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

The Emotionally Sensitive Person (ESP)

Bon Dobbs — Tue, 10 Jan 2012 21:49:43 +0000

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

The Emotionally Sensitive Person

By Karyn Hall, PhD

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

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

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

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

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

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

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

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

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From neurology to psychiatry

Bon Dobbs — Mon, 09 Jan 2012 19:28:35 +0000

Your emotional state has powerful control over your body — and Kim Bullock, MD, knows just how strong that hold can be. The Stanford psychiatrist works with patients who experience seizures that aren’t generated from the electrical brain storms of epilepsy, but instead are driven by their own psychological turmoil.

From neurology to psychiatry: Bullock probes mysterious seizures

January 9th, 2012 in Psychology & Psychiatry

As a medical student in the early 1990s in Washington, D.C., Bullock volunteered to help the mentally ill homeless population. “It was the best education of my life,” she said. “I saw how much suffering they experienced and yet how much support and community they also provided each other.” But it wasn’t until she was about to interview for a neurology residency at Stanford in 1995 that she realized her true passion was psychiatry.

“When I was in medical school I really thought I was going to be a neurologist, but in the middle of my interviews, I changed my mind,” she said. She realized she wouldn’t be able to interact with the sort of people she was fascinated with in D.C. or use the wisdom she had gained in those years if she went into neurology. So she quickly changed her application at the last minute and interviewed for a position in psychiatry. “It just felt like the right thing to do and things fell into place,” she said. “That must be evidence of the unconscious, that at the last minute I changed my mind. Another part of me knew the right direction.”

Bullock, now a clinical associate professor of psychiatry, also had deeper, personal motivations for wanting to study psychiatric disease. She grew up in the Bay Area in a family troubled by addictions. “I didn’t understand why my own family would behave in certain ways and would make such foolish choices, and that made me curious about mental illness,” said Bullock. “I wanted to understand it and have some keys for possibly fixing this kind of behavior.”

Bullock now studies another type of involuntary behavior called psychogenic non-epileptic seizures. The condition resembles epilepsy, but is not accompanied by the electrical brain wave abnormalities measured in epileptic patients. Instead, the seizures are an involuntary response to physical, emotional or social distress. The mysterious nature of these seizures and their “orphan” position between neurology and psychiatry appealed to Bullock.

The problem can manifest itself in convulsions, loss of consciousness or paralysis of a limb. It’s a disabling affliction, and patients, the majority of whom are female, are often unable to work or even drive. Although these seizures affect as many as one in 100,000 people — a rate as high as multiple sclerosis — there’s a lack of awareness in the public and the medical community, little knowledge of the physical pathways that cause them, and no standardized treatment.

Bullock had her first significant exposure to the disorder as a psychiatry resident at Stanford Hospital, where she assisted with several studies led by John Barry, MD, a professor of psychiatry and behavioral sciences. Bullock and Barry looked at the frequency of past trauma among people with psychogenic non-epileptic seizures and whether group therapy could be an effective treatment.

But as her career was taking off, Bullock grappled with a tough question. Could she take time off from her psychiatry residency to have kids? The answer, it turned out, was yes. In fact, she took two breaks from her residency to raise her two now-teenage children. “It was kind of scary because you assume most programs won’t let you back in,” said Bullock, but she added that if you ask for things, they often work out. Now, back in the clinic, Bullock continues to look for ways to treat psychogenic seizures.

Patients diagnosed with psychogenic non-epileptic seizures often receive incorrect diagnoses and treatment, said Bullock. It takes an average of seven years before patients are properly diagnosed. Typically, Bullock said, people suffering from the psychogenic seizures are first sent to neurologists who specialize in epileptic seizures. About one third of patients in epilepsy monitoring units at Stanford and hospitals across the country will eventually be diagnosed with non-epileptic seizures, but some patients take ineffective epilepsy medication for years.

Many of these patients have problems with their emotions, which can be either too extreme or too blunted. “Some patients are so shut down they don’t display emotions, are unaware of them, or have emotions all over the map that they can’t control,” said Bullock, “so we teach them skills for handling both problems.” Basic interpersonal skills such as how to appropriately ask for things or say no to requests can also be difficult for these patients, who face obstacles due to their disability, gender or other personal circumstances.

Often, psychogenic seizure patients feel they have no voice. “For example, a woman in an unhappy marriage may display these symptoms as a way to indicate that something is wrong,” said Bullock. “It can be as if their true feelings are expressed through their bodies instead of through their emotions,” she said. “In a sense the body is speaking for them.”

Other patients don’t know how to regulate their emotions, so “when they get really mad they have seizures and their bodies just go offline,” said Bullock. Still others need to address deeply buried effects of childhood trauma to end the debilitating seizures.

“Our hypothesis is that there’s something in the limbic system that is dysregulated,” Bullock said. The limbic system comprises the functionally and anatomically connected brain structures that regulate responses like emotion and behavior. There may be a biological vulnerability and a stressful environment that come together in a perfect storm, creating mental turbulence.

Figuring out the exact physical cause of the disease will be difficult because of such heterogeneity.

Nonetheless, these patients can often be cured, a fact that has Bullock hooked. “It’s so rewarding once they get control over this debilitating disease,” she said. “They get their lives back on track and go into remission. Sometimes, all it takes are simple changes, like ensuring patients sleep eight hours a day or take restful breaks at work. For others, it may be a longer journey facing some of their traumatic memories from the past and gaining new meaning from their life story. To help patients improve, Bullock thinks cognitive behavioral therapy may be the key, specifically a form called dialectical behavior therapy.

Because this kind of therapy has been effective at treating borderline personality disorder, a known emotional dysregulation problem, Bullock suspects it could also help psychogenic seizure patients. She is leading a study on how these patients respond to dialectical behavior group therapy, a type of cognitive behavioral therapy that aims to teach patients skills to better tolerate stress, regulate their emotions and improve interpersonal relationships. She hopes to one day lead a randomized controlled trial to evaluate the effectiveness of this form of therapy for treating the seizures.

Bullock draws upon her experiences of balancing career and family life — from negotiating the terms of her medical training, to the experience gained from raising two kids — to her work with patients. “In my own life I’ve had to struggle with how to ask for things and be assertive. Given your gender, career, and role in society, it can be difficult to navigate all that,” she said. “I drift in and out of enlightenment daily, but by teaching these skills I’m reiterating them to myself and making sense of my own personal challenges.”

Research is not part of the usual duties of clinician-educators like Bullock, who typically see patients and help educate medical trainees. She had to be persistent to get permission to conduct her own studies.

“I think more clinician-educators should get involved in research because we are right at the front lines, with a huge amount of observational data,” she said. “It dovetails nicely into clinical work and may be more meaningful when done by those involved in clinical care.”

Provided by Stanford University Medical Center

“From neurology to psychiatry: Bullock probes mysterious seizures.” January 9th, 2012. http://medicalxpress.com/news/2012-01-neurology-psychiatry-bullock-probes-mysterious.html

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A therapy that helps to rebuild broken lives- DBT

Bon Dobbs — Tue, 27 Dec 2011 17:46:05 +0000

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

A therapy that helps to rebuild broken lives

SHEILA WAYMAN

Tue, Dec 27, 2011

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Name has been changed
© 2011 The Irish Times

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CBT worksheets and Evaluating Meaning

Bon Dobbs — Fri, 23 Dec 2011 20:06:28 +0000

On the BPD Cafe page on Face Book, the owner of the page posted a link to downloadable versions of various CBT worksheets, including some from REBT and DBT. These are really nice to have. There are a lot of them, so I joined the SugarSynch page that allows me to download them en masse. One note about that: if you do that, you’re going to have to “un-select” one of the documents, which appears to be stuck in “synching” mode. The document that is stuck is called PsychosisSelfHelp.pdf. Also, if you want ALL the documents, you have to scroll down to the bottom of the list to make them all load.

Anyway, I was reviewing a document about the general principles of CBT (called SelfHelpCourse.pdf), and it outlines an important point about events, thoughts and emotions. I have pointed out in several articles and in my book about the behavioral chain:

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

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

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

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The important difference between lying and bullshitting

Bon Dobbs — Fri, 16 Dec 2011 19:57:55 +0000

An ATSTP List member explains the difference between lying and bullshitting as being about intent:

I think the distinction between lying and bullshitting is an attempt
to clarify the intent of the person engaged in the act.

