries and detachment. I’ve already written a LOT about boundaries and where my view of boundaries diverges with some of the other “Non-BP authors.” Today, I’d like to turn to detachment.

“Stop Walking on Eggshells” recommends on page 98, that a Non-BP “detach with love” from a BP and BPD-like behavior. This concept was “borrowed” from Al-Anon as it is made clear in SWOE. I think that “detaching” (whether with or without love) works in some situations and blows up in the Non’s face in others.

What are the differences? In WHINE, I explain that the “engine” of BPD is emotional dysregulation (which is the opposite of regulation). A person with BPD will heat up more quickly and cool down more slowly than someone without the characteristic of emotional dysregulation. One study that I cite in WHINE deals with “neutral” reactions to someone who is dysregulated. The basic evolution of an (as “Tides” calls it on her blog) Emotionally Dysregulated Moment (or EDM) is trigger -> cognition -> emotion -> expression -> behavior. Emotions can spur on other emotions. Anger is IMO the most powerful of the basic emotions and it is easily triggered, especially when a person with BPD is feeling judged. Ok, now back to detachment. On page 39 of WHINE, I explain that:

One of the most interesting findings of a study in which scientists used functional magnetic resonance imagining (fMRI) to measure the emotional reaction (limbic system activation) of patients with BPD is that these people react to neutral faces in the same manner they react to angry faces. In essence, when shown a picture of a person with a neutral expression, people with BPD showed amygdala activation as if the picture was one of a person with an angry expression. These people expect judgment and anger in others towards them and react physically and mentally to neutral situations as if they are threatening. They are likely to find “meaning” that is judgmental or threatening in an event that others would see as meaningless. A member of my list compared this reactivity to neutral faces to neutral feedback on eBay. As a buyer on eBay, you don’t give neutral feedback to a seller when everything about the sale is perfect. You give [neutral] feedback when something is wrong. A person with BPD will interpret a neutral face as “something wrong.”

Emotional detachment from an EDM will trigger more emotional dysregulation within a person with BPD. Instead, an EDM is a time to engage someone with BPD and engage them on an emotional level. Otherwise, if you detach emotionally from the situation, the BP will interpret your “calmness” and detachment as judgment or criticism. Additionally, they will likely consider you untrustworthy to validate their emotional states. What I mean by this is that if they are feeling so much emotional pain that they are dysregulated what they are really trying to do (regardless of the content what they say) is to communicate that pain to you. If they’re “dying in pain” and you’re detaching and calm, they feel they can’t come to you with the problem. On page 95-96 of WHINE, I describe this situation as follows:

The purpose of someone coming to you in an emotionally dysregulated (or close to one) state is to communicate the emotions that she feels. She may have difficulty expressing these emotions and may use other means for expressing them such as blame, sobbing, cutting, raging or other behaviors that are difficult for you to deal with. The underlying point however is one of communication – she is trying to tell you something, but she doesn’t have the language for it. Therefore, if you respond to an emotional communication in either an invalidating fashion (using one of the many, many invalidating phrases above) or in a way that doesn’t match the emotional distress, the BP will feel unable to communicate. She will think “I’m going off the deep end here and you are so calm! You don’t understand anything! You’ll never understand me!”, and not trust you. The tenor of your voice is more effective if you express your emotional identification with emotion in your voice as well, but with slightly less emotion than the BP is feeling. In other words, express distress in the identification, but less emotion than if you are actually in distress yourself.

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A New Name for Borderline Personality Disorder (BPD)?

Bon Dobbs — Tue, 22 Jul 2008 18:52:12 +0000

There has been numerous articles and discussion in the therapeutic community about renaming BPD. Here is the text of an interview with Dr. Leland Heller about a new name and about his feelings about the current Borderline Personality Disorder Name (the emphasis in this article is mine):

A POSSIBLE NEW NAME FOR BORDERLINE PERSONALITY DISORDER

Many people would like to change the terminology of the “borderline personality disorder” to a new term that more accurately describes the illness. The term “BPD” in and of itself is as if the whole person (and the personality) is flawed, rather than looking at the BPD as a medical problem it actually is.

The term “borderline personality disorder” implies that there is no hope for treatment as many mental health professionals unfortunately still believe. There is thought that this illness borders on schizophrenia, thus the term “borderline.”

What then is borderline personality disorder? These questions have been posed to Dr. Leland Heller, expert in treating borderline personality disorder.

Q. What do you think about the term “borderline personality disorder”?

A. “I think it’s a horrible, insulting label for a real medical illness. The name alone reduces serious research, stigmatizes victims, and implies the person is crazy. It denies the medical nature of the process, and implies simply a personality problem.”

Q. Do you think “borderline personality disorder” is an accurate description?

A. “No I don’t. It implies a character problem. While I’ve encountered many people with a bad character who had the BPD, most borderlines I’ve treated (over 2100) do not have character problems. “Borderline” means patients live “at the border” between psychosis and reality. When borderlines are well treated medically, psychotic experiences are few and far between – and can be treated well. Borderlines don’t live at that border, they simply go into psychosis too easily under stress.”

Q. What is the BPD?

A. “The BPD is a medical problem, likely a form of epilepsy (brain cells firing inappropriately and out of control). The characteristic symptoms include inappropriate moodiness, chronic anger, emptiness, boredom, dysphoria (anxiety, rage, depression and despair) and psychosis. The other criteria are symptoms related to these medical problems.

ALL neurological disorders can have an effect on the personality, such as Parkinson’s disease which isn’t called the ‘shaking personality disorder.’ ”

Q. What does this term “Dyslimbia” mean?

“ ‘Dys’ means malfunction, and limbia meaning from the limbic system.

‘Dyslimbia’ is malfunction of the limbic system. While other neuropsychiatric disorders involve malfunction of the limbic system, the limbic system dysfunction is profound in the BPD. I chose Dyslimbia for my patients to take the stigma away. The BPD needs a new name, one that emphasizes healing not labeling.

I don’t care if it’s renamed ‘Dyslimbia’ or not, but a more honest, humane, and hopeful name needs to be made for this illness. Patients deserve to get medical attention for ‘Dyslimbia’ (or an equivalent name), rather than have doctors and therapists shun them because they are ‘borderlines.’”

I’d like to write more about the struggle for a new name… but one of the things to note is that most researchers in this area have recommended dropping the word “personality” from the name and reclassifying it Axis I. The most common and likely new name is “Emotional Regulation Disorder (ERD).”

