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“Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.” – from the interview
Bon: I found an interview with Dr. Leland Heller about Borderline Personality Disorder. He does a good job explaining the pain associated with the disorder… Here are some excerpts. The entire interview can be read here.
Diagnosing Borderline Personality Disorder And Finding Treatment That Works
Dr Heller: Good evening, It’s great to be here. I have a way of explaining the Borderline Personality Disorder in layman’s terms that might be useful. It’s how I explain it to patients and their families.
Imagine you had a pet dog and it runs into the street and by accident it’s hit by a car. The dog’s leg is broken and it limps off into an alley to lick it’s wounds. A friend of yours sees the dog and comes over to help. The dog is now feeling trapped and cornered – a “wounded animal” – and misinterprets the friend’s attempts to help. The dog snaps at the friend’s hand who is trying to help. The BPD (Borderline Personality Disorder) is a malfunction in the brain’s trapped or “cornered” animal area. Under stress, a seizure develops in that area. That’s why under stress, while raging, a borderline will say to him or herself: “Why am I doing this” – yet be unable to stop it. It’s a seizure – nerve cells firing inappropriately and out of control.
David: And the cause of Borderline Personality Disorder?
Dr Heller: The BPD has many causes including head trauma and brain infections, but it appears that emotional hurts literally damage the brain. Most likely the brain’s support cells – the 90% of brain cells called “glial cells” – are damaged by traumas, causing the person to overreact to stress once puberty strikes. During puberty the brain’s limbic system goes into “overdrive” and adolescents are at their highest risk of seizures in their lifetime. “Sticks and stones may break my bones…but names cause brain damage.” So does incest, abuse, severe trauma, head injuries, attention deficit disorder, and other causes.
David: From my understanding, one of the biggest difficulties facing individuals who have BPD is maintaining stable relationships. This is a great cause of consternation for those people who are on the other side of the relationship. What causes this?
Dr Heller: There are a number of problems. The three most significant are 1) inappropriate mood swings; 2) misinterpretation of motives; and 3) remembering those misinterpreted motives as real. Oftentimes self-fulfilling prophecies occur, and self-hate eventually leads to a significant other coming to the same conclusion – that the individual isn’t worth being with.
…
janet: Would you please tell us more about the self-hate characteristic and how that damages the BPD or his/her relationships?
Dr Heller: Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.
crazy32810: How is self-injury related to BPD?
Dr Heller: We all injure ourselves to stop noxious neurological sensations. Interestingly we do it in a linear manner, ripping the skin. A common noxious neurological sensation is the toxins released with an insect bite. BPD dysphoria is about as bad as it gets. The pain is horrible. Many individuals have broken major bones and declared the pain of the fracture was nowhere as severe as dysphoria. When an individual with the BPD discovers that self-mutilation, or other techniques of self injury, work to temporarily stop the pain of dysphoria – they’ll do what it takes to stop it. This is no different than the individual with a fracture wants pain medication. I broke my shoulder last December and I tried to deal with it without taking narcotics. I was foolish and wrong. The pain was so bad it needed to be treated medically. Once individuals with the BPD have their chronic symptoms stabilized, and have safe medication options that work for dysphoria, the self-destructive patterns are no longer needed to stop their pain.
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. Continue reading A therapy that helps to rebuild broken lives- DBT →
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.” Continue reading New guidance for management of self-harm issued →
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.
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.
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. Continue reading I’m going to jump – Suicide Prevention and influencing factors →
People with BPD are in a great deal of emotional pain. Since emotions are immediate and primal, emotional pain is also immediate and primal. As I have said, emotions represent a land-bridge between the body and the mind. Emotional pain manifests itself in both mental and physical ways. If you have ever been depressed or “fraught with grief” over the loss of something or someone important to you, you will know what I am saying in this regard.
Depression and grief can be a trying experience for anyone. You feel pain in every area of your body and mind. Sometimes you will just want to retreat to your bedroom and go to sleep for hours, just to get some relief from the physical and mental anguish you feel. The sleep represents a distraction of both the mind and the body from the experience of complete pain. You might also use alcohol to relieve the pain by “turning off your mind.” Many people “drink themselves into a stupor” and, in doing so, extinguish the pain for a short period. Pain-killers, whether over-the-counter or prescription, can also remove pain by working on the pain at its source (in the brain where pain is actually felt). Once, when I was asked by one of my daughters about how the Tylenol knew to go to her foot (which was in pain), rather than to her head (because she’d taken it for headaches before), I explained that it acts in the brain where she feels the pain, not where the pain actually “is.” In the case of emotional pain, the pain seems to be both in the body and in the mind, but the pain-feeling area of the brain is where these drugs act. See below about substance abuse.