According to my interpretation Harry Frankfurt’s essay, “On
Bullshit” (http://athens.indymedia.org/local/webcast/uploads/
frankfurt__harry_-_on_bullshit.pdf), lying is a conscious effort to
misrepresent reality, whereas bullshitting is a conscious effort to
misrepresent the person doing the bullshitting. So the purpose of
bullshitting is to make the bullshitter seem like a different sort of
person than they actually are, or to misrepresent their own mental
state. Lying, in contrast, has as its primary goal to deceive another
person about reality.

So, if I am bullshitting you, my goal is to make you see me
differently. If I lie to you, my goal is to make you see reality
differently.

This distinction is important in the context of interacting with loved
ones. For example, my wife has told me a false story about her past,
including her educational background, her past career, and the
untimely end of her career due to an accident. None of it is true. Is
she lying to me? No, because her primary goal is not to have me
believe something that is not real. Her primary goal is to have me
see HER differently–as somebody with an extraordinary history and a
tragic accident. By the way, her goal is not just to have ME see her
differently. She has told others this story, for the same purpose. She
may even tell HERSELF this story, in order to construct an image of
herself that is more emotionally tolerable for her (though this is
pure speculation on my part).

So you can see that distinguishing between lying and bullshitting is
not just semantics. It is critical for understanding intent, and
intent matters. Intent makes all the difference. It can help clarify
the difference between a sociopath and a human being in pain. My wife
is trying to make herself feel better, not trying (as her primary
goal) to mess with my head.

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Willingness vs Willfulness

Bon Dobbs — Thu, 15 Dec 2011 18:15:42 +0000

In DBT, in the distress tolerance module, there is a concept of willingness versus willfulness. I find this concept particularly important and akin to the being right (willfulness) vs being effective (willingness) concept. Here is some information about willingness versus willfulness:

WILLINGNESS

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

WILLFULNESS

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

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

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

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Family Dynamics Around the Holiday Table

Bon Dobbs — Thu, 08 Dec 2011 17:08:51 +0000

The Holidays can be a time of stress

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

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

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

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

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

Radical Acceptance

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

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

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

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

Cope Ahead

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

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

One of these six may work:

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

Use Your Wise Mind

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

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

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

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

– Bradley W. Bloom, LCSW
Silver Hill Hospital

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

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

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Amy Winehouse and BPD

Bon Dobbs — Tue, 06 Dec 2011 16:19:55 +0000

One of my twitter followers posted the original Daily Star article about Amy Winehouse and Borderline Personality Disorder (BPD). Of course, I’d had Amy on my Celebrities with Possible BPD list for many years. If you want to read all of my articles about Amy Winehouse click here. I have no idea why the title includes ‘Mental Illness’ in quotes. Maybe it was because they were quoting the relative or maybe it brings up the question as to whether BPD is an actual mental illness. Here is the text of the article (and my comments below):

TRAGIC AMY WINEHOUSE HAD ‘MENTAL ILLNESS’

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

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

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

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

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

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

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

He said: “She never stopped trying.

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

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

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

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

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Research on Temper Tantrums

Bon Dobbs — Mon, 05 Dec 2011 19:18:48 +0000

Children’s temper tantrums are widely seen as many things: the cause of profound helplessness among parents; a source of dread for airline passengers stuck next to a young family; a nightmare for teachers. But until recently, they had not been considered a legitimate subject for science.

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

Read the entire story or hear the audio

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

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

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

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New guidance for management of self-harm issued

Bon Dobbs — Thu, 01 Dec 2011 15:49:12 +0000

The healthcare guidance body NICE has today published a new clinical guideline on the longer-term care of adults, children and young people who self-harm.

New guidance for management of self-harm issued

23 Nov 2011

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

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

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

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

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

Key recommendations include:

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

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

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

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

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

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

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I’m going to jump – Suicide Prevention and influencing factors

Bon Dobbs — Tue, 22 Nov 2011 21:20:24 +0000

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

I’m gonna jump (link)

THE DOCTOR SAYS
By Dr MILTON LUM

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

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

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

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

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

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

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

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

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

Risk factors

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

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

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

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

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

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

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

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

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

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

Danger signs

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

Other warning signs include:

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

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

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

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

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

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

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

Preventing suicide

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

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

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

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

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

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

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

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

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

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

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

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

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

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Ask Bon: Why does this person blame me for everything?

Bon Dobbs — Fri, 21 Oct 2011 13:05:07 +0000

You might notice that when dealing with someone with BPD, everything that he/she feels and everything that goes wrong seems to be your fault. You probably feel blamed for many, many things including things over which you have no control.

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

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

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

Adapted from When Hope is Not Enough

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Ask Bon: Why does my loved one with BPD do such dangerous things? (like cutting, drugs, etc.)

Bon Dobbs — Thu, 20 Oct 2011 17:49:46 +0000

People with BPD are in a great deal of emotional pain. Since emotions are immediate and primal, emotional pain is also immediate and primal. As I have said, emotions represent a land-bridge between the body and the mind. Emotional pain manifests itself in both mental and physical ways. If you have ever been depressed or “fraught with grief” over the loss of something or someone important to you, you will know what I am saying in this regard.

Depression and grief can be a trying experience for anyone. You feel pain in every area of your body and mind. Sometimes you will just want to retreat to your bedroom and go to sleep for hours, just to get some relief from the physical and mental anguish you feel. The sleep represents a distraction of both the mind and the body from the experience of complete pain. You might also use alcohol to relieve the pain by “turning off your mind.” Many people “drink themselves into a stupor” and, in doing so, extinguish the pain for a short period. Pain-killers, whether over-the-counter or prescription, can also remove pain by working on the pain at its source (in the brain where pain is actually felt). Once, when I was asked by one of my daughters about how the Tylenol knew to go to her foot (which was in pain), rather than to her head (because she’d taken it for headaches before), I explained that it acts in the brain where she feels the pain, not where the pain actually “is.” In the case of emotional pain, the pain seems to be both in the body and in the mind, but the pain-feeling area of the brain is where these drugs act. See below about substance abuse.

People with BPD are likely to feel emotional pain many times a day every day. Since these emotions are basic (like fear, sadness and anger) the reactions to them are both physical and mental. These emotional pain-states are powerful and have the ability to overpower rational thinking. When you are in pain, regardless of the source, the main reaction of the body and mind is to get out of or to relieve the pain as soon as possible and by whatever means necessary. I used the example of someone who is literally on fire. This person will try to douse the flames in any way, without thinking about the people around her and what harm may come to others if the flames spread. This situation is analogous to a person in deep emotional pain. The person will do anything to stop the pain, which is why my Internet site and Internet list are called “anything to stop the pain” (ATSTP). This “anything” includes self-destructive and relationship-damaging behaviors.

Self-injury

Self-injury can come in many forms and includes cutting oneself with razors or knives, burning oneself with cigarettes or matches, pulling out clumps of hair and picking at oneself (especially the nails and/or cheek) until blood is produced. Self-injury is one of the most difficult behaviors for the loved one to understand. In the case of BPD, self-injury is done for the purpose of pain relief, not to “get attention” or to manipulate the loved one. Most self-injury is done in private and done without the knowledge of the loved one. Occasionally, the self-injury cannot be covered-up (i.e. the blood and/or scars are apparent or the hair is missing in large area of the head) and others notice the activities. The actions themselves are fraught with shame and may lead to even more shame for the person.

In the hospital, ER doctors take a dim view of those who injure themselves and a person who engages in self-injury often avoid hospitals to avoid the inevitable judgment and lack of compassion these doctors (and nurses) will exhibit toward her. What is important for a loved one to understand is that self-injury has a purpose and that purpose is usually pain relief, not self-punishment or attention-getting. The person who engages in this behavior may feel and describe a deep “itch” inside her body that she has to rid herself of immediately.

While self-injury can provide relief from pain (through the release of endorphins, or natural, pain-killing substances within the brain), it can have risks and negative consequences. These include embarrassment, scars, infection and, in some cases, death.

Substance Abuse

As stated above, many people use alcohol and/or drugs to dampen the effects of emotional pain. With BPD, it is likely that alcohol and/or drugs will be used for this purpose. Drugs and alcohol CAN function to reduce pain. However, this pain reduction is temporary. What I have noticed from the ATSTP group is that people with severe BPD are likely to use large quantities of alcohol and/or drugs to deaden their pain. Some estimates of substance abuse by people with BPD are as high as 75%.