Net BPD Myth Debunking from “Tides…”

Bon Dobbs — Mon, 21 Jul 2008 17:50:11 +0000

A few weeks ago I discovered the “Tides of Crazy Love Blog,” which is written by someone I “know” (meaning I know her via an email board). I LOVE her writing. I really do. Recently, she started “debunking” Internet myths and misunderstanding about BPD. More power to her! Here is an excerpt from her debunking the “Rules of Engagement” from BPD411.org (the first paragraph comes from BPD411.org):

“Rule #5: If at any time the Non figures out the Rules of Engagement for BPD Land, the BPD’er must change the situation, rewrite history, and thereby purchase the Non a one way ticket back to BPD Land.” (BON Note: this is excerpted from rules of engagement)”

[Oh, good grief! This rule is crazy-making to me! Sheesh! The author writes as if the BP has the ability to come up with some big elaborate plan to drink, steal, cheat and lie. I’m beginning to think this person was dealing with an NP or an anti-social-type, not a BP. (Or MAYBE she was an NP and was merely projecting her own inner motives behind why she feels BPs do what they do. BTW, I suspect that some nons do come out of BP relationships with many more narcisistic characterists than they went in with… especially when abuse is part of the history between them. This seems to be the case with my mother and my MIL, anyway.)

Again, BPs impulsively react during moments of dysregulation… initially in response to a feeling (anxiety or fear, oftentimes) and their behavior can escalate as a result of their thoughts when they believe someone has invalidated their feeling (judged/persecuted them.) Their instinctive (or possibly “learned” in abusive situations) nature is to please, they suffer incredible amounts of shame… therefore, why would they PLAN to be bad? The fact is, most never learned how to do this “planning” thing effectively, which is why they are so prone to total freak-outs. They don’t know what else to do at that moment to make themselves feel better. In addition, they sit around ruminating about their own mistakes so much, they don’t have time to come up with a plan for their own healing, much less a plan for anything else. They live in the moment.

Yes, that’s exactly it. I’d love to post “Tides…” complete debunking posts. They’re great. Check them out here:

http://thetidesofcrazylove.blogspot.com/2008/07/net-debunk-introduction.html

http://thetidesofcrazylove.blogspot.com/2008/07/net-debunk-rules-of-engagement-for-bpd.html

http://thetidesofcrazylove.blogspot.com/2008/07/net-debunk-rules-of-engagement-for-bpd_14.html

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Book Review of WHINE from “Tides of Crazy Love”

Bon Dobbs — Tue, 08 Jul 2008 16:02:50 +0000

Holding on to Hope

The author of this book, Bon Dobbs, is the founding leader of my online google support group – ATSPGroup. His wife has been diagnosed with BPD and his daughter struggles with emotional dysregulation similar to that of BPD.

When I found this group, I had just come away from the Welcome To Oz group known as WTO-Staying. I was tremendously discouraged (support-wise), because the folks there just didn’t seem to “get” this disorder… from my perspective as a suffer and as a non to my BPDH. There were a few informed folks who were seriously trying to explain the underlying fears and irrational thoughts behind BPD, but most of the nons couldn’t seem to get past their own hurts, fears and thoughts to learn the type of communication that is most effective with a BP. I knew immediately from reading Bon’s supportive responses to group members that he and I shared many of the same thoughts and opinions about the disorder… and about how non’s tend to become affected negatively by it over time, which inevitably contributes to the further erosion of the relationship.

“When Hope Is Note Enough” (WHINE) explains all this, and goes on to offer excellent and insightful tips on how to support the BP in your life without condoning the inapproprate behavior (projecting, blaming, intense anger, impulsiveness, etc.) or agreeing with the irrational thoughts you oftentimes find yourself subjected to by the BP in your life. It’s a very validating resource, especially for nons, that teaches you how to provide a validating environment in which your BP can finally heal without sacrificing your own values, beliefs and feelings.

I’ve been using the approach in this book (naturally… thanks to my own previous therapy) since the day I found out about hubby’s MH issues. It was challenging at first, as I had to view what I knew from a different perspective, but over the past 8 months, we have really begun to see an improvement in our relationship and in my hubby’s healing process. (I think my life updates in this blog will be a testament to that… once I get them all posted anyway, lol!) I was glad to see Bon write this book. Many times, I had considered doing the same, but unfortunately, I’m not organized enough in my mind to take on such a project… at least not at this point in my life. He did an superb job bringing it all together in a way readers can easily follow and implement! I highly recommend this book, not just to nons of BPs, but to anyone who is caught up in a high conflict relationship with someone they love.

Here is a nice book review I found of my book When Hope is Not Enough. I “know” this reviewer through my email list ATSTP. She is incredibly wise and knowledgeable about BPD and being a Non-BP. She should write her own book IMO.

Thanks! Hope you enjoy and can use the book (of course, sometimes “hope” is not enough – haha).

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What separates my book from SWOE and other popular Non-BP Books?

Bon Dobbs — Tue, 01 Jul 2008 21:46:25 +0000

What separates my book from SWOE and other popular Non-BP Books?

Well, first of all… I am still with my BP wife of almost 20 years. Many books (including “One way ticket to Kansas”, “Tears and Healing” and “Stop Walking on Eggshells”) are written by people who are no longer with their “BP’s.” I have found a way to live peacefully beside my BP (diagnosed BTW). Also, I actually tell you exactly HOW to talk with your BP, to effectively deal with someone with BPD – unlike these other books. I tell you exactly what to say and how to say it. I tell you how to get your feelings noticed and inserted into the conversation.

Try it… you’ll like it (or maybe you will not like it… It is not an easy road… believe me, I know) .

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Boundaries and their effective use

Bon Dobbs — Sat, 21 Jun 2008 21:35:19 +0000

Well, well, well… I don’t know why but apparently I continue to be a subject at WTO. Weird. I posted about this a few days ago. I’ve been out of touch with the blog for a few days, while I do family stuff and take care of my email list. I really admire the people on my list; they do a great job of being both honest and validating with one another – while at the same time providing constructive advice to one another.

Boundaries… I’ve posted about boundaries many times before. I think boundaries are one of the most misunderstood concepts in the non-BP/BP relationship. While it is difficult to be a parent of anyone (much less someone with BPD) and provide no guidance to your child – I mean, it is natural to want to provide some advice and guidance to children – boundaries in the sense that many people on the Internet understand them are not effective in an emotional situation. Now, WAIT! Actually boundaries ARE effective… OK, how can I say they aren’t effective and are effective at the same time?

