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.

Related posts:

1. Emotional Glasses for Liars and Tantrums
2. Kids of BPD – or kobies

Related posts brought to you by Yet Another Related Posts Plugin.

latimes.com/health/la-he-child-temper-20111010,0,3234089.story

latimes.com

Child mental disorders: New diagnosis or another dilemma?

A proposed new diagnosis for outbursts and tantrums sparks debate in the psychiatric community. Would it help parents desperate for answers, or just add to the confusion?

By Shari Roan, Los Angeles Times

October 10, 2011

advertisement
The final straw for Carolyn Alves came last fall when she tried to help her daughter Cecelia dress for kindergarten.

The volatile 6-year-old had worked herself into a frenzy as she tried on outfit after outfit, rejecting each as unacceptable. The tantrum at full bore, she scooped up a pile of clothes and hurled them at the front door of the family’s Spanish-style bungalow in Glendale.

The clock ticked past the school’s 8 a.m. bell. Alves pulled her wailing child into her arms and held her on the couch. After several minutes, Cecelia stopped, took a breath and announced that she was ready to go to school.

“It was like watching someone who was having a mental breakdown,” Alves said. Then “a switch went off and she went back to being normal.”

Alves and her husband, Marcos, have consulted five doctors and therapists in the last four years. Cecelia has been diagnosed with a smorgasbord of psychiatric disorders — including the controversial diagnosis of child bipolar disorder — in addition to being called a normal kid.

Experts in pediatric mental health readily acknowledge that their failure to pinpoint the problem with children like Cecelia makes a difficult situation worse. And some of them are pressing for an unconventional solution: a new diagnostic category called disruptive mood dysregulation disorder, or DMDD.

Creating a diagnosis is considered a radical step in mental health circles, and the proposal has sparked much debate. The controversy underscores the fact that therapists simply don’t know what to make of the estimated 3% of children in the U.S. who suffer from severe irritability and emotional outbursts.

“Everyone wishes we could have a genetic test or a blood test” to determine which disorder a child has, said Erik Parens, senior research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y. “Unfortunately, nature doesn’t work the way we wish.”

As a result, parents may be told their children have conduct disorder, oppositional defiant disorder, attention deficit hyperactive disorder, depression or bipolar disorder — if they get a diagnosis at all.

Adding disruptive mood dysregulation disorder to the list of ailments doctors may consider would reduce the number of children misdiagnosed with bipolar disorder and treated with powerful psychiatric medications, proponents say. And, they add, improving treatment for children who have problems with mood and temper would reduce the number of children at risk of falling through the cracks in school and society.

But critics counter there is no scientific evidence to warrant recognition of a new mental disorder.

As doctors quarrel, parents like Alves struggle with the lack of medical options.

“I feel in limbo right now,” Alves said one afternoon, cuddling her painfully shy daughter. “Having a diagnosis would help me know what direction to take.”

Psychiatrists sharpened their interest in child mood problems several years ago in response to criticism over the number of children diagnosed with bipolar disorder — a debilitating condition in which periods of depression alternate with euphoria or elevated moods. It is considered incurable, although symptoms may be treated with drugs that carry serious side effects.

The idea that bipolar illness can begin in childhood caught hold in the last decade. The number of outpatient visits for children diagnosed with bipolar disorder mushroomed from fewer than 200,000 a year in 1995 to 800,000 in 2003, according to a 2007 study in Archives of General Psychiatry.

The study reinforced the notion that childhood bipolar disorder had become a fad diagnosis.

“The diagnosis means exposure to pretty potent medications,” said Dr. Jan Fawcett, a psychiatrist at the University of New Mexico School of Medicine in Albuquerque. “And, if the diagnosis holds, it means lifetime exposure to these medications.”

Such children often receive drugs like lithium or Depakote, which can cause severe weight gain, sedation and involuntary muscle contractions. They aren’t prescribed antidepressants or stimulants, which could worsen the condition in children who are truly bipolar. If the diagnosis is incorrect, however, children are deprived of drugs that could alleviate their anxiety or depression.

“We had to do something about it,” said Dr. David Shaffer, a child psychiatrist at Columbia University in New York and member of an American Psychiatric Assn. work group that proposed adding disruptive mood dysregulation disorder to the Diagnostic and Statistical Manual of Mental Disorders, the book that forms the bedrock of psychiatry. That would allow doctors to reclassify a significant portion of children who are considered bipolar, he said.

According to the definition under consideration, DMDD would be characterized by severe, recurrent temper outbursts in response to common stressors that are not developmentally appropriate and are out of proportion to the situation. Between tantrums, the child’s mood is nearly always negative, irritable, angry or sad. Such children are not like 3-year-olds who have fits if they don’t get cookies before dinner.

Symptoms would be apparent not just to parents but to teachers and others, and they would be present for at least 12 months before a diagnosis was made in a child under 10. It’s unclear how the condition would be treated, although proponents of the diagnosis say they are trying to reduce the use of antipsychotic medications.

But some of the symptoms can also be found in children with bipolar disorder or other conditions, said Dr. David A. Axelson, who argued against the proposed diagnosis this year in the Journal of Clinical Psychiatry. He and other experts say there is insufficient evidence that a distinct disorder exists.

“The scientific backing for it is quite lacking,” he said. “It doesn’t mean this shouldn’t be a diagnosis in the future, but we need solid scientific studies.”

