Friday, February 18, 2011

Quotes from the Borderline...

 "People are afraid of themselves, of their own reality; their feelings most of all. People talk about how great love is but that's bullshit. Love hurts. Feelings are disturbing. People are taught that pain is evil and dangerous. How can they deal with love if they're afraid to feel. Pain is meant to wake us up. People try to hide their pain. But they're wrong. Pain is something to carry, like a radio. You feel your strength in the experience of pain. It's all in how you carry it. That's what matters. Pain is a feeling. Your feelings are a part of you. Your own reality. If you feel ashamed of them, and hide them, you're letting society destroy your reality. You should stand up for your right to feel pain."

~Jim Morrison~ 

Post Traumatic Stress Disorder - Stats and Facts Part 3


Approximately 25% of those with BPD/ERD also meet the criteria for post traumatic stress disorder.

So let me tell you a story. I had to go to a counseling session because I made a very poor decision concerning alcohol and driving. I had to have a psychological evaluation and talk to a social worker about my past and stuff. First off, let me tell you that I hate, HATE, talking to shrinks that are not of my choosing. I don’t believe it’s any of anyone’s business to ask me such personal questions, intimate, details of my life. Especially when they inevitably make snap decisions and diagnosis because one session is not enough time to understand anyone. So anyways, I had this session. The guy (the only male counselor other than my psych I’ve ever talked to) started asking me questions off of a list of psych questions. It was clear that he cared precisely zero about me as a person. He just needed to get through his checklist. Throughout the interview he ask me questions, then instead of letting me talk, cuts me off and proposes his own theories and tangents. So he’s asking me these questions when he gets to the section on pysical/mental/emotional abuse. It’s at this point I’m debating whether or not I want to tell him the truth or just get him to skim past this. I decided that the truth would work to my benefit as it was part of why I landed there in the first place. So as soon as I start saying yes to some of his questions his eyes light up and he proclaims that I have Post Traumatic Stress Disorder. WTF? He didn’t even ask me to elaborate on the situations he was asking about. He just went on and on about PTSD, cutting me off when I tried to elaborate, and got way to excited about my potential mental disorder. It was clear that PTSD was his pet subject. So while I have technically had a diagnosis of PTSD, I don’t believe it. It makes me wonder how accurate some diagnoses are too. People are human and therefore subject to their own biases.

And while I might fit the technical criteria for PTSD, the incidents that made him jump to this conclusion had less lasting traumatic effect on me than did a really bad car accident I was in while I was at university (years after my BPD emerged).

So let’s take a look at what PTSD is (and how I potentially fit the criteria):

Causes - Psychological trauma:

“PTSD is believed to be caused by either physical trauma or psychological trauma, or more frequently a combination of both. PTSD is more likely to be caused by physical or psychological trauma caused by humans such as rape, war, or terrorist attack than trauma caused by natural disasters. Possible sources of trauma include experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).  Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, sexual assault, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, violent automobile accidents or getting a diagnosis of a life-threatening illness. Children or adults may develop PTSD symptoms by experiencing bullying or mobbing. Preliminary research suggests that child abuse may interact with mutations in a stress-related gene to increase the risk of PTSD in adults.”

Criteria:

The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as.

A: Exposure to a traumatic event
- This must have involved both (a) loss of "physical integrity", or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror or helplessness (an event was "outside the range of usual human experience.").

Yep. Definitely had a few such instances involving abuse and a particularly bad car accident.

B: Persistent re-experiencing
- One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).

You be the judge. I often have distressing dreams but they’re no longer terrorizing. Intense negative responses: If you consider an inability to let most guys touch me without utter revulsion, freaking out and regretting any instance where it occurs outside of my comfort zone, constantly disavowing any intimate male companionship (this never sticks) and quickly second guessing, overanalyzing their motives… or… when I’m a passenger in someone else’s vehicle I often have knee jerk reactions with braking too hard, or getting to close to other vehicles. This causes me to pull back, hard knees to chest, my heart rate to speed up, grabbing onto the ‘oh shit’ handle and my breath catching in my throat. I prefer to drive.