The major problem with boundaries is that most of the Nons out there believe that boundaries are something to “control” or “moderate” their BP’s behavior. This concept is absolutely ineffective and untrue. Boundaries created for other people (whether they have BPD or not) are not effective – especially when the other person has a general fear of judgment like those with BPD. Those types of boundaries are not really boundaries at all – they are RULES for the behavior of another person. They will not work in emotional situations.

Boundaries that DO work are those you set for yourself with respect to other people’s behavior. In other words, boundaries that guide your OWN behavior are effective ones. If you say to someone, “I will not go to a restaurant with you if you are drunk” (for example), what you are really doing is setting a boundary that limits/affects your OWN behavior given certain conditions. That type of boundary is effective because you, as a non-BP, have complete control over it. You can choose NOT to do something given a set of conditions.

I would encourage you to examine what you ”boundaries” you have in place and see if they are rules for other people’s behaviors or if they are actual personal boundaries that manage your own behavior and reactions. If they are the former, I expect you will end up being frustrated quickly. If they are the later, then you can find some peace when they are applied to a given situation. This statement isn’t meant to imply that someone with BPD will automatically accept your application of personal boundaries (to yourself). No, they might rage at you or try and convince you to do otherwise (i.e. go to the restaurant even if they are drunk), but you are the master of your own behavior and you can always be firm and say, “No.”

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Follow the Yellow Click Road

Bon Dobbs — Mon, 16 Jun 2008 15:43:52 +0000

Apparently, someone over at Welcome to Oz (WTO) Internet list posted a message asking about me and what I am all about concerning BPD and Non-BPs. This lead to a huge spike in traffic with my average number of accesses basically doubling over the weekend. I’m still a member of WTO, so I decided to login and take a look at what people are saying about me over there. I haven’t posted in years and haven’t logged in in months.

Obviously, there are many, many new people who have no idea who I am or what I’m about. There are a few members still hanging around who do remember me. There are a couple of people who seem to have a pretty dim view of what I have to offer – although I think that those people don’t know me very well and have interacted with me only cursorily. First, today, I’d like to outline my philosophy about BPD and Non-BPs to clear up some of the mis-statements and mis-perceptions.

I do believe that BPD is a serious mental illness and not a case of a “behavioral disorder.” In other words, BPD is not merely a case of someone just behaving badly. I further believe that much of the core issue with someone with BPD is emotional and based on poor emotional regulation skills. The reaction to strong negative emotions (and other factors, like shame and impulsiveness) cause the “poor behavior.” I put that in quotes because the behavior has a function and the function IMO is to make the BP feel better. A person (whether they have BP or not) CAN learn to behave differently in the face of strong negative emotions. It takes practice and requires the acquisition of emotional skills. However, I also believe that the emotional under-pinnings are not going to disappear, just because the person with BPD learns to behave more effectively. Emotionally, they are just more sensitive than other people – that is the way they are. In other words, I don’t believe that I have a “cure” for BPD, which was bandied about at WTO.
I also believe that the only person that you can change in a relationship is yourself. It is my opinion that once you change your own approach to emotional situations, the person with whom you are having the relationship will react to the change in various ways. Sometimes they will have a fit. Sometimes they will appreciate the “new you.” And sometimes a complex combination of emotions will arise. My “methods” are a combination of emotional understanding (of your own emotions and of theirs), emotional validation (which is complex in itself), positive reinforcement and “inserting your (the Non’s) feelings” into the conversation. There are some other skills and sub-skills, but that’s a quick synopsis. IMO this complex combination of skills (which also require practice) will improve the relationship and make sure that you don’t “walk on eggshells” around the other person. Boundaries can help – however, boundaries are a subject unto themselves, and I find that most people don’t know what boundaries are and how to apply them properly.
There was some argument at WTO that my motives were suspect, because I am trying to make some money on what I have learned and practiced thus far. I think the operative word here is trying, because I don’t really make enough money to even operate this website at a break-even level. No, I’ve not made much money at all as a “professional Non-BP” (if that’s what I am). What I have been able to do is have an impact on the lives of many people. That is pretty satisfying in itself, and I will not pretend that I wouldn’t like to do it full-time. I certainly enjoy interacting with others in my situation and exchanging advice, strategies, knowledge, etc. more than my “day-job.” But it will be a long time (and probably never) before I will be able to do that. Besides, most of my support activity and knowledge-sharing I do for free – either here on in my Google Group. There’s no charge for participating in that group or to read these posts. At this point, any money I do make just contributes to the cost of operating this website.
I don’t think that BPs have to be “let off the hook” and that they have no responsibility when it comes to a relationship. I also don’t think that you, as a Non-BP, have to forgo your feelings to live alongside a person with BPD. Both of those ideas were suggested at WTO. Neither is true. I think everyone in a relationship will have emotions, reactions, expectations, etc. Everyone is allowed to have each of these. Everyone has certain responsibilities in a relationship as well. What I DO advocate is looking at the function behind behavior and understanding the dynamic that exists. Many times I’ve seen people suggest that my methods give the BP “undo advantage” in a relationship. Huh? I thought this was a “loved one?” I don’t think that “love is a battlefield.” It’s not us-agains- them. That is just more black-and-white thinking on the part of the Non. If you’re going through a bloody divorce with someone with BPD, I can certainly understand where this might come into play, but, as I have said, my methods are about “living with and loving” someone with BPD. There is responsibility on both sides of the fence. It takes a certain environment IMO to make sure that responsibility is acknowledged – and that environment has to be one that is validating, otherwise you’re going to be caught in a shame hurricane. Nothing will get accomplished.
Finally, I believe that effective emotional skills are helpful for anyone in any relationship. Anger, sadness, spite, resentment, blame, etc., etc. lead to a corrosive environment within any relationship. My “methods” attempt to reverse some of the corrosiveness and build stronger, healthier emotional relationships. You may not agree with my methods, which is fine. Personally, I’ve had to try everything to find anything that worked.

I guess it’s better to be talked about a little, whether it is positive or negative, than to be ignored. Thanks to a group member of mine who notified me of the discussion and who defended me (you know who you are).

