Resources

Books:

Website and book entitled Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD (Paperback)by Dr. Robert Friedel. I deeply appreciate Dr. Friedel's caring attitude and dedication.

New Hope for People with Borderline Personality Disorder: Your Friendly, Authoritative Guide to the Latest in Traditional and Complementary Solutions (Paperback) by Neil R. Bockian. My personal regime includes many "alternative" treatments and Dr. Bockian's research was very helpful to me in building my own treatment portfolio over-and-above just prescriptions and therapy.

Organizations:

National Education Alliance for Borderline Personality Disorder The local family support structure is solid and they provide enormously helpful "Family Connections" classes at a price that can't be beat!

Behavioral Tech, LLC, founded by Dr. Marsha Linehan, trains mental health care providers and treatment teams in DBT. I find Dr. Linehan to be a passionate advocate for us, as well as a brilliant discoverer of a treatment that works very well for many!

National Institute of Mental Health National Institute of Mental Health link on BPD. A brief overview that focuses on the symptoms, treatments, and research findings.

National Alliance on Mental Illness. The largest advocacy and education organization supporting all mental disorders.

Excerpt from "Self Help for Managing the Symptoms of BPD"

Splitting

Before we launch into the diagnostic criteria, I would like to explain the concept of splitting to you. Once you understand the role of splitting in your illness, you can really make some headway towards your healing. Splitting, simply put, is thinking in terms of black and white, or all or nothing.

Since we’ve lived with this thinking most of our lives, we accept is as just a part of our personality. In fact, it is part of our illness and responsible for much of our misery.

Some expected outcomes of this type of thinking are intense emotional responses and blaming loved ones for things they have not done.

This type of thinking is integral to almost all of our other symptoms, and working on changing this way of thinking will surely increase our quality of life dramatically.

Learning that life is not either/or, it is both/and, will greatly improve your life experiences. You will learn to become aware of each thought and to retrain your brain to think differently than you have in the past.

How does one even begin to recognize their own thoughts and change the way they think?

In my personal experience, Dialectical Behavioral Therapy, or DBT (see back of booklet for more information) is the most effective way to retrain our brains to not think this way. If you do not have a DBT center or therapist near you who will teach these skills, a therapist who genuinely understands the way someone with BPD thinks and who will actively utilize Cognitive Behavioral Therapy, or CBT, is another good choice.

There are other means to augment what you learn in DBT (or CBT), including yoga, meditation, and support groups which emphasis changing your distorted ways of thinking.

Now we will launch into the diagnostic criteria and ways to manage each symptom! I will begin each with the clinical definition, straight from the DSM-IV manual, and then add my own helpful tips.

 

Criterion One

As quoted from the DSM IV, this criterion indicates “frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined abandonment. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. These individuals are very sensitive to environmental circumstances. They experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden despair in reaction to a clinician’s announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment).

They may believe that this "abandonment" implies they are "bad." These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors, which are described separately in Criterion 5.”

Managing the Symptoms of Fears
of Abandonment

1. Understand and validate that your fears are real to you but may not be shared by others. Accept that those
without BPD may not understand your fears because they do not share them.

2. Use the logical side of your thinking to reassure yourself that your loved one’s absence may not mean what it feels like to you.

3. Calm yourself by thinking both of your loved one’s needs and feelings in addition to your own. Perhaps they are trying to make money or just take care of themselves AND care about you at the same time.

4. Prepare yourself for separations. Assemble photographs or an object of clothing of your loved one. As you look at or touch these objects, think of happy times together and the love you’ve shared.

5. Explain your impending anxiety and then ask for specific times of when they are leaving and when they will be returning to help with feelings of uncertainty.

6. Think through what you will do during times when you are apart. Make a list of indulgent activities you enjoy and engage in them liberally. Be good to yourself during these stressful times.

7. Have a list of people you can e-mail/text/call or chat with in order to connect with others.

8. Look at the journal of good things about you listed on page thirty-three.

 

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Questions and Answers

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!) Don't have insurance, 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, based on the work of Dr. Marsha Linehan (see my links page.) One of my 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 our 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.