C: Persistent avoidance and emotional numbing
This involves a sufficient level of:
- avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s);
- avoidance of behaviors, places, or people that might lead to distressing memories;
inability to recall major parts of the trauma(s), or decreased involvement in significant life activities;
- decreased capacity (down to complete inability) to feel certain feelings;
- an expectation that one's future will be somehow constrained in ways not normal to other people.

Heh. After some such events I severed contact with certain people, wanting nothing to do with them or those that are involved with them. Avoiding situations where I might even have the possibility of running into them. Not places that I was sure they would be (though of course I won’t go there) but places they might be, where there is even a small chance of it. After one incident in my early 20’s I completely repressed events, only recalling it years later after I found a journal that I had written immediately after and then completely forgot about. I still only have flashes of this, not a full recollection. Decreased capacity to feel certain feelings. ::smirk:: I often have a complete inability to feel feelings at all. This problem is what lead to the diagnosis of my Dissociative Disorder. When I have extreme stress, loss, and/or conflict I depersonalize and derealize from my life and even my own body. I do absolutely expect that my future will be constrained. My present is currently constrained in ways not normal to other people. I have a Borderline Personality Disorder. I’m pretty sure, by definition, this qualifies for ways not normal to other people.  I believe this has more to do with my depression than any traumatic experience that I suffered after this problem began.

D: Persistent symptoms of increased arousal not present before
-These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hyper vigilance.

Long posts need more pictures
I think they need a better phrase than 'increased arousal'. This did not immediately inspire thoughts of heightened awareness if you know what I mean. I have always had extreme difficulty with sleep. I had insomnia for years that still occasionally creeps back (last night for example – so freaking tired). Even with the prescribed medication that I’m on specifically to help me sleep I have a hard time falling asleep, staying asleep, and once I wake up, calming my brain down enough to return to sleep.  Anger, hah, see this post. My therapist just brought up my sense of hyper vigilance yesterday as a form of self protection. All of these things, however, were a problem well before any real trauma that I suffered and were not the result of bad experiences that I can recall. I imagine that some of the experiences I’ve had since the onset of this most likely exacerbated the problem.  

E: Duration of symptoms for more than 1 month
- If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder.

How about years? Does years count? Acute stress disorder seems more accurate to me though.  Don’t ask me why. Maybe I just don’t want to have PTSD too.

F: Significant impairment
- The symptoms reported must lead to "clinically significant distress or impairment" of major domains of life activity, such as social relations, occupational activities, or other "important areas of functioning".

- I’ve had significant distress and impairment in social relations since I was 12 years old. This was at the onset of my clinical depression and anxiety disorder. Both precursors to my BPD. By this point my abandonment issues were also in full swing. But, again, not due to an experiences that could be considered very traumatic. I think it has more do to with a predisposition to feel things in a way that is not normal to most – BPD.


So yeah, after this very long personal assessment, I am still not a psychologist or psychiatrist and am therefore not qualified to diagnosis myself. Thoughts?

Abuse is very common in the lives of people with BPD. It is often one of the root environmental contributors to the emergence of the borderline disorder. I do not have any doubt that many people with BPD also suffer from PTSD. Recognizing this is very important for treatment because it helps understand some of the underlying factors that need to be worked through and healed.

I do wonder if PTSD leads to BPD, or if being predisposed to BPD leads to an increased sensitivity to situations that feel traumatic but would not normally be considered a traumatic event required to define PTSD.  Then again, if something feels a certain way, a situation is perceived a certain way, doesn’t that make it reality for the person experiencing it? Therefore the event occurring is in fact something very traumatic.

I don’t know.  Most likely it is a co-morbid issue building and feeding off of each other.

Thursday, February 17, 2011

Borderline Personality Disorder Facts and Statistics: Part 2

As promised I'm going to take a look at some of the more relevant facts and statistics concerning Borderline Personality Disorders. I'm only going to cover a few per post because there's a lot of them. Don't worry, there will be more.