Many people with BPD use and abuse alcohol and drugs. Often, they will ingest large quantities (more than someone without BPD could handle) and not overdose or even pass out. They may take both prescription drugs with anti-anxiety medication, such as Xanax, Ativan and Klonopin (and others); painkillers, such as Oxycotin, Vicodin or Codeine (and others); or they may take illicit drugs, such as Marijuana, Cocaine, Heroin, or Methamphetamine (and others). The purpose, again, is to remove emotional pain. Unfortunately, these substances, especially in the quantities consumed, can have several negative effects and consequences, including overdose, driving violations and an increase in impulsivity or dyscontrol. These periods of impulsivity and dyscontrol and the behaviors that result (such as “risk-taking behavior” below) may cause more shame and self-punishment when the BP sobers up.

Risk-taking Behavior

People with BPD also engage in risk-taking behaviors of various forms. These behaviors include risky sexual behaviors, reckless driving and thrill-seeking behaviors. Many of these activities could be considered life-threatening either in the short term (by having a car accident) or in the long term (by contracting HIV or another fatal sexually transmitted disease). The people with BPD will, at the time of the risk-taking behavior, most likely not consider the consequences to life and limb – either physical or legal. Again, the purpose is to halt and/or deaden the emotional pain. In other words: “it seemed like a good idea at the time.” Sexual activities can provide pleasure, dangerous driving can provide a thrill and other risky behaviors, like hanging out of windows or jumping off cliffs into lakes, can provide a rush of adrenaline that temporarily removes the emotional pain. The point is for you, the loved one, to understand that the motivation of these behaviors, however short-sighted and ill-conceived you think they are, is to remove pain.

One member of the ATSTP group reported that her husband had totaled four cars in a period of eight years. These behaviors are impulsive and therefore not “thought through.” They are another method to “put out the fire” within the person. Certainly, these behaviors can have significant consequences, physical, legal, financial and otherwise.

Eating Disorders

Another behavior that many people with BPD engage in (particularly females) is eating disorders. Whether it is starving oneself or binging-and-purging or overeating (especially secret overeating), the eating disorder is another tool someone with BPD can use to alleviate emotional pain.

Again, eating disorders can have negative consequences including starvation, ill-health, poor self-image and obesity.

Other Binge Behavior

Other binge behaviors (or indulgent/irresponsible behaviors) are binge shopping, obsessive plastic surgery and “running away” through binge travel. These behaviors provide temporary relief from emotional pain as well. And again, they can have negative consequences by damaging a relationship or financial consequences.

On a final note on dangerous behaviors: it is important to prioritize when you are trying to help the BP halt or alter their behavior. You will want to start with the most dangerous first. If your daughter with BPD is having unprotected sex and smoking marijuana, regardless of your feelings about drugs, the unprotected sex will have to come first. Also, you need to be practical about it. Giving her condoms and saying, “I can see how buying these or asking your boyfriend to wear one might be embarrassing to you” rather than insisting she no longer see the boy is probably more effective, again regardless of your feelings about premarital sex. Once the genie is out of the bottle, it is difficult to stuff it back in. You can, however, help make it safer and you do so by being effective. Of course, you also have to be brave in this situation. It can be very difficult for a parent to talk to a child about sex.

Adapted from When Hope is Not Enough

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Ask Bon: How do I get my loved one with BPD to go to therapy?

Bon Dobbs — Mon, 17 Oct 2011 18:08:52 +0000

This question often is the first question that my group is asked. Many family members of those with BPD believe that therapy is the answer. And for some with BPD therapy CAN be the answer. However, there are some complications when it comes to therapy and borderline personality disorder. They are:

Sending someone to therapy is not like having your car repaired. It involves a lot of hard work on the part of the patient/client and on the part of their loved ones and supporters.
Therapy as usual (referred to as TAU in the studies) can actually make BPD worse in some individuals. There are several BPD-specific therapies, such as DBT, Schema-focused therapy and Mentalization-based therapy.
Therapy requires the buy-in of the patient/client. If he/she doesn’t want to admit he/she has a problem or doesn’t trust the therapist with his/her feelings, therapy will likely not have a lasting effect.

Unfortunately, you can’t force someone to go to therapy if she doesn’t want to go (except through a court order). What I suggest is that you use the tools I offer for a while. After you do that for some time, the borderline might begin to gather some self-awareness or to share her inner thoughts and feelings with you. It is likely that these thoughts and feelings will be filled with shame, self-hatred and worry. At that point, you can say something like, “Boy, it must feel awful to feel that way about yourself. What do you think you can do to feel better?” or “That’s so painful to feel that way. Maybe therapy can help?”

My wife has resisted going to DBT because it identifies her as a borderline and she “doesn’t want to be that person.” She also resists because DBT seems like a therapy of last resort to her and, if she fails at it, she feels that she will have to be committed to a mental institution. I occasionally do reinforce to her that there are people who are trained to help her feel better and encourage her to look into it. She is in therapy, but not in DBT. My daughter does see a DBT therapist. She decided to go because she was so angry all the time, and she felt terrible. She wanted to learn how to feel better. At some point, her emotional pain reached an intolerable level.

I have tried to model these skills in my life and, by doing so, shown my wife that I can more adequately cope with emotional situations, both personal and interpersonal. This modeling encourages my wife to consider DBT (or another emotional training program) to help her feel better. My suggestion is that you practice effective tools, master them and use your mastery over emotional situations as a beacon for your borderline’s healing.

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Ask Bon: Why does my borderline rage at me?

Bon Dobbs — Mon, 26 Sep 2011 18:24:00 +0000

Rage burns and burns

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

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

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

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

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

Adapted from the FAQ from When Hope is Not Enough

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Emotions and Borderline Personality Disorder

Bon Dobbs — Wed, 07 Sep 2011 20:34:38 +0000

Emotions, understanding the enimga of BPD

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

A threat or not?

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

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

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

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

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

Emotion	Reflex
Fear	Run away
Anger	Attack
Joy	Rejoice, laugh, smile
Disgust	Turn away
Contempt	Judge Others
Surprise	Jump back
Sadness	Cry and withdrawal

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

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

Adapted from “Beyond Boundaries” by Bon Dobbs

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Understanding Borderline Personality Disorder from WHYY

Bon Dobbs — Fri, 19 Aug 2011 14:16:29 +0000

By her own admission, Talya Lewis was a strange child – as early as kindergarten:

Lewis: Like I remember one day I came in with white sticky tape wrapped all around my arm, and I told everyone that it was a cast and I had broken my arm.

Desperate for attention, she convinced her mother she couldn’t see, and got prescription glasses. By age 8 – her behaviors were self-destructive:

Lewis: I had a game, and I called it TP, and TP actually stood for taking pills. I would rummage in my parents’ medicine chest and I would take their pills.

This was only the beginning. Over the next years, Talya knocked her front teeth out with a hammer, started taking drugs, cutting herself, her behavior out of control in school. Her parents, whom she describes as distant socialites, didn’t seem to notice. But then came the wake up call.

Lewis: I overdosed on a bottle of sleeping pills in my high school, in the front lobby, and that was the beginning of what ended up years of long-term confinements in a private psychiatric hospital.

Talya was diagnosed with Borderline Personality Disorder, or BPD. Philadelphia therapist Edie Mannion describes it as a severe and complex mental illness with many symptoms:

Mannion: Difficulty regulating emotion, like a broken emotional thermostat, and difficulty controlling impulses, and what I see as mostly a profound amount of emotional pain.

For people with this disorder, small problems explode into catastrophes, friends become enemies, love turns to hate – often with breath-taking speed. Relationships crumble, jobs rarely last. And their families are along for the ride. Camille Myers describes life with her daughter, who is in her 30s and has BPD.

Myers: You know, at times, she doesn’t want to live, she hates me at times, her world falls apart, at times she’ll walk into a room with my friends and family, and havoc breaks loose.

Myers says relationship with her daughter is an exhausting roller-coaster.

Edie Mannion says the disorder has a bad rap among therapists, and many of the are reluctant to work with those who suffer from it:

Mannion: People were taught that people who have this are manipulative, and split people, and all of these kinds of stereotypes, that make people not want to work with people who have this

A very high suicide risk also scares therapists away. Paradoxically – that’s what attracted the field’s premier researcher to this disorder. Marsha Linehan of the University of Washington set out to test treatments for highly suicidal patients – and found herself working with borderline patients:

Linehan: They have a ten percent suicide rate, so they are the highest rate of any group that I know, and really they are really incredibly interesting to work with.