Follow up on Substance Abuse

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I haven’t bought/read it yet, but here’s a children’s book for kids with a BP mom

Bon Dobbs — Tue, 10 Jun 2008 19:35:19 +0000

I stumbled across this children’s book, An Umbrella for Alex, which is a book for kids trying to understand mom’s BPD behavior. Like I said, I haven’t bought it or read it. Maybe one of you would like to and drop me a message as to how effective it is (or is not). I know my kids know when (as my daughter puts it) “mommy’s doing it” – which I know she means that mom is acting an an impulsive BPD-like fashion.

I’m a little wary of the book though. It comes from the Personality Disorder Awareness Network (PDAN) of which I have never heard. It would seem that in my travels around the BP-world that I would have come into contact with them in some shape or form. The other thing that puzzles me is that on their resources page they have several links about divorcing and leaving a person with BPD. I know this is a reality to many Non-BPs, I’m just not sure what the attitude of the above book is in that respect.

One positive thing is this statement on their “About PDAN” page:

Our mission is to encourage, sponsor, and financially support projects related to assisting those in relationships with individuals with BPD. We encourage an atmosphere of respect and compassion for those suffering with the illness, while acknowledging the emotional distress and impairment in everyday functioning of those individuals in relationships with someone with BPD.

I would agree with that, I suppose. Here is a book review of the book.

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The Myth of the High-Functioning Borderline

Bon Dobbs — Tue, 10 Jun 2008 14:40:51 +0000

UPDATE: see this link.

Today’s subject is the Myth of the High-Functioning Borderline. I have been scouring the research on BPD to find out if anyone in the research or therapeutic community uses this term or concept high-functioning versus low-functioning Borderline. I have yet to find any author in either the research community or therapeutic community reference this concept. It crops up in the support community (in “Stop Walking on Eggshells” and on both bpd411.org and bpdcentral.com). It also crops up in the “cross-over” community (see more later) but only in a sarcastic way. The idea of high vs. low-functioning BPD doesn’t seem to hold much weight in any other community than the support community.

What do I mean by referencing these “communities”? I think that there are basically three BPD/Non-BP “communities” out there: the research community, the support community and the therapeutic community.

The research community is comprised those scientists doing medical research (and psychological research) on BPD. They publish scholarly articles and research in medical and psychological journals. Some “supposed” psychological researchers publish in the less-well-known and scientifically suspect journals (see my article about “Demonic Possession and BPD” for an example of this type of researcher). For the most part, these researchers don’t try and “cure” BPD, they merely provide data to other professionals about the configuration of BPD, the biology of BPD and the “common” features of BPD. This group of people does not differentiate between high-functioning and low-functioning BPs. In fact I have found no reference to high- or low-functioning BPD at all in any of these research papers or reports.

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

The therapeutic community is those practitioners (mainly psychologists, psychiatrists, social workers, other “therapists” and consultants) that try and “cure” or remediate BPD in patients. Some (very few) also serve the families, friends, spouses, children, etc. (the Non-BPs). Their purpose in life is to help the BP overcome or to effectively manage their disorder. In this group of people, I have found no mention of high- or low-functioning BPs. The only “partial” mention is that of Dr. Paul Mason, who co-wrote “Stop Walking on Eggshells” with Randy Kreger. Several of these people within the therapeutic community have written popular books about BPD, including “Sometimes I Act Crazy,” “Lost in the Mirror,” “The Angry Heart,” and “I Hate You, Don’t Leave Me.” None of these books, as far as I can tell, refer to the idea of high-functioning vs. low-functioning BPD. Of course, Dr. Marsha Linehan and Dr. John Gunderson are prominent individuals within the therapeutic community. Their theories about BPD have a distinct influence on how therapy is conducted with people with BPD.

The final community is the support community. This community is comprised of ex-BPs, Non-BPs and others who provide advice about how to “deal with” BPD or with someone with BPD. This community includes myself, the authors of “Stop Walking on Eggshells,” the author of “Tears and Healing,” A. J. Mahari, the proprietors of bpd411.org and others. Only in this community have I seen any mention of high- vs. low-functioning BPD.

Some individual and organizations actually straddle the support/therapeutic (or even the research/therapeutic) community split. These include: myself (at least I hope so), TARA, A. J. Mahari and others. Some of these are more therapeutic (or at least psycho-educational) like TARA. I try and be both psycho-educational and to offer support resources to Non-BPs; yet, in doing so, also try and dispel the many, many myths about BPD (where possible).

The problem with assigning either high-functioning or low-functioning to a person with BPD is that the very nature of the disorder debunks these categories. BPD is chiefly an emotional disorder (with impulse control issues). Emotions are ever-changing, like waves that carry the mind along for the ride. Whether someone is high-functioning or low-functioning at any given time will be subject to their current emotional state. If a BP is emotionally dysregulated they will adapt to that (usually) painful state in whatever way that they have learned will assuage the pain. Some people with BPD will cut themselves, take drugs, avoid situations or behave in other ways that might be considered harmful to themselves or those around them. If a BP is not dysregulated, he/she has no need to behave in these ways. The core point is that BPD is about emotional instability and no person with BPD will be always high- or low-functioning. A person with BPD will swing – sometimes wildly – between several polar ways of feeling and behaving.

I suspect many “high-functioning” BPs do not have BPD at all. I have read many, many posts on Internet boards in which the “BP” in question clearly does not have the disorder. Many times, if you read carefully, you will find that these “high-functioning” BPs are diagnosed by their (usually) ex-wives, just because the “xBPh” (ex-husband with BPD) raged or was selfish during their relationship. BPD is more than raging – and as a Non just because you’re “walking on eggshells,” it doesn’t mean that your “BP” has the disorder at all. In fact, recently the list owner of WTO (the Welcome to Oz Internet list) asked the women Nons on the list if there husbands (or, more appropriately, ex-husbands) exhibited the symptoms of Narcissistic Personality Disorder (NPD). Every “Non-BP” that responded to that request confirmed that their “BP” met the criteria for NPD.

New! An eBook that can help you in your relationship with someone with Borderline Personality Disorder. Beyond Boundaries is the next step in the evolution of the Non-BPD/BPD relationship.