David Miklowitz, a professor of psychology at UCLA, said he feared that many doctors who were reluctant to label children as having bipolar illness or conduct disorder would adopt DMDD as a default diagnosis.

“I think they are actually solving one problem but creating another,” he said. “The risk, with a diagnosis like this, is that clinicians who are strapped for time will slap on this diagnosis and say, ‘I’ve got it figured out.’ ”

The debate has been polarizing and uncharacteristically bitter for the mental health community. In his recent paper, Axelson and his colleagues charged that the proposal was “a step backward for the progression of psychiatry as a rational scientific discipline.”

And a past editor of the Diagnostic and Statistical Manual of Mental Disorders, Dr. Allen Frances, has written several critiques of the proposal, including one last summer that accused the scientific review group that endorsed DMDD of running a “sham review process.”

“New diagnoses are as potentially dangerous as new drugs, and we need a much tighter regulatory mechanism to ensure that they are both necessary and safe,” Frances said in an interview.

Fawcett acknowledged that more scientific evidence was typically needed to justify a move like this.

“Creating a new disorder should require much more evidence than we have,” he said. “But, on the other hand, there is a much bigger problem here.”

Alves doesn’t care what doctors decide to call her daughter’s condition, but she wants them to come up with a firm diagnosis. She wants strategic help for the child who, at 9 months, was having long bouts of screaming and uncontrollable crying and who, at age 3, would bang her head against the floor if something upset her.

Alves remembers the sunny day in June when the family attended Cecelia’s kindergarten performance at school. Cecelia didn’t want to go on stage and erupted in a 20-minute meltdown before reluctantly joining her classmates.

“It’s more apparent all the time that this is not just a tantrum,” Alves said.

Related posts:

1. The Borderline Child
2. The ICD-10 may provide a better diagnostic criteria for borderline than the DSM-V
3. Miami Dolphins Player Brandon Marshall admits to Borderline Personality Disorder

Related posts brought to you by Yet Another Related Posts Plugin.

1. Physical sensitivity to the sensory input. This sensitivity may include the inability to tolerate loud environments, to wear “scratchy” clothing or expressions of disgust with smells that others are not sensitive to.
2. Inconsolable as a baby or toddler. The “borderline” child is more likely to exhibit more distress than his/her siblings and have long crying jags and/or temper tantrums.
3. Migraine headaches and/or other physical, chronic pain. Pain is a common feature of BPD. This pain may show up in childhood as a migraine or some other form of physical pain.
4. Inability to integrate the meaning emotional experiences. This represents at some level a “failure to mentalize” on the part of the child. He/she may exhibit an inability to understand the emotions of others as displayed in their faces and/or through their actions.
5. Intense personalization of events. The belief that all things are “about them” or “about their feelings,” particularly social events and situations.
6. Anxiety leading to avoidant behavior. This can represent itself through avoiding social situations (e.g. “because those people are mean”) and or avoiding academic tasks.
7. Intense emotional reactions to frustration. Temper tantrums and the inability to tolerate frustrating emotional situations, particular social ones. This can manifest itself in violence or in bridge-burning.
8. Shame. The feeling that he/she is not a worthy person and “deserves” to get hurt. He/she may also “run away” from friendships or social situations that are shame-inducing.
9. Not feeling “normal”. Young people with BPD seem to feel at some level “something is wrong with me” or “I’m not normal”.  The feeling of “strangeness” seems to be a theme in young people with BPD.
10. Expectations of doom. The concern that at any time the world is going to come down around their ears, especially socially. Sometimes there is paranoia around this subject, as if their friends are really “fooling” them into believing they’re liked. At any time, the borderline child could be rejected and ostracized.

While this is probably not a completely exhaustive list of the traits of the borderline child, these are the common traits I’ve experienced and been told. It is important for parents to identify an “emotionally vulnerable” child as early as possible. The road of an adolescent and young adult borderline can be dangerous, painful and even deadly. Borderlines are 400 times more likely to commit suicide than the general population. Based on the non-scientific polls conducted on my website, 70-75% of borderlines abuse substances, engage in self-injury and attempt suicide at least once in their lives.

Related posts:

1. Adopted Children and BPD
2. Understanding Borderline Personality Disorder from WHYY
3. BPD Myth Busting: 7 common myths about Borderline Personality Disorder

Related posts brought to you by Yet Another Related Posts Plugin.

Genetics in Borderline Personality Disorder

I was reading an article called “Social cognition in borderline personality disorder: evidence for disturbed recognition of the emotions, thoughts, and intentions of others” and noticed a line in the article that said this: “Thus, in addition to high heritability of BPD (Torgersen et al., 2008), these results argue that environmental factors (e.g., trauma) contribute to disturbed social cognition in BPD. In sum­mary, for the current study we expected PTSD to be a negative predictor of social cognition.” That intrigued me on two levels. One was the “high heritability” part, because often I see comments about BPD and how many people believe that it is mainly caused by childhood trauma (and/or invalidation). In WHINE I state this: As I said earlier, one of the causes of BPD is the “invalidating environment.” Now, it could be that it is not an actual “cause” (and that all the real causes of BPD are biological), but more a reinforcer of BPD. So, the second part of the article that intrigued me was the idea that “we expected PTSD to be a negative predictor of social cognition” – and the discussion and methodology of comorbid PTSD with BPD. What they found was that people with BPD (with or without comorbid PTSD) are less able to understand the intent, thoughts and motivations of social interactions in others – in other words, people with BPD can’t mentalize as well as controls. They also found that this lack of ability is more marked in people with BPD who also have comorbid PTSD. The fact that they mention comorbid PTSD at all is something of a revelation – or perhaps should be to us nons. Many people come to support lists and do research on the Internet and begin their “introduction” of their BPD person with a long list of childhood traumas that explains why the person has BPD. This current research would indicate that PTSD and BPD are clearly two separate disorders and that, while PTSD is a contributor to poorer functioning that BPD alone, BPD is in itself a highly inheritable disorder and biological in nature, yet “reinforced” or made more severe (especially in a social functioning sense) when PTSD is present.

