Dear Tami - Borderline Personality Disorder Support

Tami answers some of the top questions she receives about Borderline Personality Disorder. Read on for her thoughts on medication, triggering events, and how to talk to someone with BPD in order to help calm them down.

Questions and Answers

Dear Tami:

I have a friend who is very intelligent and successful, but she seems to totally "lose herself" when she is with someone else. Because of this, she feels like she can't be in a relationship at all anymore. Can you explain what might be going on for her? --Sharon

Dear Sharon:

There are four separate Borderline Personality Disorder issues at play here, and they all work together:

The first issue goes along with unstable self image and feelings of emptiness = tying yourself to people, etc. to have a sense of stability.

The second is feelings of abandonment so you hyper-focus on the other person.

The third is splitting. Black and white. I am with you, so it's all about you, and I can't regulate me in all of it.

Also, often when people with Borderline Personality Disorder leave a relationship they do a different form of splitting by completely cutting the other person off. There are many partners and family members out there suffering the consequences of this.

The fourth is a lovely one, actually...and it is that you just love so passionately that you can't help but attend to the every need of your love.

With the right help, your friend can have both. She can both be herself and have a happy relationship.

I'll be routing for her!

--Tami

Dear Tami:

I have heard that you do not use any medications. My daughter is on five medications and would love to get to the point where you are! I know you use some alternative medications; would you tell me what they are?-Sandra

Dear Sandra:

I'm a big believer in medications, though I do not use them, and I'll explain why in a moment. Here is why I think medications are awesome, however: there is a biological basis for the symptoms of our disorder that may be dramatically improved with certain medications.

Some of the symptoms that may improve with medication are: depression, energy levels, distorted thinking, stress tolerance, anxiety and sleep disturbances.

As the brain heals, there may be a reduction in, or an elimination of, medications. So if you want to get off medications, keep up your cognitive therapy, which is the chief way we change our brains :-) I think that is such good news! Having said that, many remain on certain medications for a life-time because they find them so useful.

I do not use medications for two reasons:

1. I have twenty years of experience with herbal remedies and nutritional therapies. Once I figured out what my symptoms were (those mentioned above), I adjusted the vitamins/minerals/herbs and foods I was eating to help alleviate those symptoms (it is working very well!)

2. I do not have insurance that covers medications. This is an especially useful thing for you to know, because it is very possible for each of us to do our own research and take recovery into our own hands! It's our first exercise in learning to overcome our black and white thinking (and change our brains!) For example: If you don't have insurance, guess what? There are other options! Don't have access to a therapist who understands BPD? There are other options! You get the picture :-) Problem solve by doing research, asking lots of questions, and bouncing ideas off of anyone who will listen (including me!)

Dear Tami:

During your presentation you mentioned triggering events, could you tell us more about that topic? -Elaine

Dear Elaine:

I touch on that subject in this month's article, and point to my own two worst external triggers as being interpersonal conflict (usually relating to my feeling abandoned or invalidated) and performance demands (tough love especially.)

Currently I am receiving Dialectical Behavior Therapy (DBT), based on the work of Dr. Marsha Linehan (see my Borderline Personality Disorder Resources page.) One of my dbt skills training handouts from my class defines triggers in this way:

"An internal or external event can prompt emotion. Internal events, such as your thoughts, behaviors, and physical reactions, can provoke or stir up emotions. When the environment impinges and you react emotionally, this is called an external trigger...[A]n emotion is prompted by a person's interpretation of the event."

It is interesting to note that someone with a Borderline Personality Disorder diagnosis may be triggered internally as well as externally. Ever wonder why one might seem fine one moment, and then with no prompting external event, their mood suddenly changes?

In Dialectical Behavior Therapy, we learn how to identify the thought... which can lead to the emotion... which can lead to the action of acting out or acting in.

Dear Tami:

I wanted to let you know that your personal insight into this disorder has helped us understand our daughter more than anything we've come across. It seems that we just can't say the right thing to her. Will you help us understand how to speak with her so as not to upset her? Also, why does she sometimes want to be with us and at other times distance herself from us. It's very confusing. -Bill

Dear Bill:

I have Borderline Personality Disorder, but not all of us are the same, even though many characteristics may apply across the board. Speaking for myself, the single most important thing that can be said to stabilize and HEAL me, is to hear validating language. Perhaps it may be helpful for you to understand what is going on inside me at the moment. As an example, you may perceive that I am blowing a situation completely out of proportion and over-reacting. In fact, I am not acting, or over-dramatizing what I am feeling. In fact, I am probably minimizing the way I really am feeling at the time.

Think of the most painful event you have ever encountered in your life and multiply it a few to a hundred times: That is what I am feeling at that moment.

Think: What would your response be to a loved one at a funeral, or at the scene of a crime, or an accident? The first words would be soothing, comforting, or acknowledging the painful, emotional, situation at hand. Yes, details must be attended to... but the emotional response is appropriate and effective for that scenario. You intuitively know that emotions over-rule logic at that time, and you have sympathy for that. You know that if you offer a shoulder to cry on, or a sympathy card, that it will help the person better deal with the tasks at hand.

For us, because of the way our brains work, many events that you may manage with less difficulty may send us to the grave-site or scene-of-the-accident emotionally. The most efficient way of helping us many times is to simply use the preface, "I know this is upsetting to you" or "I know this has been very difficult for you and I'm here to help" before you say anything else. This may, in fact, diffuse our internal storm to some degree so that we can function once again.

I believe that much of our most impulsive behavior is due to our intense frustration at not being understood. Once we feel understood, much of that inner turmoil may dissipate, and we may better then be able to focus on the logical side of life.

Also, I believe your daughter deeply desires an intimate and sustaining relationship with you. That is what she wants. Her disorder prevents her from that and it is very difficult for her to be away from those she loves. The reason she leaves, or isolates away from you, is that the intensity of her emotions is too much for her to handle at the time. She may be afraid she will say something to hurt you, or do something wrong that she regrets later or is ashamed of. She may be very afraid of disappointing you, because, after all, she really IS "different."

Those with untreated, or new-to-treatment Borderline Personality Disorder are some of the most intensely lonely folks around, with no way to resolve their pain. Remember that. She is not so much rejecting you, even though she may, exactly, say those words. Take comfort in these facts in each and every interaction. Try to turn each thing she says that causes you self-doubt or grief around to feeling deep compassion for her painful condition and see if that helps with her borderline treatment.

I deeply appreciate your concern for your daughter and am touched by you reaching out to understand her. My hope is that she comprehends that concern and care and that it is healing to her. I realize that emotional validation may seem counter-intuitive to a "let's pull ourselves up by the bootstraps and fix it" mentality that many of us have been taught, but this is a less than helpful approach to highly emotional creatures such as myself and your (I'm certain) brilliant and amazing daughter.

I'll be glad to answer any more questions you have! Once again, I am deeply grateful for you. The fact that you are reading this shows you care, and/or that you want to grow and get better. Pat yourself on the back for that! (validate yourself :-)

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