NPD (which IMO is more likely a disorder that appears to be “high-functioning ‘BPD’”) and BPD are distinctly different disorders. There may be a slight bit of overlap – deep, deep down within the psyche of the individual (and that is shame, most likely), but the basic configuration of the disorders are quite different. People with BPD do not like themselves, for whatever reason. People with NPD adore themselves, for whatever reason. That alone separates the two disorders. While people with BPD may exhibit “deserving” behavior (that they deserve love, riches or whatever), people with NPD believe that being “special” is their birthright and want to be surrounded by important or exclusive groups of people. The thing to note with BPD is that the “deserving” behavior is counter-balanced with “undeserving” behavior – polar opposite feelings and behavior that is the hallmark of BPD. So, it seems unlikely to me that “high-functioning” (or low-functioning) BPs can actually exist.

Let’s briefly look at the DSM-IV diagnostic criteria for BPD and NPD , and we can illustrate the differences. First, BPD:

Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called “splitting.”
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.

And now NPD:

has a grandiose sense of self-importance
is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
believes that he or she is “special” and unique
requires excessive admiration
has a sense of entitlement
is interpersonally exploitative
lacks empathy
is often envious of others or believes others are envious of him or her
shows arrogant, haughty behaviors or attitudes

Clearly, these two conditions are different. Some interpersonal aspects may seem similar (#8 in BPD and #6 and #7 in NPD); however, the emotional aspect of BPD (#6) is not present in NPD. There seems to me to be a split between self-hatred and the instability of self (in BPD), and self-importance and self-love (in NPD). I’m not sure this a gulf that can be bridged sensibly between the two disorders.

Why does it matter? Well, IMO it matters a lot, because the “prescription” that is effective for BPD is not the same prescription that works with NPD (or other variants on the Narcissistic spectrum). NPD is not a chiefly an emotional disorder, and emotional tools that are so effective with BPD will not be effective with someone with NPD. Now, you might say, “My ‘BP’ is diagnosed and he/she is always thinking about his/herself.” That may be true, yet, IMO, this type of “thinking” about oneself is really experiencing overwhelming negative emotions. It is difficult for anyone to think about anyone else when they are in deep emotional pain. As I have said in the past, I have coined (with the help of others) the term IAAHF (it’s all about his/her feelings) to help represent this state to Non-BPs.

Which brings me to my final point: self-diagnosis. It is dangerous to diagnose your loved one with BPD (or any other mental disorder). Only a trained and knowledgeable (and yes, I know, there are too few of these) professional can diagnose a person with any disorder. Assuming on your own that your loved one has BPD can be troubling for the relationship (at best) and damaging to their (and your) mental health (at worst). After reading a self-help book, such as “Stopping Walking on Eggshells” (SWOE), one has to be careful to diagnose someone else with the disorder. Even my book, “When Hope is Not Enough” (WHINE), can be used to “diagnose” your loved one with BPD, but I’d like to dissuade you from doing so. Instead, I would suggest you use the tools in my book (or, for that matter, SWOE) and see if they work. If my tools do not work, I suspect either you haven’t practiced enough (it takes time, believe me, it took me 2 years) or your loved one does not have an emotional disorder. I personally tried what I learned in SWOE for months before I realized that those “tools” were not effective in my life – which is why I bothered to write a book in the first place.

If you are tempted to introduce yourself to a support group with the statement, “I am married to a high-functioning BP…,” I’d suggest you take a step back and see if your loved one has the other signs of an emotional disorder (which BPD is and NPD is not).

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Saving yourself from Cognitive Distortions

Bon Dobbs — Tue, 10 Jun 2008 12:10:11 +0000

Some time ago I posted a list of Cognitive Distortions. I never posted the “antidotes” to these until now. Here they are:

1. Identify The Distortion: Write down your negative thoughts so you
can see which of the ten cognitive distortions you’re involved in. This
will make it easier to think about the problem in a more positive and
realistic way.

2. Examine The Evidence: Instead of assuming that your negative thought
is true, examine the actual evidence for it. For example, if you feel
that you never do anything right, you could list several things you
have done successfully.

3. The Double-Standard Method: Instead of putting yourself down in a
harsh, condemning way, talk to yourself in the same compassionate way
you would talk to a friend with a similar problem.

4. The Experimental Technique: Do an experiment to test the validity of
your negative thought. For example, if during an episode of panic, you
become terrified that you’re about to die of a heart attack, you could
jog or run up and down several flights of stairs. This will prove that
your heart is healthy and strong.

5. Thinking In Shades Of Grey: Although this method may sound drab, the
effects can be illuminating. Instead of thinking about your problems in
all-or-nothing extremes, evaluate things on a scale of 0 to 100. When
things don’t work out as well as you hoped, think about the experience
as a partial success rather than a complete failure. See what you can
learn from the situation.

6. The Survey Method: Ask people questions to find out if your thoughts
and attitudes are realistic. For example, if you feel that public
speaking anxiety is abnormal and shameful, ask several friends if they
ever felt nervous before they gave a talk.

7. Define Terms: When you label yourself ‘inferior’ or ‘a fool’ or ‘a
loser,’ ask, “What is the definition of ‘a fool’?” You will feel better
when you realize that there is no such thing as ‘a fool’ or ‘a loser.’

8. The Semantic Method: Simply substitute language that is less
colorful and emotionally loaded. This method is helpful for ‘should
statements.’ Instead of telling yourself, “I shouldn’t have made that
mistake,” you can say, “It would be better if I hadn’t made that
mistake.”

9. Re-attribution: Instead of automatically assuming that you are “bad”
and blaming yourself entirely for a problem, think about the many
factors that may have contributed to it. Focus on solving the problem
instead of using up all your energy blaming yourself and feeling
guilty.

10. Cost-Benefit Analysis: List the advantages and disadvantages of a
feeling (like getting angry when your plane is late), a negative
thought (like “No matter how hard I try, I always screw up”), or a
behavior pattern (like overeating and lying around in bed when you’re
depressed). You can also use the cost benefit analysis to modify a
self-defeating belief such as, “I must always try to be perfect.”

No related posts.

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Why did I bother to write a book?

Bon Dobbs — Thu, 29 May 2008 19:12:53 +0000

Interestingly, I have sold more downloaded books than print copies thus far. I have sold about twice as many of the downloaded version (at $7.50) than the print copy ($19.95). This is not something that I expected to happen.