- 2% of the general population are afflicted with BPD.
That’s a lot of people. That’s 1 in every 50.  In the United States alone this translates to approximately 5.4 million people. Perspective: this is the entire population of Tibet or Denmark (suppresses joke about ‘something is rotten in the state of Denmark’). That’s enough people to make our own country. Hah, that’s actually a pretty scary thought. We could have an emotional regulation tax. The government would be rich. The likelihood of finding better treatment would sky rocket though, or plummet, crash and burn depending on whether our universal health care coverage administration could manage their mood swings. Considering the massive amount of people that BPD affects, you would think there would be much more research into this disorder but to this day BPD remains one of the most misunderstood personality disorders. Often being considered a ‘catch all’ for a multitude of co-morbid symptoms (which it certainly has) instead of it’s own distinct disease. There has been some research, but not nearly as much as other personality and mood disorders. Most of this research has gone into assessing the symptoms, and understanding the causes, but it’s still a long ways from finding a cure or finding optimal treatment. Is there really a cure for personalities though? Part of me still resents the implication that there’s something wrong with my personality. I happen to like my personality. I’m pretty fantastic (on good days). Also, modest. On the other hand, I have a lot more bad days than good and I do recognize that I have a lot of defective tendencies that I am working to change.

Random: 1 in 50 people have digestive problems w/ daylilies. Gradually build up to eating them. WTF?!?

- 69% to 75% exhibit self-destructive behaviors such as self-mutilation, chemical dependency, eating disorders and suicide attempts.
I wonder if this is counted by individual people or by how many of each of these destructive behaviors present. I’ve had every single one of these self-destructive behaviors at some point + more. As mentioned before my thoughts of self-harm are slipping away. For one of the first times in my life I don’t need such an extreme reminder that I am, in fact, living in this world. This is such a surprising revelation for me because for almost 18 years these thoughts have been a constant companion. One I am not unhappy to be rid of. Chemical dependency for me was alcohol. I’ve never done drugs (except by Rx), nor will I. I have this thing where I actually like my brain functioning to it’s fullest potential. I’m still fighting with my eating disorder and my body image. This is one of the more insidious, less overt, of my problems because I hide it so well. I manage to come across as a health nut, but not problematic. I’ve been in recovery from this for years with only minor relapses. My body image is a completely different story though.

Instead of suicide attempts I would think this has more to do with suicidal gestures, thoughts, threats, as well as attempts. I threatened myself with suicide often when I was younger. I didn’t tell almost anyone about this, especially not anyone that would have done something about it. When things were so bad that I believed this was my only option, I didn’t want anyone to stop me. Telling people who would stop me is counterintuitive to the success of this plan. What’s the point of wanting to die and then telling people who will take away that necessary relief? I didn’t have hope for ‘a cure’. I didn’t have hope for anything. There was maybe one person that I can look back on that I think it was more a need for attention, a need to know that someone cared, more than anything. It was certainly a cry for help. I couldn’t hold onto the belief that anyone would remain in my life, that I wouldn’t always be alone. I needed the affirmation that there would be someone that stays. Ironically, I got rid of him years later and, surprise, my life has gone on and improved considerably.


- 8 - 10% die by suicide usually due to lack of impulse control over depression.
Lack of impulse control. Hm. I’m not sure most people consider suicide on a whim. It’s rarely a spontaneous decision. Suicide is a last result, when things have been so bad, for so long, it’s impossible to believe that things will get better. It’s a thought that is only toyed with at first. Creeping thoughts now and again that become pervasive over time as things don’t seem to ever get better. As happiness and hope become things so far lost to the past that a future including these elusive things can’t be seen. It’s not an impulse, it’s a cancer of the psyche that infects over time.