People with BPD are likely to feel emotional pain many times a day every day. Since these emotions are basic (like fear, sadness and anger) the reactions to them are both physical and mental. These emotional pain-states are powerful and have the ability to overpower rational thinking. When you are in pain, regardless of the source, the main reaction of the body and mind is to get out of or to relieve the pain as soon as possible and by whatever means necessary. I used the example of someone who is literally on fire. This person will try to douse the flames in any way, without thinking about the people around her and what harm may come to others if the flames spread. This situation is analogous to a person in deep emotional pain. The person will do anything to stop the pain, which is why my Internet site and Internet list are called “anything to stop the pain” (ATSTP). This “anything” includes self-destructive and relationship-damaging behaviors. Continue reading Ask Bon: Why does my loved one with BPD do such dangerous things? (like cutting, drugs, etc.) →
This is a ground-breaking article and admission by Dr. Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), about her own struggles with mental illness and self-injury. A must read!
June 23, 2011
Expert on Mental Illness Reveals Her Own Fight
By BENEDICT CAREY
HARTFORD — Are you one of us?
The patient wanted to know, and her therapist — Marsha M. Linehan of the University of Washington, creator of a treatment used worldwide for severely suicidal people — had a ready answer. It was the one she always used to cut the question short, whether a patient asked it hopefully, accusingly or knowingly, having glimpsed the macramé of faded burns, cuts and welts on Dr. Linehan’s arms:
“You mean, have I suffered?”
“No, Marsha,” the patient replied, in an encounter last spring. “I mean one of us. Like us. Because if you were, it would give all of us so much hope.”
“That did it,” said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. “So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward.”
No one knows how many people with severe mental illness live what appear to be normal, successful lives, because such people are not in the habit of announcing themselves. They are too busy juggling responsibilities, paying the bills, studying, raising families — all while weathering gusts of dark emotions or delusions that would quickly overwhelm almost anyone else.
Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation’s mental health system is a shambles, they say, criminalizing many patients and warehousing some of the most severe in nursing and group homes where they receive care from workers with minimal qualifications.
Moreover, the enduring stigma of mental illness teaches people with such a diagnosis to think of themselves as victims, snuffing out the one thing that can motivate them to find treatment: hope.
“There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life,” said Elyn R. Saks, a professor at the University of Southern California School of Law who chronicles her own struggles with schizophrenia in “The Center Cannot Hold: My Journey Through Madness.” “We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.”
These include medication (usually), therapy (often), a measure of good luck (always) — and, most of all, the inner strength to manage one’s demons, if not banish them. That strength can come from any number of places, these former patients say: love, forgiveness, faith in God, a lifelong friendship.
But Dr. Linehan’s case shows there is no recipe. She was driven by a mission to rescue people who are chronically suicidal, often as a result of borderline personality disorder, an enigmatic condition characterized in part by self-destructive urges.
“I honestly didn’t realize at the time that I was dealing with myself,” she said. “But I suppose it’s true that I developed a therapy that provides the things I needed for so many years and never got.”
‘I Was in Hell’
She learned the central tragedy of severe mental illness the hard way, banging her head against the wall of a locked room. Continue reading Dr. Marsha Linehan comes out about her own struggles with mental illness →
In a recent article/review of Borderline Personality Disorder treatment options and management methodologies, the author quotes the Dr. John Gunderson in the New England Journal of Medicine May 26 issue:
“…BPD is present in about 6% of primary care patients and persons in community-based samples and in 15 to 20% of patients in psychiatric hospitals and outpatient clinics,” writes John G. Gunderson, MD, from the Psychosocial and Personality Research Program, McLean Hospital in Belmont, Massachusetts. “Patients with BPD usually enter treatment facilities after suicide attempts or after episodes of deliberate self-injury. Such episodes result in an average hospital stay of 6.3 days per year and nearly 1 emergency room visit every 2 years, rates that are 6 to 12 times those among patients with a major depressive disorder.”
As you can see BPD has a major financial impact on the health care system, not to mention the distress for the patients and their families.
When reviewing the various treatment options, the author says this about mentalization therapy:
Mentalization-based therapy is a cognitive or psychodynamic therapy including individual as well as group therapy. While assuming a “not-knowing” stance, the therapist insists that the patient “mentalize,” or examine and label his or her own experiences and those of others. This emphasis on thinking before reacting may be a process central to all effective therapies.
That “not-knowing” stance is what I tell the nons that I know: Be a detective, not a judge.