I have been asked time and time again why I bothered to write a book. There are other books out there, including the best-selling Non-BP book “Stop Walking on Eggshells” (or SWOE). I read SWOE about 2 ½ years ago and found it lacking. The big problem with it for me was that the prescription for “taking back your life” wasn’t working in my life. The application of boundaries, for example, wasn’t effective. So, I sought out other resources that would be effective. I wrote my book “When Hope is Not Enough” for four main reasons:

Other books on the subject (most notably SWOE) didn’t work or tell me HOW to do things. I needed the know-how. My book tries to supply the know-how to “deal with” someone with BPD. I learned a lot from SWOE, but again, I wanted to know WHAT to do and HOW to do it.
Obviously, the money angle comes into play. I have wanted to quit my day job for a long time now, but I need the income to support my family. I’d like to do this “Non-BP” thing full time. I feel that the Non-BP’s are missing the support resources. While I do run the ATSTP email list to help support Non-BP’s, I didn’t feel like that was enough – plus, it doesn’t pay me anything. I am hoping that I will get better sales once the book makes it to Amazon. That should happen in about a month or so.
I wanted to collect all of my tools and skills in one place. Often, I have to re-educate newbies (and even some old timers) on my email list. I find myself going over the same old ground again and again – explaining the disorder, instructing on the proper use of boundaries and validation, etc., etc. It’s difficult for me to step back in time and put myself in the mind-set of someone who knows little about the disorder and what to do in the face of it. I wanted to create a compendium for the attitudes and tools that are effective when dealing with BPD. One of the key tools is, of course, emotional validation. I expect to write another eBook specifically on validation, what it is and how to do it properly. I explain it at length in my book, but there are many other concepts I have to explain before I explain validation. I think a dedicated eBook in which I explain in detail the validation process would help.
Finally, the members of my email list asked me to write the book. They were also looking for a single resource that collected all of the knowledge about dealing with highly emotional people in one place. I hope the book will function in this way.

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Why Hope is Not Enough

Bon Dobbs — Wed, 28 May 2008 17:53:53 +0000

A comment on the title of my book, When Hope is Not Enough. I’ve had several people say the book is perfectly titled and others say they don’t like the title. I decided to title it that because I believe that you need more than love to help someone with BPD and to help yourself. The problem with love is that saying “I love you” to someone with BPD can be invalidating. Saying “I’m proud of you” can be even more invalidating. And saying “You can do it” even more so. Let me explain.

Validation is about the other person’s emotions (the BP). It is not about you and your feelings. The statements of “I love you” or “I’m proud” of you are about you. A person with BP needs to learn that their emotions are normal and that everyone feels that way from time-to-time. If they feel weird or broken, healing cannot begin. In fact, the likelihood of poor (even suicidal) behavior follows those feelings. A simple of expression of your love for them could spiral into a session of self-hate. If you say, “I love you” in response to their poor self-image, a likely reaction (in their minds) is “then you’re stupid, because I don’t love me.” When someone feels like they are not able to cope, telling them they CAN cope breeds mistrust. In other words, if you express positive feelings or “positive mental attitude” statements, they are likely to not trust you, because, on the inside, they believe they CAN’T do it, and you’re not seeing their feelings for what they are.

So, love is NOT enough. What you need is skill. In the book I try to teach the skill (through attitudes and tools) necessary to start the healing – for the BP and for you.

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Mentalization Based Therapy Shows Promise with BPD

Bon Dobbs — Wed, 14 May 2008 19:07:29 +0000

Here’s an article on mentalization based therapy (MBT). A snip:

The study, “8-Year Follow-Up of Patients Treated for Borderline PersonalityDisorder: Mentalization-Based Treatment Versus Treatment as Usual,”is the latest analysis of a randomized trial first reportedin AJP in October 1999 and titled “Effectiveness of Partial Hospitalizationin the Treatment of Borderline Personality Disorder: A RandomizedControlled Trial.”

Joel Paris, M.D., an expert on BPD, explained that mentalizationtherapy, developed by Bateman and Fonagy in the 1990s, is basedon attachment theory and on observations that BPD patients havea failure of “mentalization”—the ability to observe theirown emotions and those of other people and to appreciate howtheir behavior may affect others.

“Mentalization-based therapy can be considered as an amalgamof psychodynamic and cognitive methods,” he told Psychiatric News.

For instance, a case report included in the study describesa 24-year-old woman who was referred from forensic servicesafter her arrest for setting fire to her university dormitory.

She had a history of recent suicide attempts and regularly burnedherself with cigarettes and a hot iron. In individual sessions,treatment initially focused on clarifying her own feelings andothers’ experience of her; later it progressed to helping herappreciate how her experiences of self-doubt and emotional turbulenceled to a sense of fragmentation that was controlled only byexperiences of intense physical pain, according to Bateman andFonagy.

“The individual therapist identified these processes while focusing onthe way she represented her own mental states and those of otherswith whom she interacted,” they wrote. “Gradually this was exploredwithin the relationship with the therapist.”

They report the patient as stating, “It never occurred to methat what I did had an effect on anyone else.”

I have to say the suicide figures are astounding, especially when it comes to attempts. I mean, over 80% in two of the categories!

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Why would you trust me?

Bon Dobbs — Wed, 14 May 2008 02:10:41 +0000

Lately, I have been considering this question. Why would you (the Non-BP) trust ME? I mean, I’m nobody, right? I’m not a therapist. I have written a how-to book for Nons. (like “Stop Walking on Eggshells” – great title BTW – and my book will appear soon too… haha). Who the heck am I? Right?

Well, I am a regular person who loves and lives with someone with Borderline Personality Disorder. I have been living with someone with the disorder for more than 15 years. A couple of years ago I decided to learn as much as I can about the disorder and abut what I could do as a loved one to make my life easier. I did read SWOE and the SWOE workbook. I started using the “tools” in SWOE immediately after I finished the book. (A quick note on SWOE. The co-author of that book doesn’t live with a BP, in fact she never had a relationship with a diagnosed BP. In the intro to SWOE she says she had to find out what was happening with a relationship that had just ended – with a man (I suppose) who was not officially diagnosed. Who would you believe more? Someone who has lived with a BP for fifteen+ years (like me) or someone who had a FORMER relationship with an undiagnosed BP? You can choose which person is more knowledgeable).

I also got on the Welcome to Oz (WTO) mailing list and started reading the advice of other Nons (although WTO is mainly a bitch session). Eventually, I started proving advice to others there. (If you are a member of WTO you can look up my archived posts). I met several people there who became my friends and walked with me on my quest to figure out what the heck was going on with our spouses, partners and children. After that I attended a DBT-FST (Dialectical Behavioral Therapy Family Skills Training) workshop.That taught me a lot. But ultimately, I had to find the techniques that worked for me.