- Successful suicide rate doubles with a history of self-destructive behaviors and suicide attempts.
I can see how this would be true. Once you’ve thought about it for so long, made a couple attempts, the prospect of death can become less scary, more necessary because it becomes so ingrained in everyday thought. Personally? Suicide is my greatest failure. And by ‘greatest’ I mean one that I am most grateful for. Nothing makes you appreciate failure so much as looking back on the wonderful things I could have missed out on had I succeeded in ending my life when I was younger. Every now and again when I hit a low or things go wrong and I feel absolutely hopeless the thoughts creep back, but I no longer consider suicide an option. For as bad as things can seem sometimes I have lived enough, experienced enough, to know that things change. As long as there is a chance for change, there is a chance for things to get better.

My sense of humor is often inappropriate
- 10% of all mental health outpatients; 20% of psychiatric inpatients

I beat the stats on the inpatient thing, though probably I shouldn’t have. Other than one evening in the psych ER which was do to an overreaction from an ex {<~~~ bastard}, I’ve never seen the inside of a hospital for psych problems. Physical medical problems caused by mental problems (remind me to tell you about the sweet potato some time) yes, but not for being out of my mind in need of a ‘rest’. I am certainly an outpatient if you consider seeing talking to my PCP, my psychiatrist, and going to therapy twice a week outpatient.  What can I say, I’ve grown and matured a lot when it comes to my mental health. BPD is not easy to deal with. After more than 15 years trying to fight it on my own, finally I found assistance and it’s made so much difference. Ok, so maybe my learning curve isn’t so high but I’m getting help now.


Wednesday, February 16, 2011

Intolerable boredom

 Arg. Being bored drives me insane. I’m down to my last few days at this current job. I have no more work to do. I absolutely can’t stand this. I’m antsy and anxious. I’ve asked my boss for some small project to do (he hasn’t responded to my request), I have read all of the blogs I follow, done a ton of research for my own (seriously I have fodder for probably 75 posts), updated my Tumblr (which is an extension of this blog but with more pictures), got up, smoked a cigarette, I’ll go to the gym on my lunch break, exhausted my news sites…. And it’s not even noon. I can not just sit here all day and stare at my screen with nothing to keep me entertained. I’m actually looking forward to nuking a veggie sausage and chopping up my apple at lunch just to have something to do with my hands. I’m ridiculously frustrated. I do not sit still well. My brain keeps roaming down destructive paths, like why does my friend IM me everyday but has begun to deviate from our traditional greeting? Of course I ruminate on this for days and finally ask him, but he hasn’t responded and now I think he’s trying to ignore it and avoid answering the question. Then with another friend I’m plotting to take over a dormant volcano to create a young super villains’ boarding school. Who does that? At least going to the gym spends time. It almost goes too fast. Going to the gym is like a time machine. It’s wonderful. Driving there takes time, working out takes time, I even read while I’m biking or doing some other forms of cardio so I’m distracting myself while I’m distracted. It’s like taking myself completely out of my own world and dropping me into a parallel dimension of productivity. Time flies, my mood lifts, I come back to work, and suddenly the hours begin to drag on and on and on again. This is intolerable. I don’t like having the space for my thoughts to roam freely. They like to find the hardest places and off road into peril, BASE jumping off cliffs without a freaking parachute. Ugh. This is why I am always busy. This is why I actually like to work and be challenged and immerse my mind in the most difficult things I can find. It blots out the noise.

Update: So I asked my friend why he didn't ask me how I was doing anymore. When I got back from the gym he had responded. Though in the mean time I had convinced myself that his wife was interfering to disrupt our relationshp, and our friendship was ending. Anyways, he said he just hadn't realized and then asked how I was. My cognitive/emotional process? I was relieved and instantly felt better because he had responded and we continued chatting as normal. Cognitively I am suspicious and I don't believe him. How do you do something everyday for almost a year, deviate, and not notice that you've deviated? He has no reason to lie to me, and as far as I know, has never lied to me before. Trust issues much? You betcha. Feeling betrayed and relieved at the same time is exhausting and incredibly confusing. 