Linehan has developed what many hail as the most successful treatment for this disorder. It’s called Dialectical Behavioral Therapy, and is an intensive, long-term intervention that tries to end the destructive cycle of intense pain and strong reaction.

Linehan: The first thing you have to do is radically accept that you ARE hurt, and be mindful of that emotion, but also, you then have to move to trying to regulate the hurt and regulate actions related to hurt

Patients learn these skills in individual and group sessions, during phone coaching, and the therapists have a strong support system.

Part of the treatment is to teach family members how to de-escalate situations. Camille Meyers has taken the course and gives an example. Recently her daughter asked her for help with directions, but got very angry when Camille printed out maps for her:

Meyers: I don’t want to read maps, I don’t like maps, maps don’t help me!!!!!!!!

Camille remembered not to fan the flames:

Meyers: Previously my reaction would have been okay, I can’t believe you’re telling me this, you asked me to help you, I spent all of this time … if you think they are not going to be helpful to you, I understand, maybe maps don’t work for you

Her daughter has started Dialectical Behavior Therapy, and is doing well so far.

Talya Lewis, meanwhile, says she’s in recovery after many turbulent years. She works as a therapist, helping people understand Borderline:

Lewis: With this disorder I want people to have a wall of compassion, where you protect yourself, but at the same time, you can deal with the person in this kind of ongoing way, and empathetic manner.

She says her disorder didn’t go away, but she works constantly to manage the symptoms. It is, she admits, exhausting to be her.

By: Maiken Scottmscott@whyy.org

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Top 10 Emotional Needs

Bon Dobbs — Thu, 18 Aug 2011 19:06:00 +0000

Top Ten Emotional Needs of Children (and most adults)

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

Accepted
Believed in
Cared about
Forgiven
Loved
Safe
Supported
Trusted
Understood
Valued

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

From eqi.com.

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Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance

Bon Dobbs — Mon, 15 Aug 2011 16:18:10 +0000

A mere critical stinging comment can just as easily send a person suffering Borderline Personality Disorder into “emotional anaphylactic shock.”

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

Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance

By SONIA NEALE

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

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

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

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

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

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

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

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

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

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The Art of Happiness, 10th Anniversary Edition: A Handbook for Living (Hardcover)

By (author) Dalai Lama

List Price:	$25.95 USD
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Release date October 1, 2009.

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Overcoming Chronic Resentment

Bon Dobbs — Mon, 08 Aug 2011 18:13:06 +0000

An excellent blog post from Dr. Steven Stosny, who is loved by many people on the ATSTP List, on overcoming chronic resentment.

Overcoming Chronic Resentment and the Abuse It Causes

By Steven Stosny

Created Aug 5 2011 – 7:26am

Recovery from relationships that have suffered chronic resentment is long, complex, and fraught with setbacks, whether the couple breaks up or tries to repair the damage done to the union.

Unlike anger, which is stimulated by discreet incidents or thoughts, chronic resentment is a general ego defense – the more fragile the ego, the more resentment required for defense. For those most in need, ego-defense is more important than learning, truth, and reason. Hence resentment greatly distorts thinking – through oversimplification, confirmation bias, inability to grasp other perspectives, and impaired reality-testing (inability to distinguish thoughts from reality). Over time, resentment becomes a world view or way of life. Because the resentful have to devalue others to protect their fragile egos, chronic resentment in intimate relationships inevitably leads to some form of verbal or emotional abuse and, eventually – if the couple hangs in there – to contempt and disgust.

Characteristics of Chronic Resentment in Relationships

High emotional reactivity – a negative feeling in one triggers chaos or shut down in the other

External regulation of emotions – unpleasant emotions are regulated by attempts to control or devalue the other

Automatic defense systems (See ADS post)

Power struggles – try to “win” or exert power rather than reconcile and connect

Criticism, stonewalling, defensiveness, contempt

Walking on eggshells – both parties feel this, but typically one will internalize, second-guess, and reangle the self in vain attempts to avoid the other’s resentment or abuse

Narrow and rigid emotional range – the parties seesaw between resentment and depression, with little emotional experience in between.

Treatment Resistance
Although it is better understood as a collection of bad habits rather than addiction, as some have suggested, resentment shares with the latter the need to “hit bottom” before there is motivation to change. That’s because resentment requires an attribution of blame: “It’s someone’s fault that I feel bad or powerless.” Their negative emotions seem like punishments that require retaliation rather than motivations to heal and improve. Resentful people typically have to hit bottom – lose a relationship or get fired from a job or suffer yet another failure before there is sufficient motivation to reverse years of bad habits.

Successful Treatment of Chronic Resentment

Resentful people feel devalued and powerless without resentment. Before giving up a defense they have likely held since adolescence, their egos need a more effective way to feel valuable and powerful, i.e., able to act in their long term best interests, without violating their deepest values. Successful treatment must employ commitment to their deepest values so that the motivation to build value outweighs the motivation to devalue. It must:

Increase core value – the ability to create value and meaning in life and stay true to their deepest values (The resentful consistently violate their deepest values by devaluing the people they most value.)

Emotional reconditioning – forming healthier habits of internal regulation.

In successful treatment, the resentful learn to focus on what they most deeply appreciate, what they most want to build, and the value they most want to create in life. Once they experience the enduring power and vitality of acting on the motivation to create value, compared to the constricted emotional range of resentful living, they can begin to develop a powerful sense of self that is less in need of ego defense and capable of maintaining a compassionate, loving relationship over time.

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Ask Bon: How do I balance validating somebody’s feelings with protecting myself or my children from emotional abuse?

Bon Dobbs — Mon, 08 Aug 2011 15:23:16 +0000

Q: How do I balance validating somebody’s feelings with protecting myself or my children from emotional abuse?

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

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

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

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

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

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

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

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The Empathic Civilization?

Bon Dobbs — Tue, 19 Jul 2011 20:21:04 +0000

RSA Animate – The Empathic Civilization

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Emotional Independence and the Types of Love

Bon Dobbs — Mon, 18 Jul 2011 17:51:48 +0000

Sometimes Love Hurts

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

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

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What Diane Schuler’s story can tell us about emotional honesty and acceptance

Bon Dobbs — Mon, 20 Jun 2011 16:46:08 +0000

You may or may not remember this story from 2009. Diane Schuler, a mother and aunt with her children and her sister’s children in a min-van, goes the wrong way on the Taconic Parkway in Westchester county and plows into an SUV head-on killing three in the SUV and 4 children and herself in the mini-van. Toxicology reports showed she had a blood alcohol level of .19 over twice the legal limit of .08. She also reportedly smoked marijuana and had several ounces of undigested alcohol in her stomach. Here’s an article that analyses the NY Magazine article about her husband Daniel Schuler. This analysis from Jezebel.com, points out the problems, isolation, secrets and tragedy that can exist when a spouse is unable to communicate his/her emotional pains.

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

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

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

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

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

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

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

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10 Signs you’re a highly sensitive person (HSP)

Bon Dobbs — Tue, 14 Jun 2011 16:32:30 +0000

I like to refer to this as ESP (Emotionally Sensitive Person), but I came across a blog on Psych Central today on which was posted this article: 10 Signs You’re a Highly Sensitive Person. Here’s the text:

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

By Zoë Kessler, BA, B.Ed.

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

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

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

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

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

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

1 ) Loud Movie Soundtracks (P)

non-HSP: Wow!
HSP: Ow!

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

2 ) Big, Excited Crowds (S)

non-HSP: Fun!
HSP: Run!

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

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

non-HSP: Miss
HSP: Bliss

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

4 ) Crude Sexual Innuendo (S)

non-HSP: Bad-ass
HSP: Simply Crass

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

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

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

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

5 ) Brassiere (P)

non-HSP: Wearable
HSP: Unbearable

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

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

6 ) Unkind Remarks at Work (O)

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

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

7 ) Violent Films (S)

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

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

8 ) Circus In Town (S)

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

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

9 ) Tags In Clothes (P)

non-HSP: laundering navigation
HSP: endless irritation

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

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

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

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

How about you? HSP too?