I’ve had conversations with several BPD “experts” about borderline behavior. There seems to be an assumption that many people with BPD are “silent” or “high-functioning” and do not engage in dangerous and/or ineffective behavior often attributed to the “typical” borderline.
In my group recently, a non-BPD was questioning his own “sanity” (I put it in quotes because I don’t believe that people with BPD are insane) and speculating that he was the one with BPD. One of our longer-time posters replied:
If you’re not throwing full-blown temper tantrums, freaking out because EVERYONE is out to get you, threatening to hurt or kill yourself, running away from those who love you because you’re afraid they’re going to leave you first, complaining that NOBODY loves or respects you AND popping pills and guzzling alcohol all at the same time… then, I think, you can go ahead and disqualify yourself.
Based on the polls that I have conducted over the past few months, I believe that she is right on the money. Here are the poll results from the last few polls about borderline behavior:
 Borderline Behavior Poll Results As you can see by these polls results, more than 73% responded that their borderlines (or themselves if they have the disorder) indicated that they have engaged in self-injury, suicide attempts and/or substance abuse. While these polls are certainly not scientific and it’s pretty much impossible for me to understand the profile of a person that responded, they results are, for me, striking. If 7 out of 10 (or more) individuals engage in these “low functioning” or ineffective borderline behaviors at some point in their lives, what should that tell us?
I believe that it tells us that the “typical” profile of someone with BPD is the “low functioning” or “classic” borderline. While I am sure there are others out there that operate in pretend mode (and pretend everything is ok while they “white-knuckle” their way through life), the vast majority of people with BPD seem to be caught in a spiral of ineffective and often dangerous behavior. They seem to me to be sending the message that they are in a great deal of emotional pain and are suffering greatly – that they will do anything to stop the pain that they feel. It also indicates to me that it is vital for parents of child with borderline-like traits and feelings do their best to get the child into appropriate treatment before their teenage years.
Today is the 5th 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.
A report from CNN about self-harm/self-injury in teens:
Websites may encourage self-injury in teens, young adults
Young adults and teens may believe that hurting themselves is normal and acceptable after watching videos and other media on Web-sharing sites like YouTube, new research indicates.
The findings, published in the journal Pediatrics, warn professionals and parents to be aware of the availability and dangers of such material for at-risk teens and young adults.
Deliberate self-injury without the intent of committing suicide is called “nonsuicidal self-injury” or NSSI. An estimated 14% to 24% of youth and young adults engage in this destructive behavior, according to the study. NSSI can also include relationship challenges, mental health symptoms, and risk for suicide and death, the study noted. Common forms of self-injury include cutting, burning, picking and embedding objects to cause pain or harm.
While other studies have looked at the availability of online information about self-injury, the authors focused on the scope of self-injury in videos uploaded on YouTube and watched by youth. They described their work as the first such study and noted that their findings could be relevant in risk, prevention and managing self-injury.
The authors focused on YouTube because, according to the site, since its inception in 2005 “YouTube is the world’s most popular online video community, allowing millions of people to discover, watch and share originally-created videos.”
Using the site’s search function the researchers looked for the terms “self-harm” and “self-injury,” identifying the site’s top 50 viewed videos containing a live person, and the top 50 viewed videos with words and photos or visual elements. The top 100 items that the study focused on were viewed over 2 million times, according to the analysis, and most – 80% – were available to a general audience.
The analysis of the self-injury content found that 53% was delivered in a factual or educational tone, while 51% was delivered in a melancholic tone. Pictures and videos commonly showed explicit demonstrations of the self-harming behavior.
Cutting was the most common type of behavior; more than half of the videos did not contain warnings about the graphic nature of the behavior. The average age of uploaders of the self-injury material was 25.39 years, according to the findings, and 95% were female. The authors surmise that the actual average age is probably younger because many YouTube users say they are older in order to access more content.
The study concludes that the findings about the volume and nature of self-injury content on YouTube show “an alarming new trend among youth and young adults and a significant issue for researchers and mental health workers.”
The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the risk for self-injury.
The study warns that health professionals need to be aware of this type and source of content, and to inquire about it when working with youth who practice self-injury because sites like YouTube can reach youth who may not openly discuss their behavior.
Self-harming is not typical behavior for otherwise untroubled teens and young adults, explained Dr. Charles Raison, an Emory University psychiatrist and CNNHealth.com’s mental health expert. It’s an action that kids with psychiatric problems may try.
“NSSI is a young person’s affliction…one in ten will kill themselves,” he said. “A lot of people will outgrow the behavior.”
Raison said that it’s common for troubled young people to share information about hurting themselves. Treatments can include antidepressants, antipsychotic drugs and psychotherapy.
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