Anyway, this research led me to another scientific study called “Familial Resemblance of Borderline Personality Disorder Features: Genetic or Cultural Transmission?” In which the researchers studied twins, siblings and parents of borderlines to determine the genetic underpinning of BPD or whether the environment and/or cultural influences could have more of an influence on the development of BPD. They found this: “In the present study an extended twin-family design was applied to self-report data of twins (N = 5,017) and their siblings (N = 1,266), parents (N = 3,064) and spouses (N = 939) from 4,015 families, to estimate the effects of additive and non-additive genetic and environmental factors, cultural transmission and non-random mating on individual differences in borderline personality features. Results showed that resemblance among biological relatives could completely be attributed to genetic effects.” and this: “There was no effect of cultural transmission from parents to offspring.”

Recently, in the ATSTP group, we have been discussing the idea that shame/honor-based cultures  and whether that environment could be explanatory in some sense of the development of BPD. It appears (at least based on this 2009 study) that the development and transmission of BPD is NOT cultural. It is essentially genetic (mainly “additive”, meaning it is more than one gene involved) and the environment has an effect, yet cultural transmission was not apparent.

They do go on to say this: “Gene by environment interaction implies that genes determine the degree to which an individual is sensitive to an environment. In the presence of gene-environment interaction, individuals with a ‘sensitive’ genotype will be at greater risk of developing BPD if an undesirable environment is present, than individuals with an ‘insensitive’ genotype.” So, basically, although this interaction has not been fully studied, it appears that some sort of “sensitive” genotype is required to develop BPD.

Related posts:

1. Bellman’s Syndrome – BPD and Chronic Pain
2. Possible Genetic link in BPD?

Related posts brought to you by Yet Another Related Posts Plugin.

Lindsay Lohan and BPD?

I read an article today about Lindsay Lohan from Fox News’ Dr. Keith Albow entitled “What Lindsay Lohan’s Parents Stole From Her”. While I can certainly understand Dr. Albow’s point at some level (although mostly I believe it was to attract readers to Fox with a catchy title about Lindsay Lohan’s situation), I have a problem with Dr. Albow’s analysis of Ms. Lohan’s parents. My problem has several facets to it, so you’ll have to bear with me as I go through them. The first part of my problem has to do with the “blaming the parents” aspect of mental health care and the attitude of mental health care professionals. When you take a child with possible BPD or with behavioral issues like Ms. Lohan has reportedly experienced (those include possible theft, substance abuse, sexual orientation confusion, impulsive actions, self-injury, depression, anxiety and the like), the first thing that is assumed about you is that the child has experienced trauma, neglect or abuse by the parents (that is, YOU). Oftentimes this is NOT the case. I have two daughters (fraternal twins) and one of them has emotional regulation issues, the other does not. The environment in which they were raised was essential the same. The thing is, the children are not the same. I know of another individual who has two daughters, two years apart in age, one of which is a drug addict who never attended college and the other has a ph. d. They were also seemingly raised in the same environment. Granted, neither my children nor the daughters of my friend are child stars as Ms. Lohan was. Yet, my problem #1 is blaming the parents. It doesn’t do anything to help Ms. Lohan. In DBT there’s a couple of rules that you learn at the beginning. One of these “rules” (or guidelines) goes something like this: Even though I didn’t cause some of my problems, I still have to be responsible for solving those problems. In other words, even if you lay the cause and responsibly solely at the feet of Ms. Lohan’s parents and what they “stole” from her, it doesn’t function to make Ms. Lohan behave more effectively or feel any better. Instead, now that she is an adult, she will be required to take responsibility for her behavior and learn the skills necessary to function in a more effective manner, regardless of who caused her problems. I want you all to understand though, if she DOES indeed have a mental illness, these problems might be more difficult for her to overcome. That is because IMO (and in the recent opinions of many scientists) there is a biological component to most mental illnesses (including BPD) and, whereas many people with BPD also have comorbid PTSD from trauma and/or abuse/neglect, many do not. I believe that in order to have BPD the biological component must be present. Dr. Marsha Linehan’s bio-social model seems to reflect this. In other words, in the case of my twins and my friend’s daughters, what is different about each of them is their biological system, not the environment. The kids are different biologically. In the case of Ms. Lohan, perhaps she also has a biological feature that would increase the likelihood of impulsive behavior (among other features).

Now this brings me to point #2 which has to do with boundaries and the fuzzy understanding of what boundaries are. Dr. Albow says:

If she’s guilty, she did it for the same reason she illegally used drugs and drove under the influence and—maybe—assaulted an employee at The Betty Ford Center: She had so much stolen from her as a young person, had her boundaries violated so feloniously, that she considers the boundaries of others irrelevant.