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

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

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I-AM-MAD Skill makes it to Partners in Wellness Blog

Bon Dobbs — Fri, 03 Jun 2011 18:10:38 +0000

In the post “When Your Partner Says They Are In Pain, Validate” Kate Theda of the “Partners in Wellness” blog specifically used my I-AM-MAD communication skill to teach her readers about validation. Here is the intro for the log post:

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

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

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

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

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

Bon Dobbs — Fri, 03 Jun 2011 14:36:40 +0000

Emotional Dysregulation and BPD

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

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

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

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

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

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

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

(adapted from When Hope is Not Enough)

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Simon Baron-Cohen discusses empathy and the science of evil

Bon Dobbs — Thu, 02 Jun 2011 15:15:44 +0000

Simon Baron-Cohen has been giving interviews about his new book The Science of Evil: On Empathy and the Origins of Cruelty in which he discusses “mind-blindness” in autism and the lack of empathy in other disorders, including BPD. Here is the text of the interview he gave to Time magazine. I have added emphasis on the part that I find most “telling” about BPD. I have to disagree though that people with BPD have zero empathy. They can behave that way at times, but people with BPD can exhibit a lot of empathy and compassion when their motivation is not IAAHF, pain avoidance or threat reaction. When their emotions become reflective, rather than reflexive, the empathy come through.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What stunts the development of empathy in personality disorders?

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

What defines borderline personality disorder?

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

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

So how would you address increasing empathy in these conditions?

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

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

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

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

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

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

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

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

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

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

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

Why does empathy seem especially lacking in the teen years?

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

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

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

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

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

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

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

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

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

Find this article at:

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

You can buy to book here:

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The Science of Evil: On Empathy and the Origins of Cruelty (Hardcover)

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Confirmation of IAAHF

Bon Dobbs — Wed, 01 Jun 2011 13:42:34 +0000

A few days ago, I saw some confirmation of “it’s all about his/her feelings” come across the ATSTP Email Support List. A woman who has been a member for a while posted this about her husband with BPD:

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

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

As you can see, there are two interesting notes in that post – one that it’s all about his feelings (IAAHF) and secondly that she didn’t want to accept that it was not about her feelings. Tough thing to face, but at some point, it’s more effective to accept that the motivation is IAAHF and, more so, that that’s the motivation that will have the biggest impact on an emotionally sensitive person.

First Search on IAAHF

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5th Anniversary of ATSTP List and Some Support for Non-BPDs

Bon Dobbs — Tue, 10 May 2011 16:03:44 +0000

Today is the 5^th anniversary of the Anything to Stop the Pain support list. After over 50,000 messages and 600+ members, it is still going strong. The ATSTP list is offered for free to non-BPDs. In honor of this momentous occasion, I will clip a response from me to a list member. Any personal details have been removed. The only thing blog readers need to know is that this man’s wife has been diagnosed with BPD and is asking him for a divorce. We also have a couple of recovered borderlines on this list and they are a valuable resource (as is noted here):

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

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

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

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Burnout, Compassion Fatigue and why non-BPDs lack compassion for borderlines

Bon Dobbs — Thu, 31 Mar 2011 13:50:45 +0000

Emotional Burnout

Do non-BPDs have enough compassion for people with Borderline Personality Disorder? A few months ago, Dr. Kristalyn Salters-Pedneault, PhD, About.com’s BPD guide, posted a message entitled “Have Compassion” in which she said: “Many times each week I receive reader comments, forum posts, and personal emails that are incredibly hateful toward people with BPD. I do understand that many people have been hurt by individuals with BPD, and that usually these comments are written from a place of pain and anger. But, I am often shocked by the level of vitriol in these comments.” She went on to implore non-BPDs to have compassion for those suffering from BPD saying: “People with BPD deserve your compassion. I am not saying that people with BPD do not behave in ways that are hurtful, nor that they should not have to accept responsibility for these actions (and, by the way, you may not realize it, but they usually do, after the fact, and with a deep sense of shame, guilt, and remorse).”

In January, Randi Kreger, the author of “Stop Walking on Eggshells” and “The Essential Family Guide to BPD”, responded to this message on her “Stop Walking on Eggshells” blog. She responded: “Yes, Family Members Are Compassionate! In fact, family members (FM) of people with BPD are some of the most compassionate people out there. Those who know about BPD are aware their BPD FM didn’t ask for the disorder.”

I have been thinking about both of these posts for months. I have noticed that when non-BPDs “wash up on the shores of the ATSTP list” they are generally NOT compassionate. I also have found that just telling them that their borderline loved ones “deserve their compassion” does not work. There has to be a period of learning, skills application and understanding the mechanics of the disorder before they begin to develop compassion for their loved ones with BPD. So, I asked myself: why?

When reading The Lucifer Effect: Understanding How Good People Turn Evil (a book about how “normal” people behave in evil ways), I stumbled onto two concepts that I believe explain why non-BPDs do not have compassion for their borderlines at the beginning. These concepts are: Emotional Burnout and Compassion Fatigue.

Emotional Burnout

Burnout (or emotional burnout) is characterized by three basic building blocks. Those are (with an explanation of each with respect to non-BPDs):

Emotional Exhaustion – the emotional intensity of the interactions with a borderline are exhausting. As I indicate in “When Hope is Not Enough” the emotional tolerance of someone with BPD is set far lower than a person without BPD. Therefore, emotional crises are much more likely to occur. I know from experience with my family members that have emotional regulation issues, I get very tired when there’s an EDM (emotionally dysregulated moment). Some of these “moments” can last a while, thirty minutes or longer, and it’s very difficult for me to have compassion when I am emotionally exhausted.

Cynicism – unfortunately, because the emotional tolerance of a person with BPD is set so low, I have found that many non-BPDs are quite cynical about the reactions of a borderline to “trivial” things. Often, non-BPDs express that their borderlines are “freaking out” over “nothing” or that the borderlines are just inherently evil (in fact, my post about “demonic possession and BPD” is one of the most popular and most commented upon on this blog). BPD is often thought to be a “character flaw” or a case of the borderline just “behaving badly”. These attitudes lead to more cynicism on the part of the non-BPDs. Additionally, the non-BPD’s compassion is often conditional. It seems to be a case of “I’ll have compassion for you when you start to behave better (or go into treatment or get out of the fantasy world you’re living in)”. This leads to more cynicism, because the borderline is not “keeping up their end of the bargain.”

Inefficacy – I have written about learned helplessness on this blog before. I feel that the non-BPDs try to control that over which they have no control. This leads to inefficacy (and learned helplessness). The idea that nothing they try has any effect on the situation.

Compassion Fatigue

Compassion Fatigue is a condition that generally health care professionals (such as nurses) or charity donors develop when they have just “seen too much pain and suffering” to extend their compassion. I think with respect to non-BPDs, it begins to develop when (through cynicism) the non-BPD begins to feel that the borderline is “crying wolf” too many times (i.e. they are getting “overly upset” about things that are “trivial” and that the intensity of the reactions are “too much” for the situation as the non-BPD sees it). Non-BPDs then begin to withdrawal their compassion. I once had a therapist tell me and my wife that we couldn’t continue to “live at the intensity level that we were living at.” I believe that because of “psychic equivalence” (when the borderline gets into “feelings = facts” mode, or that their mind actually reflects the environment, even when it is misaligned with how the non-BPD sees things), the non-BPD develops more and more cynicism about the behavior of the borderline, gets emotionally exhausted by the frequent emotional crises and gets discouraged when all that they’ve been taught to do (boundaries, tough love, behavioral contracts, talking sense to the borderline, etc.) don’t have any effect, the non-BPD develops compassion fatigue and begins to feel that the borderline is just “dramatic” or a “lost cause”. Interestingly, compassion fatigue is also referred to as secondary traumatic stress disorder, which seems to apply to the situation with non-BPDs.

So, do non-BPDs have enough compassion for borderlines? At the beginning, before they begin to behave effectively and before they adjust their attitudes about BPD, I’d have to say “no”. However, emotional burnout and compassion fatigue CAN be combated. How? I’ll cover that in a subsequent post.

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First Search on IAAHF

Bon Dobbs — Mon, 28 Mar 2011 12:41:06 +0000

I coined the phrase “It’s All About His/Her Feelings” (IAAHF) as a mentalization tool to understand the MOTIVATION behind much of the confusing behavior of those with BPD. Last week, I got the first search engine search on IAAHF. See below:

IAAHF

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

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

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

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

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Some post-Valentine’s BPDish poetry

Bon Dobbs — Wed, 16 Feb 2011 15:35:57 +0000

Something I stumbled across over the weekend. Talk about “I Hate You. Don’t Leave Me!”

Emotional Idiot
Maggie Estep

I’m an Emotional Idiot
so get away from me.
I mean,
COME HERE.

Wait, no,
that’s too close,
give me some space
it’s a big country,
there’s plenty of room,
don’t sit so close to me.