Now you know why I have that quote on my home page!

 

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 BPD, 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 BPD 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.

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 :-)

Take good care,

Tami

How in the World Can I Help Her?!?!?!?

1. Use validating, non-judgemental language. I have this as number one for a reason! No matter what he is saying, repeat something back to them that they just said, just so they know you are listening. It is not helpful to correct, lay blame, lecture, etc. Listen without jumping to conclusions.

2. Find treatment options and present them to us. Don't expect us to be able to have the energy to do this for ourselves if we can't get out of bed.

2. Educate yourself. There are logical reasons why we behave the way we do! If you can understand "why", then it makes all the many small, as well as large, decisions we have to make each day much easier. You will receive clarity of direction for your loved ones' life, your own life, and you will learn not to take the behavior personal (very important!)

3. Lower your expectations, wayyyyyyy down. Accept that we are severely impaired in key areas of brain functioning and therefore are not capable of things that come easily for others. This is a big one for people to swallow! Here is a typical conversation: "But she is so talented! She has her PhD and yet she can't even hold down a job! I just can't accept that she can't work!" Trust me, if she is not working, she can't. But, with your support and proper treatment, she will work again! But it may take a while.

4. Learn to remain calm in crisis. If you think this one is impossible, think again. We live in internal crisis most of our lives and we are learning how to stay calm--so can you! Model this for us so we know it is possible!

5. Continue to model appropriate behavior, but don't try to "teach" us the right or wrong thing to do until we are ready. This seems counter-intuitive to parenting 101, but we often can not tolerate instruction from our loved ones without it inducing immense shame and fear.

6. Likewise, if you are fortunate enough to be married to one of us, don't expect that we are capable of negotiating through the typical daily life decisions with you until the core symptoms of our illness are somewhat under control. Once we learn how to regulate our emotions, understand that many of our thoughts are altered and gain effective communication skills, you will be delighted to find our conversations becoming much more productive and pleasant.

7. Take care of yourself.

8. Go to support groups!

9. Never, ever, ever discount the power of your love! It is the demonstration of your vulnerable love that will help heal the incredible hurt we usually are feeling. Trust your heart!

Congratulations! It's Just Borderline Personality Disorder!

You or some-one you care about has been diagnosed with BPD! I hope you have heard by now that BPD is highly treatable! Now you can finally get on with living a good life! I can tell you from my experience, that once you get over the initial shock of finding out that you have a brain disorder, things start to get better as you realize how nice the treatment is and how we finally have a place you belong!

I was thinking, when I was diagnosed, that having a mental illness confirmed what I had already suspected, that the culmination of all my pain and suffering would be my becoming a homeless person that no one cared about or wanted to be with. I felt REALLY sorry for myself, and yes, I believe, I was entitled to be able to wallow in some self pity for a bit. But quickly I found out that FINALLY I had an answer, a treatment and a cure! Hurray!

So, here is where I suggest you start: find out good sources of information, number one, and then with that information, find good treatment options and good support.

Research:

Now, this is the first thing I'm going to tell you about research: beware of what you read on the web! There are some angry people out there whose approach, in my opinion, is not helpful to any of us. We are in this together, and there is a lot of empirical evidence and compassionate advice that is beneficial to concentrate on for our healing.

If you are a reader, my favorite books are: New Hope for People with Borderline Personality Disorder by Dr. Neil R. Bockian and BPD Demystified by Dr. Robert Friedel. These books offer multiple treatment options, including traditional and alternative treatments, as well as useful information on self-help and the family perspective. Dr. Friedel, while professional and clinical in his approach, has a section on his relationship with his sister, Denise, who had BPD, and it helps me feel validated to know his passion for his work is fueled by his emotions towards his sister. These books can be read by consumers and supporters as well.

If you are a supporter, you may have figured out on your own that we consumers are very sensitive to what you say to us. There is a reason for that, and I'll point out right here that the flip side to us getting upset about things so easily is that we feel all emotions deeply, including our love for you. But, I digress...because we feel so deeply, especially early in our recovery, there are some things that a supporter can read that a consumer possibly could not. One of those books is Stop Walking on Eggshells. If you are a supporter and are looking for answers on how the heck to talk to us (quick!), there is a chapter on communicating with us that is right on!