Ahh, boundaries! Anytime I mention BPD to anyone who is not steeped in the world of BPD/non-BPD, including and especially therapists, one of the first things out of their mouths is boundaries (after trauma/abuse). This doctor doesn’t understand boundaries and the way that they function. A person like Lindsay Lohan doesn’t have a boundary problem, she has an emotional problem. You could rewrite the first sentence like this:

If she’s guilty, she did it for the same reason she illegally used drugs and drove under the influence and—maybe—assaulted an employee at The Betty Ford Center: she is in a great deal of emotional pain, has issues regulating her emotions, is impulsive and will behave in an “anything to stop the pain” manner. She acts on her emotions and action impulses before she thinks of the consequences.

Her problem is dysphoria and a poor sense of well-being, which in turn leads to impulsive behavior like shoplifting a necklace when you could just afford to buy one.

I don’t want to go into a long discussion of boundaries here. I‘ve talk about boundaries so many times, it gets old. If you understand my view of boundaries and rules and consequences and intent and the differentiation between these important behavioral and mental concepts, you’ll immediately see why I object to the “boundary violation” explanation of  Ms. Lohan’s make-up and behavior. No, the problem with Lindsay Lohan is (IMO) dysphoria, poor impulse control, emotional dysregulation and a large amount of emotional pain. That is why she does the drugs, steals things (allegedly), engages in risky behavior, cuts herself, etc. It’s not because she “considers the boundaries of others irrelevant”. That statement just shows me that you, doctor, don’t understand boundaries, despite your status as a mental health professional and a Fox News guy. In fact, it has NOTHING to do with the other’s boundaries or feelings at all. It’s all about her feelings.

My last problem with the article has to do with this statement:

Assault and theft. Lindsay Lohan, I would venture, knows all about those things, very deep inside. And not just because of what she did. No, no. Don’t believe that for a moment. Mostly, this is a story about what was done to her.

No, it’s not a story about what was done to her. I’m sorry, but the problem for Ms. Lohan is two-fold. Firstly, if she does indeed have mental health issues, emotional issues, substance abuse issues, and behavioral issues, it is her responsibility as an adult to address those effectively. The question is not “what was done to her by whom?” – it’s “what does she do about it now?” She’s no longer a child. She must address her behavioral issues with the help of a mental health, substance abuse and/or behavioral health specialist. If she continues to play out the approach that Dr. Albow espouses here – the “I had a f*cked up childhood” approach, she’s going to continue to behave ineffectively. What she’s doing is anything to stop the pain, yet, ironically, it is causing MORE pain for her because she’s behaving in an ineffective manner.

Secondly, like everyone in society, Ms. Lohan has to learn that her behavior has consequences, even unintended ones. Sure, she might have a disorder like BPD in which she would find it difficult NOT to behave impulsively and in a pain-killing way, yet when all that is done, she has to face the consequences of her behavior like everyone else. As I have said in the past, just because you didn’t mean to burn down the house while playing with matches, doesn’t mean the house magically comes back from the ashes. No, the house is still in ashes whether your parents abused/neglected you or you were just trying to stop the pain inside your head. Ms. Lohan’s behavior has consequences and sometimes those consequences are going to jail. The judge is not going to accept the argument, “my parents made me do this by taking away my childhood.”

And all of that brings me back to the serenity prayer, which (as I have said in “When Hope is Not Enough”) I always thought was a stupid cliche, yet, Lindsay Lohan is an excellent example of those words at work. (And BTW, I am not a support of A.A., despite my reference to the prayer). Ms. Lohan has no ability to change what her parents did to her. That is something she must accept. Trying to change those things will  cause frustration and, in her case, maybe incarceration. What she CAN change is her future by learning to behave more effectively and manage her emotions more effectively. If she doesn’t do that, she’s going to end up helpless (“my parents made me this way and there’s nothing I can do about it”), in jail or on the wrong side of the grass.

Related posts:

1. Amy Winehouse is back in the news again
2. Why would Lindsay Lohan shoplift?
3. Lindsay Lohan and possible BPD (more detail this time)

Related posts brought to you by Yet Another Related Posts Plugin.

Tough Love and BPD

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

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

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

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

Related posts:

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

Related posts brought to you by Yet Another Related Posts Plugin.

Are you and your BP on the same team?

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

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

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

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

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

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

Related posts:

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

Related posts brought to you by Yet Another Related Posts Plugin.

Learned Helplessness and PTSD

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

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

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

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

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

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

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

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

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

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

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

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

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

Related posts:

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

Related posts brought to you by Yet Another Related Posts Plugin.

Possible Genetic Causes Of Borderline Personality Disorder Identified

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

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

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

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

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

Related posts:

1. Genetics and BPD
2. Adopted Children and BPD
3. Widely Used Bipolar Screening Test Widely Wrong

Related posts brought to you by Yet Another Related Posts Plugin.

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

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

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

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

Related posts:

1. A Note about BPD and Boundaries And SWOE
2. Cheerleading as an effective relationship skill
3. Tough Love is not an effective approach to BPD

Related posts brought to you by Yet Another Related Posts Plugin.

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

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

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

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

Related posts:

1. Why did I bother to write a book?
2. Book Review: Overcoming Borderline Personality Disorder
3. A new book from Bon

Related posts brought to you by Yet Another Related Posts Plugin.

I also found an article called “Spiritual Glasses to Understand the Difficult Child” which was described with the question: When you get frustrated with your child, what is the most effective discipline? I was intrigued and decided to read the article.