Hey, where are you?
I haven’t seen you in days.
Whadya, having an affair?
Who is she?
Come on,
aren’t I enough for you?

God,
You’re so cold.
I never know what you’re thinking.
You’re not very affectionate.

I mean,
you’re clinging to me,
DON’T TOUCH ME,
what am I, your fucking cat?
Don’t rub me like that.

Don’t you have anything better to do
than sit there fawning over me?

Don’t you have any interests?
Hobbies?
Sailing Fly fishing
Archeology?

There’s an archeology expedition leaving tomorrow
why don’t you go?
I’ll loan you the money,
my money is your money.
my life is your life
my soul is yours
without you I’m nothing.

Move in with me
we’ll get a studio apartment together, save on rent,
well, wait, I mean, a one bedroom,
so we don’t get in each other’s hair or anything
or, well,
maybe a two bedroom
I’ll have my own bedroom,
it’s nothing personal
I just need to be alone sometimes,
you do understand,
don’t you?

Hey, why are you acting distant?

Where you goin’,
was it something I said?
What
What did I do?

I’m an emotional idiot
so get away from me
I mean,
MARRY ME.

You can buy Maggie Estep’s “Diary of an Emotional Idiot” below:

Diary of an Emotional Idiot

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Understanding Accountability and BPD

Bon Dobbs — Thu, 06 Jan 2011 20:48:04 +0000

Often, I have had nons say to me that they want their borderlines to be accountable and responsible for their actions. I recently got a 1 star review of “When Hope is Not Enough” that indicated that the reviewer felt that my approach to BPD was a “recipe for walking on eggshells”. It’s clear to me that the reviewer didn’t really understand the content of my book. The reviewer went on to say that: This book doesn’t hold a BPD anywhere close to being responsible for her actions by granting the notion of “emotional dysregulation” a power of grand excuse.

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

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

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

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What BPD Feels Like

Bon Dobbs — Sun, 31 Oct 2010 16:45:43 +0000

Excellent article about what BPD feels like:

What BPD Feels like

A lot of friends and family members want to understand what the BPD sufferer is going through, but they don’t have a proper understanding of what is actually happening. For the BPD sufferer it is hard to explain what it feels like when honestly, they don’t know exactly what it is that isn’t “normal”. People around the BPD sufferer know that something isn’t right with the person, but quite often the sufferer does not know there is anything wrong, which is why they can attack you when you suggest there may be.

As a BP sufferer myself, I can say that there are definitely times when you can “cope” better than others. But then there are times when it is all you can do to get out of bed. Your emotions can be that out of control that you suffer an emotional pain that is similar to the experience one feels when a loved-one has died, but it doesn’t get better and there is no reason for it. Some people deal with emotional pain in various ways, such as drinking, using drugs, crying all of the time, or becoming angry. It can affect BPD sufferers in different ways, depending on how they usually deal with stressful situations. I know for me I have a strong belief in being non-violent as I know that if I don’t keep my anger in check it can verge on being out of control, so I work extra hard to avoid that. Unfortunately that means that I will do things like drink or drugs to distract myself, and so I have had addiction problems in the past that I have also had to deal with. This is quite common in BPD personalities, as they try to do whatever it takes to find a way to distract themselves, or ease their pain, for a little while. If they find something that works, even if it is for a little while, then they will latch onto it in the hope that if they do it all of the time the pain will go. This obviously doesn’t work, and provides the BPD sufferer one more thing they need to fix in their life.

At my worst, the ability to think clearly or to make rational decisions is completely gone, and it is almost an impossible task. You can try your hardest to take your time to think about things to make the right choice, but this doesn’t happen. It is unclear whether this is a response to the overload of emotions on the brain or another cause due to this illness, but it is a fact.

Then there is also the other part of BPD which can cause depersonalisation, which can cause huge problems in a person’s life. Depersonalization is when the person experiences a sense of detachment from the self. It is often associated with sleep deprivation or “recreational” drug use. It may be accompanied by “derealization” (where objects in an environment appear altered). Patients sometimes describe depersonalization as feeling like a robot or watching themselves from the outside. It may also involve feelings of numbness or loss of emotional “aliveness.” When I have experienced this it is almost like I have been tricked into thinking I have no feelings for certain things. For example, a few years ago I went through this phase of depersonalization in which I was convinced that I had no feelings (almost overnight) for my partner. Whilst in hospital after a suicide attempt I met someone there, and thought that because I felt something for them that my relationship with my partner must be over, so I split up with my partner. A few weeks later my feelings for my partner kicked back in and I realized that I had made a huge mistake. Luckily for me my partner took me back after this indiscretion, but I know it is the only chance I have. I now understand from this experience that I can’t always trust my emotions, because for me, as a BPD sufferer, they are not all real.

BPD sufferers can also experience bouts of dissociation, which can lead to dissociative amnesia. This means that they will have no memory of what happens when they are in a dissociative state. Dissociation is the state in which, on some level or another, one becomes somewhat removed from “reality”, whether this be daydreaming, performing actions without being fully connected to their performance (“running on automatic”), or other, more disconnected actions. This can be a lot more serious than the usual “automatic pilot” that most people will experience, and can be as a result of depersonalization as well.
Family members and friends say that BPD sufferers have extreme mood swings for no reason, and while this is true to outsiders, the BP sufferer always thinks they have good reasons. They feel like they are only reacting to what the people around them are doing, but this is only because their view of what is happening around them is skewed. Because of the extreme emotional reaction they have to normal events, what may seem small to other people becomes a huge thing in the mind of a BPD sufferer. For example, if my partner looks at me in a weird way, it could mean absolutely nothing on their end, yet I may blow up at my partner because in my mind it means that they are angry at me. The mind of the BPD sufferer makes these kinds of assumptions all of the time – they believe that they are experts in reading people and body language, when in fact they are the exact opposite. And it is when they make these errors in judgment that they react wrongly and overly emotionally, and the friend, partner or family member has no idea why. In our mind it all makes sense, as we tell ourselves we know what is truly going on, when in fact we have no idea.

The fear of abandonment is also a major issue in the life of a BPD sufferer, and this is what can cause most of the issues when it comes to personal relationships, either romantically or not. When starting a new romantic relationship, the BPD sufferer will usually test the potential partner to see whether they will stick around. If the partner passes this test, then the BPD sufferer will latch on and treat that person like they are a God/Goddess so that the other person will fall in love also. Once the BPD sufferer is comfortable with where the other person is at, they may then start to switch between intense bursts of love/hate that confuse the other person. This is not done consciously to torture the other person – in fact, the BPD sufferer has no idea that they are doing it. They are actually responding to perceived events in their own mind which causes them to act this way, even though these acts don’t exist. For example, there are times in my relationship where my mind makes the leap that my partner is cheating on me even when I know in reality that this is not the case. All it takes is for me to experience rejection one night when I make sexual advances, and my emotional response is out of control to try to figure out what the problem is. In my mind it couldn’t actually be that my partner is tired from work and our children – it has to be more than that. So I go into this emotional free-fall until it ends up in an argument where my partner has to defend themselves from something they haven’t even done.
It is extremely difficult for BPD sufferers to have successful relationships, and it is because of our reaction to the fear of abandonment which is the reason why a lot of non-BPD sufferers refuse to have relationships with us. I can certainly understand why, if my partner was always looking for the negative in our relationship instead of just being happy. I know for me if I have times where I recognize that I am happy, it will be quickly followed by me searching for a reason that things are bad as I can’t believe that things are as good as I think they are.

The BPD sufferer can not accept that things are good or happy or uncomplicated – they expect things to go wrong any second and are always searching for any sign of this occurring. It even gets to the point that if they can’t see one then they will make one up (sub consciously of course) so that they can prove themselves right. This can be very frustrating for those around them, as they constantly go through this dance of proving to their partner or loved one that they are not leaving. It eventually gets to the point where the BPD sufferer will push the other person that much that they will leave, and then the BPD sufferer is in some way validated for doubting the person in the first place. It is a no win situation.

Another area in which BPD affects my life is in maintaining focus on areas in my life. For example, I will develop an interest in religion, so I will then have to read books, watch documentaries, live, talk and breath religion until a few weeks later when suddenly this obsession will pass. It also happens in things like career choice. I have started University study four times as each time I start a course I am 100% sure that this is what I want to do, but as soon as I start studying I lose interest so I stop. I have sunk money into so many ridiculous career choices and money making schemes that I guarantee I will commit to, only to have given up when my focus changes to something else. I can get so excited by something only to give up on it after a month or so, and it is just as frustrating for me as it is for those around me.