Treatment:

I'll tell you in a nutshell, to save you a lot of time, what the current thought is on treatment. For some of us medication is helpful and for some not necessary. For all of us therapy is essential, and if your therapist doesn't know how to treat BPD, she may be doing more harm than good, so find one who knows your disorder! For all of us, DBT skills training can be enormously helpful and downright awesome! I have included links to all the information you'll need.

Support:

I recommend NEA BPD, and I have included their information on my links page. They are an informed, passionate and helpful organization. Additionally, NAMI has support groups that encompass all brain disorders. It is my understanding that BPD is a newcomer to their list of disorders, so some chapters may be more helpful than others. However, many BPD sufferers are diagnosed with multiple illnesses, so NAMI may be a supportive environment for a range of disorders.

Keep your mind open to possibilities...if you can't afford or can't find a particular solution, there will be another one! It's NOT black or white...there are many options. And be encouraged! Things can get better now!

Take care, Tami.

How it Feels to Be Inside My Brain

If you conduct a Google search right now, you will see plenty of studies that show that our brains, physically speaking, are different. This knowledge, hopefully, will bring you some relief, especially if you have experienced the self-doubt that we've felt when those around you expect you to act "normal" when your brain doesn't function well. I am presently participating in a study of my brain because I believe current research is a part of the reason for our hopeful future!

Here are two examples I just pulled from a quick search (note: I have not thoroughly researched these particular studies and am not endorsing them, I am merely citing them as some of the many that are out there):

"The patients with BPD had nearly 16% smaller volumes of the hippocampus (P<.001) and 8% smaller volumes of the amygdala (P<.05) than the healthy controls." Clink on link to study here.

"Subjects with BPD had a significantly smaller frontal lobe compared to comparison subjects." 

There is a ton of research that shows our brains really are different than "normal" people, and that helps explain things like our lack of impulse control, why we feel pain so deeply and why pleasure is often hard to feel.

I have a friend who has great compassion for his mentally retarded sister but refused to extend grace to his daughter with Borderline Personality Disorder. The reason, he explained, was that he believed his daughter was just being willful and lazy, while his sister obviously had a disability! Ahhhhhhhh!!! Can you see how we might get a little (OK, a lot) worked up sometimes? Yes, we may appear to be some of the brightest and most talented people out there, but on various levels, we don't THINK very well at times and suffer from degrees of impairment, when all the while, people around us expect WAY more from us than we are capable of!

And when those we care about express disappointment or frustration about our "failures", this causes us great (di)stress and then our brains function even more poorly. The other biggest stressors include: heavy performance demands (such as tough love, layoffs) and relationship difficulties (such as perceived or real abandonment.) These stressors may cause us to be "triggered" or highly aroused. (A note of great encouragement: you learn early in recovery what are your biggest "triggers" so you can start to avoid those situations. This often brings some degree of immediate relief. Eventually, you actually learn how to tolerate things that upset you greatly in the past.)

Because our emotions spike quicker, higher, and last longer than "normal" people, once we get triggered, we quickly go into a fight or flight response. Our internal response is more intense and lasts longer than most people. It feels like your adrenaline is coursing through your body, your heart is rapidly pounding and your thought processes are focused only on defending yourself, running or on dying. You can not think logically at this time because your emotions over-ride cognitive ability. On top of all that, it takes a very, very long time to calm down (up to three days for me), which is one of the reasons why many with our diagnosis self-harm or turn to drugs or alcohol--to try to stop feeling that way.

What it feels like in my head at that point is that I can NOT think clearly, except to defend myself, run or die. Fight or flight. Multiplied.

I hope that helps explain a little. One of the many reasons DBT training is so helpful is that it teaches us how to 1. become aware (mindful) of what exactly is going on in our brains and get control of our thoughts instead of them controlling us, 2. how not to get triggered in the first place and 3. how to calm ourselves down. It works! There are also medications that help with a lot of this and can offer enormous relief while the skills are being learned.

Take good care,

Tami