I have to say, I was surprised by the wisdom in some of her comments. I find it interesting that what she says about children can be applied directly to people with BPD. Consider the following:

If your child is a chronic liar, parents worry and panic. The spiritual glasses allow you to see a very insecure child with poor self concept or image. Are your expectations of him too high? Why does he feel worthless? Is he bullied around by friends or older siblings?

I get more searches on this blog for “lying,” “liars,” “chronic liars,” etc. than about anything else. (Actually to be honest the most searches I get are about “celebrities with BPD” or some variant of that, but lying-related searches come in a close second.) I’d like to take her words and apply them to BPD and replace the words “spiritual glasses” with “emotional glasses.” I think if you look at a chronic liar, which many people with BPD are, you will find that one motivation for lying is a poor self image, feeling worthless or insecurity. These concepts are interrelated and spring from shame. People with BPD do have a poor self-image. Even though many nons report that their loved one with BPD is selfish or narcissistic, in reality people with BPD actually hate themselves. This feeling arises from shame as well, but the shame also arises from emotional invalidation. Mrs. Treasures doesn’t really provide a prescription for dealing with a liar, other than not to label (judge) the child as a “difficult child” right away and try to understand them and set proper expectations. The same can be said of a non’s relationship with a BP. Judging their behavior as “difficult” right away or setting expectations too high can invalidate the BP’s emotional responses. This sets up an “invalidating environment” for the child’s emotions and the effects of an invalidating environment are summarized by Dr. Marsha Linehan:

[The] effect of an invalidating environment, especially when basic emotions such as fear, anger, and sadness are invalidated, is that a person in such an environment does not learn when to trust her own emotional responses as valid reflections of individual and situational events. Thus, she is unable to validate and trust herself… If communication of negative emotions is punished, as it often is in invalidating environment, then a response of shame follows experiencing the intense emotion in the first place and expressing it publicly in the second.[i]

If a person is unable to trust herself, she can not validate herself and a “response of shame follows” emotional experiences. That is one pathway to BPD. If you punish a child for feeling inadequate, for example, if the child is lying to you because he wants to make himself feel better about himself, then you are invalidating his emotional responses.

Mrs. Treasures also say this about temper tantrums:

For your younger children showing tantrums and hitting other siblings, the spiritual glasses permit you to see a child struggling to deal with his immature emotions. The child’s frustration is his inability to communicate his feelings and needs to his siblings.

Again, if we substitute “emotional glasses” for “spiritual glasses” and “BP” for “child,” I believe she is accurately describing the state of someone with BPD. People with BPD are emotionally immature. It’s not their fault; it’s just that they were not raised in an emotionally supportive environment. They feel that by feeling emotions intensely, they are wrong and should be punished. Again, the shame comes into play. They do have an “inability to communicate [their] feelings.” Because of the invalidating environment, the BP becomes unable to trust her own emotions and becomes frustrated and angry. THAT is what fuels rage more than anything.

OK, now what do you do to counter-act an invalidating environment (with both children and BPs)? You learn to validate their emotional responses. I have quite a few examples of validation techniques on this site and if you follow this link, you can read about validation.

[i] Linehan, Marsha, Cognitive-Behavioral Treatment of Borderline Personality Disorder, pg 72

Related posts:

1. Genetics and BPD
2. Shame and Invalidation
3. Talking to someone with emotional issues

Related posts brought to you by Yet Another Related Posts Plugin.

http://www.helium.com/tm/339437/individuals-suffering-borderline-personality

In which the author gives some insight and advice about “dealing with” someone with Borderline Personality Disorder. I’d like to look at her advice by excerpting some of her text and then offer a little commentary.

First of all, she says this:

Individuals suffering from borderline personality disorder are very self-destructive and they have great difficulty forming any good relationships. A deep-seeded fear of abandonment is behind every wayward action and prolonged mood swing. It’s [sic] victims are mainly women who show frequent displays of inappropriate anger and who exhibit forms of self-mutilation. They also act on impulse, without regards to consequences and than [sic] hold others responsible for their actions. They are sexually permissive and may indulge in binge eating and drug abuse. Victims of this disorder may shop lift. Hell bent on harming themselves, they live with no discipline or boundary.

While this characterization is generally true, it suffers from what wikipedia calls “weasel words”. Basically, the words that are used slant the information toward being extremely judgmental. What I mean is the use of the words “great difficulty forming any good relationships,” “every wayward action and prolonged mood swing,” “show frequent displays of inappropriate anger,” and “they live with no discipline or boundary” all show us that the author is judgmental toward the sufferer. The idea of “prolonged mood swing” is incorrect as well, since the “moods” of a person with BPD generally last only hours. Also, the idea that “they are sexually permissive” MAY be true for some of the sufferers, but not for all. The idea that a “fear of abandonment is behind EVERY wayward action” is also incorrect. Much of the “actions” are motivated by pain relief and/or shame. Use of the words “no discipline” betrays the authors true feelings about people with the disorder and tells me she doesn’t understand the disorder very well (see below on “Tough Love”).

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

The author goes on to say:

Group therapy can resolve self-destructive behaviors. These individuals learn better from their peers because of their resistance to authority. Impulse behavior can be curtailed in this same setting.