A lot of BPD sufferers, including myself, have experienced episodes of self harm and suicide attempts. Luckily for me I have never been successful, but unfortunately 10% of all sufferers are. This number should indicate how hopeless, distraught and pained BPD sufferers are. Suicide is not something anyone takes lightly. I know for me, every time I have thought about it, it has been over a long period of time, until finally it gets to the point where it feels like I have no choice. It is not something I rush into. Suicide is only an option to sufferers because they are not thinking clearly, and are having inappropriate reactions (which they can’t control) to events and the environment around them.

To a lot of non-BPD sufferers it can seem like the BPd sufferer is using suicide attempts as a form of manipulation. From my experience, although I can’t speak for everyone, this was never my intention although I can see how it has been interpreted like this. Normally to get the point where suicide is considered the BPD sufferer is experiencing an episode of immense pain for a long time, although sometimes if they can feel one of these episodes coming on they may consider it as a way to stop the torture they are about to sink into. When I have got to the point of actually attempting suicide, for me it has been more about preventing other people from being hurt by me than trying to hurt them by committing suicide. As I have previously said, I can not say that this is true for all sufferers, but I know the majority would feel this way.

Episodes of self harm are also common for BPD sufferers. I have experienced these episodes on many occasions, but for me there is not always one reason as to why I do it. Sometimes it is because I feel so much emotional pain I want to let it out so I try to do it physically, other times it is because I am feeling absolutely no emotion that I want to feel pain so that I know I am still capable of feeling something. Some times it is even because I am almost in a psychotic state that for me it makes sense to cut myself if an angel tells me to. Whether this is what the doctors call true psychosis or not I am not sure, but it can seem real enough at the time. All I know is that the ability to think properly becomes that distorted that things that would normally seem stupid become really good and sensible ideas. You start believing things that could not possibly be true, and can even imagine conversations with people that don’t exist.

BPD affects virtually every area of a sufferer’s life. It affects the decisions they make, how they respond to stimuli in their environment, how they behave towards themselves and other people, and their emotional reactions. I could not imagine anyone choosing to live this lifestyle, as it destroys virtually everything around them. Overcoming BPD is the biggest challenge a sufferer has, but it is possible with a lot of hard work. And to have any semblance of a normal life it is necessary.

No related posts.

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

Bon Dobbs — Fri, 22 Oct 2010 14:48:47 +0000

How much do feelings of emptiness matter in BPD?

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

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

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

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

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

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A Preoccupation with Interpersonal Relationships

Bon Dobbs — Wed, 13 Oct 2010 17:42:40 +0000

This feature is a new one that I have added to my “model” of BPD. I added it because I was attending the International Society for the Study of Personality Disorders (ISSPD) and listened to Dr. John Gunderson present a detailed model of his experience with BPD. The purpose of the presentation was to present a “real world” clinical model of BPD from the viewpoint of someone with many years of experience treating the disorder. One of the features that Dr. Gunderson provided was this “preoccupation with attachments.”

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

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

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

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

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

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

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

Distancing and Detachment as an Interpersonal Strategy

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Tough Love is not an effective approach to BPD

Bon Dobbs — Fri, 06 Aug 2010 17:45:14 +0000

Tough Love and BPD

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

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

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

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

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Nice Article about Empathy and Coping with BPD

Bon Dobbs — Thu, 05 Aug 2010 15:12:23 +0000

Article about empathy and coping with BPD:

Moran: Inspiration through empathy: Living with mental illness

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

***

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

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

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

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

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Emotional Independence

Bon Dobbs — Wed, 28 Jul 2010 16:05:16 +0000

When new members “wash up on the shores” of the ATSTP list, they are confused, angry, helpless and exhausted. One thing I also noticed is that new members are emotionally entangled with their loved ones with BPD. Sometimes when people speak of “boundaries,” they use the phrase “where you end and I begin.” The word boundary has many meanings, and have talked about effective boundaries a lot on this blog. Yet, this idea of “where you stop and I begin” is very important when you’re entangled in another person’s emotions. A Non-BPD must learn to heal, to unpack emotional baggage, to acquire the emotional skills to help to detangle the morass of emotional issues that may be keeping him/her in confusion and pain.

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

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

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

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Has Depression become a Catch-All Diagnosis?

Bon Dobbs — Tue, 29 Jun 2010 19:21:10 +0000

Anti-depressants and Depression

I believe that it has. Why? Well, there are a number of reasons that depression is a catch-all diagnosis. One certainly is the influence of the pharmaceutical industry given that billions of dollars are spent on anti-depressants each year. Also, doctors who are not mental health professionals (like GP’s) are prescribing anti-depressants if their patients are “depressed”.

Unfortunately, sometimes depression is not accurate. Many times when people say “I’m feeling depressed” they are really expressing that they are feeling emotional pain. Sometimes emotional pain is normal, sometimes a great deal of emotional pain is not normal and becomes problematic. When someone is feeling too much emotionally, it is not depression.

Depression is usually a problem when someone is feeling a strong lack of emotions – causing a lack of interest in the usual activities (including sex) that once gave us pleasure. Although many configurations of “depression” exist (because it is a non-specific term nowadays), the configuration in which one lacks emotions is alexythimia, although if one lives without pleasure it’s called anhedonia. I suspect that most people, when they describe being “depressed” are really describing a combination of anhedonia (where they can’t enjoy anything anymore) and social anxiety.

As I said above, another configuration that is referred to as “depression” is when the emotional pain becomes too overwhelming. In this case the person is feeling too much and would possibly beg for anhedonia because, while the pleasure would not be present, at least the pain would go away. I think that BPD probably involves more of this kind of “depression” than other disorders. The constant emotional pain leads people to doing anything to stop it (thus, this site’s name), including substance abuse, sexual promiscuity, risk-taking, self-injury and other seemingly self-defeating behaviors.

How can this be explained? How can someone be in such emotional pain all the time? One explanation comes from the study of u-opiods in the brain. A recent study by Stanley and Siever showed that people with BPD have too few u-opiods (the precursor for natural pain-killing neuro-chemicals) AND have over-active u-opiod receptors. This combination provides a baseline of pain and, when opiods are added, the brain feasts on these pain-killing substances with the over-active receptors. This is why some people with BPD can ingest large quantities of pain killers to seemingly little effect (or less effect than those without the disorder). I have heard people with BPD say they only feel “normal” while taking pain killers.

So, the question here is two-fold: First, are anti-depressants an appropriate treatment for emotional pain that is not really “depression”? And secondly, if not, what is? Low-dose pain-killers?

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Emotional Profiles: Are you a volcano?

Bon Dobbs — Tue, 29 Jun 2010 17:32:19 +0000

Some more from “Beyond Boundaries”:

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

Tolerance. This is the sensitivity a person has to triggering events. Those with a high sense of threat awareness (like people with BPD) are likely to have this factor set at “hair trigger.”

Onset. This is how quickly the emotion gets to full intensity.

Intensity. This is how intense the emotion affects a particular person.

Duration. How long the emotion lasts and continues to affect the person’s thinking.

Return to baseline. How long it takes a person to “get over” the emotional reaction.

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

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

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The power of “When you do this, I feel that”

Bon Dobbs — Wed, 23 Jun 2010 20:26:56 +0000

Recently, in the ATSTP group we discussed the power of saying “when you do [whatever], I feel [whatever else].” This formulation of words is very powerful when dealing with an emotional person. It does a couple of things that are important. First, it lets the other person know that you have feelings as well. Sometimes someone with BPD will feel that they are the only one in the world with feelings to be hurt. DBT actually “encourages” this way of thinking IMO. Since DBT is all about the client’s emotions and behaviors, the “other’s” (the therapist) feelings and behaviors are not often taken into account. This situation is not really ideal for a family member. Saying: “When you did [this], I felt [that]” often does the trick. It’s basically the “inserting your feelings” tool from When Hope is Not Enough. However, you need to make sure that you are communicating your feelings, not your judgments about the behavior. That is, use feeling words (sad, angry, afraid, etc.) and not judgment words (manipulated, disrespected, etc.). If you use feelings words, you can’t be argued with.