I have found a combination of attitudes and tools that are generally effective in having a relationship with someone with BPD. It is difficult, but my life is much better than it was three years ago. So, why trust me? Because I have experimented and found some things that work.

Read my book, I implore you. It’s not just self-promotion – it’s tried and true knowledge. Sure, you can buy SWOE and read it – but I’d like to know AFTER you read it and try it – is it effective?

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CBT + Zen = DBT (a quick guide)

Bon Dobbs — Tue, 29 Apr 2008 15:38:14 +0000

Some time ago on when I was on the Welcome to Oz (WTO) Internet group, I started posting about the benefits of DBT (Dialectical Behavior Therapy) for treatment of Borderline Personality Disorder (BPD). I have since left that group and started my own (the ATSTP Google Group). However, at WTO the discussion turned to DBT and its effectiveness (or lack thereof). There is one member of WTO who came down against all behavioral therapies. He posted the following message as a follow up to a message about DBT:

DBT is a behavioral therapy.

The idea is to learn a new behavior by repeated conditioning.

“Fake it until you make it”

It can be effective…Pavlov showed that a lower species can
learn through behavior therapy.

The question is then…is there a better way?

My thought…learn what you need before seeking a product….then buyer beware.

My reaction to this message was complete disbelief. I can only suppose that this guy (who is a Christian BTW) doesn’t believe that humans are in the category of “lower species” (probably because they have a soul and are made in the image of God, as opposed to animals). Of course, his alternative (or “better way”) was his personal belief in Transactional Analysis (popularized by “I’m OK, You’re OK” in the 70s) and the “inner child vs. inner adult” dynamic. That is garbage and hasn’t been shown to be effective with BPD at all.

So, how does DBT work?

DBT is a behavioral therapy. It teaches skills to modify a person’s behavior. Basically, the client begins to behave in a fashion that is different that the behavior that they previously exhibited. The purpose is behavioral modification. The new behavior becomes reconditioned over the old behavior. There person become “retrained.” One of the main problem with BPD is poor/ineffective behavior. If the behavior can be modified, the results of the behavior will not exist. In other words, if you choose NOT to cut yourself, you will not have to go to the hospital and get stitches. Interestingly, I find that this “theory” follows the Buddhist idea of “dependent arising” – which governs “conditioned existence.” That idea is formulated as follows:

When this is, that is.
From the arising of this comes the arising of that.
When this isn’t, that isn’t.
From the cessation of this comes the cessation of that.

See this Wikipedia entry for more information.

DBT functions in four general areas:

Core Mindfulness
Distress Tolerance
Emotional Regulation
Interpersonal Effectiveness

One of the differences between DBT and CBT is that DBT emphasizes acceptance of certain things versus complete change. Why? Here is one explanation from Marsha Linehan in the interview with David Van Nuys on “Wise Counsel”:

Dr. Marsha: All right. DBT or Dialectical Behavior Therapy is an integration of two major approaches. The first approach is the approach of cognitive-behavioral therapy.

Dr. David: OK.

Dr. Marsha: So, it contains within that sort of standard cognitive-behavioral therapy or behavior therapy. As behavior therapy changes and improves, DBT changes right along with behavior therapy, cognitive-behavioral therapy and improve.

Dr. David: OK.

Dr. Marsha: Then it balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative primarily from contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients.

The acceptance end of the treatment is two-part. It’s a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it’s called “dialectical” is because it’s a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time.

Dr. David: Yes, when I first heard the term “dialectical, ” of course, I immediately thought of Hegel and Karl Marx and so I wasn’t quite sure of what the relationship was but they did talk about synthesis and antitheses and then the… Have I got that right?

Dr. Marsha: Yeah, it’s the theses…

Dr. David: Theses and antitheses.

Dr. Marsha: The antitheses and then the synthesis. The notion is, “everything contains within it its opposite, ” which really means that nothing exists really without an opposite of it. Even if you take something as mundane as a box, there couldn’t be a box if there wasn’t a non-box, a no-box, a not-box, because a box is very defined as it’s this so there’s obviously something that’s not a box.

Everything that exists has its opposite and Dialectics looks at the tension between; what exists and its opposite, or the theses and the antitheses or the opposite, and looks at the transaction between them, and that tension and that transaction which always brings about change.

Dr. David: In terms then of your therapeutic work and your therapy model, what are those two poles of tension?

Dr. Marsha: Oh, there are many. There are many, many, many poles. One of the most fundamental poles is that within every unwise act, there is some inherent wisdom. Taking heroin, which is long term, a dysfunctional, destructive behavior in our culture. Within there, is the wisdom of, “You feel better immediately.” So there is dysfunction and function always coexisting together.

The tension is finding the synthesis of; “Are there other ways for example?” or “How to radically accept that if one’s in great pain, getting out of pain is reasonable” while at the same time accepting that if one is in great pain, getting out of great pain by doing something that will continue to pain in the future is not reasonable. You’re always looking for a synthesis, where is a point that without rejecting the other side.

Here is another explanation of why acceptance was inserted into DBT by Marsha Linehan:

Dialectical Behavior Therapy represents an integration of two traditions: the behavior and cognitive-behavioral therapy tradition which is focused on developing technologies of change, and the mindfulness tradition that comes out of various spiritual practices including Zen Buddhism and contemplative Christian practices. At the start of her career, Dr. Linehan set out to develop a treatment for chronically suicidal patients and found that many of them were so overwhelmed by significant problems that it was not possible to address them all. Instead of focusing solely on how patients could change, what was required was also to help patients to better tolerate their circumstances. She was familiar with Christian contemplative spiritual practices that emphasized surrender to God, but sought out alternative teachers (e.g., a Zen Buddhist and a Benedictine Monk) who could teach her a “technology of acceptance” that would be more free of particular religious overtones. After taking several months to immerse herself in acceptance practices, she began the task of translating them into a language that behaviorists could accept and DBT was born. Though at first she thought the therapy was for suicidal people, in 1980 when the diagnosis of Borderline Personality Disorder was added to the DSM, she realized that it was really a therapy made for treating BPD and similar sorts of issues.

So, through applying behavioral change (from CBT) and acceptance (from Buddhist practice) DBT effectively treats BPD (and similar sorts of issues).