Which is basically wrong. Group therapy does work (especially in the context of DBT), but not for the reasons that the author suggests. It is not a “resistance to authority” that drives the effectiveness of group therapy. Instead, seeing that one is not the only sufferer and having the ability to support one another normalizes the disorder. You are not just the broken, shameful person that you feel you are. Interestingly, many people with BPD will criticize others in the group and report that they are not as “crazy” as those people are.

The thing I have the most problem with is this:

Tough love may be needed from family members and loved ones before the person asks for assistance.

This statement is completely false and possibly harmful. Here is the text of a post of mine in the ATSTP group which addresses Tough Love:

Depending on the actual problem with your son(s) the idea of “tough love” might be the worst thing for him (them). While it seems to work for substance abuse, tough love can be an awful mixture for those with ERD-like issues. The problem comes down to the “invalidating environment” as Marsha Linehan puts it. Tough love will invalidate a person’s basic feelings and lead to shame and the feeling of “brokenness”. I have seen this first-hand with one of my daughter’s friends. This friend is 16 now and is a classic BPD/ERD case. She has been kicked out of several “lock down” facilities. Recently her mother sent her to a “tough love”/boot camp. It was a total disaster for the kid and for the family.

A better approach IMO, is emotional validation + a sense of personal responsibility. This combination is built through letting the person know that feelings are not wrong or right, they just ARE. The second half comes through building mastery over their behavior associated with feelings. Bad feelings just exist. This is important because often a person with such issues will use behaviors (like drug abuse or cutting or raging) to make the bad feelings go away as quickly as possible. They need to learn to tolerate the distress and behave in an effective manner. Once this new behavior/reaction to feelings is practiced, they can eventually build mastery over the behaviors. This works backward to help quell the feelings.

It seems that most parents believe that emotional validation = “giving in” (or agreeing with the child or “poor discipline” or whatever). This is NOT the case. It’s difficult for me to express this more firmly. Remember the word “emotional” is important. If you validate invalid behavior, you are enabling. It is important to separate in your mind the emotions (which are natural) from the behavior (which can be painful to all involved). If that separation can be communicated to the person with ERD, it can be worked with. It is difficult, but possible.

Unfortunately, tough love is not the answer.

Related posts:

1. Book Review of WHINE from “Tides of Crazy Love”
2. Tough Love Reconsidered with BPD
3. Courtney Love loses custody of her daughter

Related posts brought to you by Yet Another Related Posts Plugin.

My wife can be very validating and understand at times (even more than me); however, she also takes the “life is hard” and “get over it/suck it up” route with our children at times. I don’t know if you other nons have experienced the same thing, but I see a lot of that in my Google Email Group. If you’d like to discuss this further, you can leave a comment here or, better, request to join the Anything to Stop the Pain Google Email Group by going here:

http://groups.google.com/group/ATSTPGroup

Related posts:

1. A Note about BPD and Boundaries And SWOE

Related posts brought to you by Yet Another Related Posts Plugin.

The effect of genes on the development of BPD is likely substantial. The effect of common family environment may be close to zero.

While the study doesn’t conclude that BPD is 100% inherited, it does point to certain genetic factors in the BPD adaptive behaviors (or maladaptive).

The main point of posting this is to chip away at the myth that BPD and other personality disorders are all the “fault” of parenting or abusive environments. One of the big problems that I have seen in the social, psychological and medical community is that when a child is identified as borderline, the parents immediately come under suspicion as being abusive or neglectful. This can cause more consternation and confusion on the part of the parents who are already dealing with a serious mental illness and the issues that come with it.

There is a common myth concerning BPD. That myth is that BPD is completely and only caused by abusive environments. Invalidating environments can be a contributing cause – but these invalidating environments do not have to be abusive. If a certain child is emotionally unstable, sometimes the parents’ reaction is “cut it out” or “get over it”. The problem with this approach is that the child feels how they feel regardless of their adpative abilities (or lack thereof). In other words, the child may feel scared or angry even if there is no external reason to feel that way. These feelings (or the inability to control them) CAN be genetic – it might be that that is just the way that they ARE.

That being said, BPD is not a sure thing or a life sentence. The sufferer can learn skills to adpat to their emotional states. Their families can also learn these skills and, if they do, they can stop contributing (even unknowingly) to the borderlines problems.

It is saddening that personality disorders (particularly Borderline and Schizotypal) are classified as Axis II disorders when other disorders (like Bipolar and Schizophernia) are Axis I. Why does it matter? It matters because of access to mental health care is restricted due to insurance coverage limitations.

Related posts:

1. Invalidating Environments

Related posts brought to you by Yet Another Related Posts Plugin.

This was my response on WTO to a woman who was very angry with her daughter for lying to her and for having friends over to her (the mother’s) house all night when the mother specifically prohibited it. The mother felt very manipulated and angry – she felt the daughter was disobeying her to hurt her. FYI, the daughter is 23 and was diagnosed with BPD when she was about 16.

Hi. Yes, I thought that your daughter was in a situation like that – around 21-25, diagnosed with BPD and once in a residential facility. The reason I asked those specific questions is that I have seen other young women in the exact situation as your daughter and acting exactly the same way. I could further speculate that your daughter has trouble keeping a job (even a very menial one), has difficulty getting up in the morning, smokes (or once did) or does (or did) rely on drugs or alcohol, etc. – typical BP behavior for young women her age.