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

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BPD, Self-Regulation and Others

Bon Dobbs — Tue, 08 Jun 2010 16:28:28 +0000

Ok, after posting about book sales recently and stuff like that, now it’s time for a much more substantive post about BPD. Today, I plan to talk about self-regulation and a new study that points out an intriguing aspect of BPD. There has been much talk in the BPD research and clinical community about the “core” of BPD. Once it was thought to be a personality disorder or even an extreme form of PTSD. Dr. Marsha Linehan (the inventor of DBT) talks about dysregulation in a number of systems, the most important of which (in my interpretation) is the emotional regulation system. People with BPD are extremely emotionally sensitive and subject to emotional “cues” or triggers. They seem to have a less tolerant (in the “controls” sense of the word, meaning more highly sensitive) emotional system. They are triggered more easily and the reactions seem to be more intense and longer-lasting. In “When Hope is Not Enough” I compare this feature to a heat-sensing device and say:

The core problem with BPD is poor emotional regulation. That particular problem can cause other symptoms to arise as the person with BPD becomes emotionally dysregulated. This term emotionally dysregulated (or just dysregulated) is used to denote the state in which a person with BPD is overcome with powerful and, at many times, misaligned emotional reactions. Remember that emotions don’t arise on their own; they are based on cues or triggers from the environment and compared by our “emotional immune system” to the meaning of the cue. For a person with BPD, the meaning can be misjudged or, as is more often the case, the sensitivity to emotional cues is greatly heightened.

An example is a heat-sensing system that helps to detect and suppress fires. Sometimes companies will install heat-sensing equipment in addition to smoke detectors so that they can protect assets that need a certain temperature to operate (e.g. computer equipment which might cease working at a high temperature). The setting at which an alarm goes off might be 80 degrees Fahrenheit. In the case of someone with BPD, the setting (or “tolerance” as it is called in the control community) is naturally set much lower, at say, 50 degrees Fahrenheit. That means that the alarm will be raised much more often and lead to a reaction to the alarm. In other words, people with BPD will experience many, many (what you would consider) false alarms. However, these false alarms seem completely real to them, because their tolerance for emotional triggers is set very low. They are constantly running a fire drill. Unfortunately for you, the BP may drag you along unwillingly and unwittingly for the drill. (Pages 32-33 of WHINE)

As you can see, the position I take in WHINE is that emotional regulation is the “core issue” of BPD. This position is in line with the DBT way of thinking, which is why one of the “modules” of DBT is emotional regulation skills.

The question is today: is emotional regulation at the “core” of BPD? Or does it go deeper than that? Is there a “cause” for emotional regulation? What are the triggers and how does a person with BPD’s internal feelings affect this “systems dysregulation”?

In the American Journal of Psychiatry, Drs. Stanley and Siever recently (January 2010) publish an article entitled “The Interpersonal Dimension of Borderline Personality Disorder: Toward a Neuropeptide Model “ in which they seem to posit (in my interpretation again, since I am a lay person and not a doctor) that this systems dysregulation actually has another cause instead of being a “core cause’ of the disorder. They begin the article like this:

Borderline personality disorder is a complex disorder associated with substantial morbidity, mortality, and public health costs. Prominent symptoms include suicidal behavior, nonsuicidal self-injury, aggressive outbursts, and emotional reactivity, all of which typically manifest in an interpersonal context. For several years, there has been an ongoing discussion about whether impulsive aggression or affective dysregulation is at the core of the disorder. While these factors are important in borderline personality disorder, it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.

They go on to say this:

It is noteworthy that many symptoms in the interpersonal domain of borderline personality disorder are actually manifestations of intrapersonal difficulties (e.g., difficulty being alone and misperception of the intentions of others as malevolent), and this dimension could perhaps be reconceptualized as “intrapersonal dysfunction.” We suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous and may rely heavily on a sense of interpersonal contact and connectedness.

So, what’s afoot here? What are they saying and what does it mean to the nons of the world?

It seems to me that they are saying two very important things about BPD that has previously been “unnoticed” as DBT has reigned the clinical community. These are:

“…it is the exquisite interpersonal sensitivity that frequently triggers both dysregulated affect and impulsive behaviors, which suggests that this sensitivity perhaps rests at the core of the disorder and may in turn drive impulsivity and dysregulated affect.” Basically, that the interpersonal sensitivity is the “control” of is sensitive to the (emotional) heat.
“We suggest that an internal feeling of well-being, stability, and self-regulation in borderline personality disorder is tenuous and may rely heavily on a sense of interpersonal contact and connectedness.” That means that the lack of internal well-being makes the person with BPD sensitive to interpersonal cues.

What do those two important factors mean to you – the loved one or family member? In my mind they mean that a person with BPD uses people in close personal relationships to self-regulate. In other words, being unable to self-regulate internally, they look to external people to regulate their emotions, reactions, sense of well-being and behavior. They believe at some level that you, the loved one, is an extension of their mind, emotions and feelings and assume to you “should know what to do” when they are feeling dysregulated.

What SHOULD you do when this situation occurs? What should you do when they are triggered? What should you avoid?

I believe that the most effective answer is to help them learn to self-regulate and self-validate. This “lack of well-being” is an unpleasant feeling (I would imagine) and probably feels like a HUGE lack of control. I mean, if a person has to rely on other (unpredictable) people to self-regulate, how must that feel? Having compassion for that feeling is definitely a goal. However, before that comes (and it can be cultivated BTW), one can listen, ask, redirect the choice, validate, normalize and cheer lead when appropriate. Don’t defend or minimize. Living a life in which you’re always waiting for the other shoe to drop has got to be unpleasant.

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Validation Article from DBT’s perspective

Bon Dobbs — Tue, 06 Apr 2010 17:28:35 +0000

Here is an interesting article on emotional validation for parents of people with BPD… from a new blog about understanding DBT.

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

How Do We Validate

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

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

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

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

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

References:

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

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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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On My Side

Bon Dobbs — Mon, 31 Aug 2009 17:18:24 +0000

Are you and your BP on the same team?

I often hear people with BPD/ERD say that they feel that their loved ones are “not on my side” or that the loved ones are “supposed to be on my side.” This phrase stuck out at me when I read the story about the suicide of Megan Meier (the “MySpace suicide” case), because, although I have no insight into Megan’s mental health, clearly when she was insulted and rejected on MySpace, and she was emotionally dysregulated. She came to her mother, and after her mother admonished her for the use of foul language on MySpace, Megan cried and said, “You’re my mom. You’re supposed to be on my side!” (This according to her mother’s reports).

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

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

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

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Shooter in PA and painful emotions

Bon Dobbs — Wed, 05 Aug 2009 20:29:46 +0000

Here is a video put out by PA Gym shooter George Sodini about his emotions… I post this not to provide him with sympathy. He made a horrible choice that will ruin the lives of many. I post it because it illustrates the power of negative emotions on a person’s psyche.

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

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Sin, Zen and the Art of Emotional Skills

Bon Dobbs — Thu, 23 Jul 2009 15:23:36 +0000

Practice and Balance

When I was a child, I went to a fairly fundamentalist church. We had this Christian tract that showed man on one side and God on the other, with “clouds of sin” in between, obscuring man’s view of God. Repentance and faith in Jesus would “clear the air.” There was another one, with which you are probably familiar if you’ve ever been exposed to these things, where man is on one side and God is on the other and there is a big gulf of sin in between. The cross ends up being the bridge that allows man over the gulf.

Now that I am a grownup I lean more toward skillfulness than faith. However, the idea of “clouds” obscuring a “true view” of reality still appeals to me. These clouds are not sin now, they are ineffective cognitions, whether cognitive distortions or negative emotions. I see the interaction between two people as a dance or a piece of music in which each plays a part. Training, practice and conditioning all come into play when one is preparing to dance. If a dancer over-thinks, she is sure to fall on her rear or step on her partner’s toes. If one’s mind is engaged in cognitive distortions or negative emotions, one can’t dance properly.

Years ago, I read “Zen and the Art of Archery.” In the book, the author has to develop a certain mind-set to hit the target. Much of this mind-set involves getting out of one’s own mental way and practicing the skill until it becomes second-nature. Whether it is archery or dance or interpersonal relationships, I find that much of the time, most people get in their own way and end up a tangle of resentments, anger and emotional pain. There are too many automatic thoughts and learned emotional responses that cloud a person’s ability to perform effectively in a relationship.

My suggestion to counteract this is for people to:

Clear the mind of cognitive distortions and negative emotions
Don’t assume another person’s motivation
Practice effective skills to the point of complete mastery
Relax, take a breath, slow down

You can purchase “Zen and the Art of Archery” here:

Zen in the Art of Archery

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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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