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Self-destructive friends — what to do? (from CNN)

Bon Dobbs — Thu, 21 Feb 2008 18:44:38 +0000

Self-destructive friends — what to do? (from CNN)

By Elizabeth Bougerol

(LifeWire) — When Theresa heard her friend was getting married, her heart sank.

“I told her I thought it was a mistake,” says Theresa. “So she kicked me out of her wedding party. We didn’t speak for six months.”

And the happy couple?

“Within a year, her husband left her for another man,” said Theresa, who asked that her full name not be used.

For Theresa, a medical receptionist in the Adirondacks, this was one more incident that followed a familiar pattern: Her friend picks the wrong man, and Theresa is left to pick up the pieces.

The final straw came when Theresa’s friend gave a different boyfriend power of attorney even though Theresa begged her not to.

“I just felt powerless,” says Theresa.

Such hard-to-control impulses cause behavior that is not only self-destructive but prompts frustration and anger among friends and family trying to lend a hand.

Roots of self-destructive behavior

“Nobody wants to watch someone they love hurt themselves,” says Angela Wurtzel, a psychotherapist in Santa Barbara, California, specializing in “hunger diseases” like eating disorders, self-injury and compulsive shopping.

But in almost all cases, she warns, trying to help will backfire.

What a well-intentioned friend may see as a clear-cut problem with an obvious solution — an anorexic should eat more, for example, or a compulsive shopper should cut up the credit card — is something far more complex.

“These compulsions serve a purpose as a self-soothing or coping mechanism for deep psychological pain,” Wurtzel says.

This helps to explain the individual’s resistance to change — which frustrates those who try to intervene.

“Friends feel powerless because they are,” Wurtzel says. “These compulsions have roots in issues that have taken a lifetime to develop.”

“A friend can offer support, but finding the reasons behind the behavior, and breaking down resistance? That’s a therapist’s job,” Wurtzel says.

Setting boundaries

When the friend you’re trying to help can’t let go, should you?

“I had to,” says Michael, whose attempts to help a friend spiraling out of control after her mother’s death were thwarted repeatedly.

“It started with drinking and drugs, then she quit her job, canceled her cell phone, just dropped off the map — like an animal that goes off to die,” says the IT technician living outside of Washington, DC.

Michael, who asked that his full name not be used, said he wanted to help “but in my experience, helping someone who’s not ready pushes them away — and makes you worse, because nothing you do makes a difference.”

Michael’s friend ultimately sought professional help, but they’re no longer close. Theresa has lessened contact with her friend.

“I miss our friendship,” says Theresa. “But I don’t miss the teary 3 a.m. phone calls.”

Helping for the wrong reasons

Despite good intentions, some helpers may be overly invested in fixing friends who can’t seem to fix themselves.

“I definitely attract needy people,” says Theresa. “When I was able to help (the friend), it felt good — but that became harder and harder, and she’d blame me for letting her down.”

“It’s much easier to focus on another’s problems than to acknowledge our own,” says Wurtzel, who works with patients who repeatedly seek out helper-helpee relationships. “And this can become its own compulsion, recreating a familiar dynamic that’s just as self-destructive for the helper.”

“If you’re compelled to intervene in these situations, ask yourself what you’re getting out of it,” Wurtzel says.

Finding a balance

According to Wurtzel, the key to helping a self-destructive friend lies in a delicate balance of compassion and boundaries. She offers advice for lending a hand while preserving the friendship — and your sanity:

• Set expectations, but don’t make demands. “An adult relationship is based on expectations, standards and values, with compassion for differences,” Wurtzel says. “Demanding the other do things for you and the relationship creates a power struggle.”

• Make the other feel heard. “People with self-destructive tendencies expect others to be angry with and abandon them,” says Wurtzel. “You can validate their difficulties without condoning the behavior.”

• Understand your powerlessness. “If you feel powerless in the situation, it’s because you are,” Wurtzel says. “The battle of self-destructive behavior is within the person, between them and them.”

• Resist the rescue impulse. If someone’s always swooping in to save the day, the self-destructive person has no reason take care of themselves. “Lay out your expectations for the relationship, for what you’re willing to do and what you expect them to do,” Wurtzel says. “It creates the impetus to change.”

• Set boundaries — not for the self-destructive person but for yourself. “Otherwise the relationship becomes unequal, unhelpful and destructive to both people,” Wurtzel says.

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PUVAS and DBT Skills

Bon Dobbs — Mon, 03 Dec 2007 19:58:14 +0000

PUVAS is an acronym that comes from “Stop Walking on Eggshells” it means:

Pay attention
Understand fully
Validate emotions
Assert yourself
Shift responsibility where it belongs

Paying attention to what is being helps us avoid making assumptions.

Understanding what someone is trying to communicate may require seeking clarification so we don’t make assumptions.

Validating the emotional statements of the other person will pave the way for further smooth communications.

Asserting yourself is a form of setting boundaries and is a very important piece of the healthy communication process.

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

Basically, it is similiar to a combination of DEAR MAN and the GIVE skills from DBT. DEAR MAN is extremely helpful for have a conversation with someone who is emotional and to prevent from engaging your emotions yourself. DEAR MAN is:

DEAR (what to do):

Describe – describe the situation WITHOUT being judgmental. Just say what happened without making value judgments of the meaning of what happened or the intentions of the other person.

Express – express how you feel about it with an emotional word (such as sad, glad, mad or scared). Do not judge with this statement either.

Assert – assert what you’d like to happen in the future in this situation – what will not trigger the emotion you expressed.

Reinforce – reinforce means to back up the other person’s statement that moves toward what you wish. If the person says, “I’m sorry. I will try and not do that in the future.” You say, “I would really appreciate that. I don’t like feeling [whatever]. That would make me much happier.”

MAN (how to do it):

Mindfully – this is the “pay attention” part. You should be totally in the conversation and listen to the responses. However, you should ignore statements that are not addressing the issue at hand. You can also repeat your points agina until the other person fully understands what you are saying.

Appear Confident – even if you don’t feel confident discussing the point, you should appear confident. This prevents the other person from attacking or playing on your vulnerabilities.

Negiotiate – in cases where a “middle ground” makes sense, being willing to negiotiate is helpful because no one comes out the total “winner” or “loser”.

The GIVE skills are this:

Be Gentle – don’t attack.

Act Interested – listen carefully to what the other person says and the needs expressed.

Validate – use emotionally validation skills to “soften the blow”.

Easy Manner – use an easy manner and do not dominate the conversation.

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