I think I can help explain the motivation behind her actions. After you read this you can choose to believe me or not, but these comments are based on my experience with several BPs from a support group (a physical one) that I attended. I met many parents of BP daughters and spoke with them about their daughters behaviors and, after several weeks, their feelings. It took some time to see through the behaviors to the feelings. What I am giving you here is sort of a “short cut” to the underlying feelings of your BP daughter. It may be hard to believe at first, but I would encourage you to consider it carefully.

First of all, it totally stinks to have your daughter not heed your requests. It’s got to be extrememly frustrating to have a daughter who seems to sepcifically disobey you and lie to you on a daily basis. It also must be infuriating to see her “buffalo” the doctors that she goes to see.

However, I think I can explain all of that. I have found that BPs pretty much all feel the same way inside. So, I am going to speculate that the reason that your daughter lies to you and disobeys you to have her friends over is twofold (but inter-related):

1) She is too ashamed of herself to say “no” to her friends. She doesn’t want them to know that she’s “crazy”. She feels that the consequences with her friends to say “no” to them are greater than the consequences she will incur by lying to you. Meaning, her lying is not specifically to hurt you (although it DOES hurt you a lot, as I can see); instead, her lying is about her feelings of shame and her inability to say “no” to her friends because of it. It is VERY common for BPs to overcommit themselves to other people because they are desperately seeking approval from their peers. They feel that to be a good friend (and, for them, a good person), they have to give everything to their friends (at first). When this doesn’t make them feel any better inside, they withdrawl suddenly from friendships in anger – they split the friends black. But ultimately this behavior of valuation and devaluation is rooted in their inner shame about who they are. Why do they feel that way? Well, that could lead to a much longer discussion, but let’s just say that they ALL DO.

2) At 23, she is desperate to be “normal” and not be “crazy”. The stint in the in patient facility and the diagnosis of BPD has put a big red “C” (for crazy) across her chest. She’s terribly afraid that her friends will see that she is crazy and will run away from her (fear of abandonment). This fear is also rooted in shame. She is ashamed that she is not just a normal young woman like all of her peers. She’s 23, so she thinks “isn’t it ‘normal’ to be able to have friends over to your house all night?” The problem is she doesn’t know how it actually feels to be normal. And that she is not normal enough to have her own place yet (that probably also deeply embarrasses her). She has always (I suspect from when she was a little girl) felt uneasy about her feelings – she has always felt weird and broken inside. She is ashamed of that feeling, because it is not normal. She probably constantly worries about not being normal, about being broken. And then she worries about worrying too much and on and on. They (the BPs) all feel this way too. So she is fighting not really against you specifically, but against her own feelings of being not normal, of being crazy.

Anyway, I understand why you would feel that her actions are specifically designed to hurt you. She “buffalos” the doctors for the same reason. She is ashamed to admit to herself that she’s “crazy” in any way – although deep down she’s always known that she is “different” or “weird inside”. I have verfied these feelings with many different borderline teens, young adults and adults (including my wife and my “pre-BPD” daughter). I used to think that there was malice involved in their actions, but now I believe their actions are sad attempts to try and fill that deep sense of emptiness that they have inside them. They really don’t consider how their actions effect you at all. It takes time and learning before they can see that.

OK, I don’t know if I’m right on the money as far as the daughter is concerned. But feel free to comment if you think I am or am not.

Related posts:

1. Courtney Love loses custody of her daughter
2. Turning the Mind around Social Situations
3. Out of the darkness, Daughter Raises Awareness of BPD and suicide

Related posts brought to you by Yet Another Related Posts Plugin.

– snip

The WTO site is all about the “non” and
setting “boundaries” does this come from SWOE???

The non label does come from SWOE as far as I’ve been able to tell. It is in common usage now throuhgout the Internet and the BPD community in general. I know some in the DBT trade that are extremely upset about the use of the term non. A reponse from one of these people: “Would you call someone living with a cancer victim a ‘non’?” (as in non-cancer-patient). The belief that BPD is a medical condition (rather than, say, a purely behavioral one) is very strong in that community. Part of that is because most of the people I have met are parents of BPD daughters (all of them, no sons). I think they don’t want to feel that they have contributed in any way to their child’s condition. I can understnd this – it is painful enough to have a child with BPD, it is even more painful to think that you caused it.

At WTO we went round and round about nature vs. nuture. I think there is a combo of each involved. Most of the “non” community thinks that sexual or physical abuse is the ONLY cause of BPD. Clearly, that is not true. My wife was sexually abused, but my daughter (who shows signs of emotional regulation problems and impulsivity) has not been. As for parenting “style” – we have many times told my daughter to “cut it out” when she was acting particularly emotional – and that is invalidating. The completely weird thing is I always thought I’d treat all my children the same way, but now I know it won’t work. They are all different and all need different treatment of their emotional needs.

As for boundaries, I’m not sure why that seems to be the focus of the people that read SWOE. I hadn’t read it in a while, but I looked over the workbook and found the following:

1) It has a very validating message toward the nons, but a very “us vs. them” message to the BPs. I can understand this since the audience is the nons. We feel confused and upset and those feelings need validating as much as the BP’s feelings. Most BPs that have read the book think it is brutal toward them. Why? Because it paints them in a fairly manipulative light. I don’t think they find themselves to be manipulative. I no longer see my wife as manipulative, she just doesn’t have the self esteem or social skills to be that way. What is true is that her feelings are all about HER – so it feels like there is a selfishness in it, even when she hates herself.

A note from a borderline’s site on SWOE:

Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder

This is written primarily for those who care about someone with BPD rather than for BPs themselves. However, I have read it (I need to know what they’re writing about us) and can’t say I was over-impressed. I don’t think it presented BPD in a favourable light at all and it was written very much in an ‘us versus them’ style (a very provocative stance to present to a borderline!). It may provide important validation for those suffering at the hands of their BP’s confusing behaviour and help to explain where some of the ‘odd’ behaviour comes from, but I found it hard to evaluate the ‘self-help’ section as I found it very patronising. I believe there is a second edition of this out now, so who knows, maybe some of these problems have been ironed out. As far as I know it’s still the only book on BPD specifically for the friends and family of BPs so you may have no choice…

2) Boundaries DO play a large part in SWOE, but I think most people mis-understand them. Boundaries are for yourself. The idea that “control” of the BP can be affected by boundaries is clearly not the case. I think that what happens with boundaries is that nons have such anger and are feeling that their partners are doing all these crazy “out of control” things, that they are very empowered by the idea of boundaries. Usually the nons are co-dependant and either allow the behavior to happen or blow up and get angry with the BP. The boundaries provide them with a new sense of control over their life – so they’re like “whohoo!” Also, the boundaries provide nons with something that they can do without having to understand the BP at all. Meaning, it says, “all of the crazy behavior is the BP’s fault, they have no boundaries, they are manipulative, they are evil, etc.” so the nons latch on to that idea without having to take any responsibility for their own invalidating behvaior and without having to “look at the problem through the BP’s eyes” (being empathetic) and without having to show unconditional love to some one who is emotionally ill (compassion).

3) There are some nuggets of good information in SWOE (such as the DEAR and PUVAS techniques), but much of that good info is ignored by the nons that read it for the above reasons.

I can certainly see why nons would feel that it has not been about their feelings for so long that they need someone to say “Take care of YOURSELF and set up boundaries to do so”. It is a simple message and seems to be the only one that is tauted in most non boards.

Unfortnately, it is a recipe for divorce, if that’s the ONLY thing you do. It sucks to be a non, but I expect it sucks even worse to be a BP. If you want to help your BP, compassion is the key, not boundaries. You can’t save them, but you can deal with them in such a way that they will not go directly to Oz.

Of course, they have responsibilties too – like working to get better (and if you follow DBT, accepting themselves the way they are), but that is a decision they have to make. You can’t make it for them.

– snip

If you want to join my Non-BP-Bashing-”Non”-Email-List, go here:

http://groups.google.com/group/ATSTPGroup.

Related posts:

1. Stop Walking on Eggshells and Boundaries
2. Beyond Boundaries eBook now available on the Kindle!
3. Updated Beyond Boundaries eBook

Related posts brought to you by Yet Another Related Posts Plugin.

Related posts:

1. Blaming the parents
2. Development/Transmission of BPD: Genetic, Environmental or Cultural?
3. Ten signs of possible Borderline Personality Disorder in children

Related posts brought to you by Yet Another Related Posts Plugin.

Related posts:

1. Blaming Never Helps
2. The Borderline Child
3. Parents hope to raise awareness of BPD after daughter’s suicide

Related posts brought to you by Yet Another Related Posts Plugin.

Seeking to clarify some of these issues, my colleagues and I followed up a group of adolescents who had been referred for assessment to an adolescent unit in Sydney, Australia (Rey and others). Follow-up consisted of a lengthy interview during which a variety of diagnostic instruments and questionnaires was administered. These included the Personality Disorders Examination (Loranger). At the time of initial assessment, the average age was 14 years, while at follow-up it was 20 years. Of the 205 subjects who were located, 145 were fully interviewed. About half of these (44 percent) were female. During the ensuing six years, four of the subjects had died. One female, initially diagnosed as having attention-deficit disorder with hyperactivity, died of a heroin overdose following a period of severe disturbance during which she probably met criteria for conduct disorder. Two males suffered from conduct disorder. One committed suicide; the other died of multiple organ failure caused by hepatitis one day after being released from prison. One male had an adjustment disorder with disturbance of conduct. Reports from relatives at the time of follow-up suggest he was well-adjusted. He died in a car accident. There were 114 (56 percent) individuals with a disruptive disorder diagnosis among the 205 subjects located. Although numbers are too small to draw conclusions, these findings suggest that mortality (3.5 percent) among adolescents with these conditions is likely to be high.

Putting the mortality rate aside, we find that 56% were diagnosed with a disruptive disorder as children. The point here is that there was something wrong with them as children, although it was not labeled a “personality disorder.” If up to 10% of people with BPD take their own life, then it would seem to me that identifying the candidates for BPD as children would be paramount. If there is a constellation of childhood illnesses – childhood bipolar, ADHD, ODD, CD, etc. – then these children can be monitored to help them develop emotional skills to handle their labile emotional states. Here is a quote from a personal interview with a Borderline:

At about the age of 13. I kept feeling like something was missing in me, like I was “”defective”". My social skills were bad, and there was a growing feeling of a void inside me. I went to the school counselor, but as I could not yet identify what was wrong, was not really helped. At 14 I started to suffer from suicidal thoughts. It has never gone since. It’s always there, like some undercurrent. My parents are emotionally crippled in many ways and they could not help or understand, they would tell me to stop being so sensitive.

http://www.borderlinepersonalitytoday.com/main/interviewc.htm

Related posts:

1. Ask Bon: Why does my borderline rage at me?

Related posts brought to you by Yet Another Related Posts Plugin.