Borderline Personality Disorder Facts and Statistics

Because I am too exhausted to do a real post today here are some interesting statistics that I’ve collected from various sources. I will very likely make this a multi-part series to talk about some of the more relevant individual statistics and expound with my own theories and research information. I think knowing the basic stats can be helpful in recognizing some of the risk factors. Knowing things to watch out for makes it easier to focus on things that need to be given attention to. Personally it’s also helpful for me to know just how prevalent this problem is. Makes me feel less isolated and shows that this issue is not being ignored in hopes of treatment. Other statistics and related topics I hope to touch on soon: Biological/genetic factors, gender presentation, BPD ‘types’, and family pathology.

Borderline Personality Disorder Facts and Statistics

Prevalence:  BPD has a higher incidence of occurrence than schizophrenia or bipolar disorder,
·         2% of the general population
·         10% of all mental health outpatients
·         20% of psychiatric inpatients
·         75% of those diagnosed are women
·         75% have reported physical or sexual abuse
·         30 – 60% of those presenting with a personality disorder have BPD.

- Borderline personality disorder is also known as emotional regulation disorder (ERD).

- ERD is a debilitating biological disorder.

- 69% to 75% exhibit self-destructive behaviors such as self-mutilation, chemical dependency, eating disorders and suicide attempts.

- 8 - 10% die by suicide usually due to lack of impulse control over depression.
- Successful suicide rate doubles with a history of self-destructive behaviors and suicide attempts.

- 50% experience Clinical Depression

- Approximately 25% of those with ERD also meet the criteria for post traumatic stress disorder.

- Of Dual Diagnosed People, 50-67% have ERD.

- Most experts in this field agree that ERD is on the wrong axis code. Presently on Axis II. Should be Axis I.

- ERD has received very little attention and funding by our nation's health care system.

- Most clinicians are either mis-educated or under-educated about ERD and appropriate treatment. Thus people continue to suffer.

- Those who received standard community based inpatient and outpatient psychiatric treatment show this form of treatment to be marginally ineffective when measured 2-3 years later. 

- Treatable with medication initially and psychodynamic therapy complimented with dialectical behavior therapy (DBT). Therapy without proper medications is not recommended by many Drs. in this field.

- Cause of ERD is unclear but it appears to be a combination of genetic and environmental factors. More research is needed.

- Severe headaches and migraine appear to be more prevalent in patients with BPD than the general population.

- ERD is highly stigmatized in the world.

- Many clinicians refuse to treat ERD.

- ERD is virtually unknown to the public.

- Studies show inadequate regulation of serotonin, dopamine, and other neurotransmitters in those with ERD.

- Discontinuation of medications are high at 50%.

- On the Minnesota Multiphasic Personality Inventory (MMPI), ERD patients do not show a common profile. Personality traits appear to be a combination of histrionic, narcissistic, and antisocial personality.

- ERD (borderline personality disorder) can be extremely hard on families.  - Families need support.

- Decreased glucose uptake in medial orbital frontal cortex may be associated with diminished regulation of impulsive behavior in BPD.

- Comorbid conditions in BPD may also affect the ability to act responsibly.

- Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders.

- These results indicate that many of the features of adult patients with borderline personality disorder may initially appear during childhood and adolescence and that these features may be used to differentiate borderline from other personality disorders


- Traumatic events were reported by 70.7% of the borderline subjects. (aapel: For 30% thus, the cause is different)
Among them 25.8% sexual abuse, 36.4% physical abuses, 43.7% emotional abuses, 9.3% physical negligence and 43.0% witnesses of violence.

- Patients reported significantly higher rates of psychiatric disorders in their families in general, especially anxiety disorders, depression, and suicidality.

Tuesday, February 15, 2011

This made me giggle...

Pulling the trigger

Unfortunately I have a lot of these.

- Being alone when I need friends (specific friends) – my loneliness is the worst trigger I have.
- My best friend not texting or IMing back – feeling ignored, abandoned, automatically thinking I’d done something wrong that caused this lack of attention.
- Seeing women that I wish I looked like.
- A friend sending me artistic nudes - reminding me of how I used to look or thinking that since I don’t look that way I am not good enough in his eyes.
- Seeing highly stylized clothing that I love but can’t yet pull off.  
- Going over my calorie count for the day – loss of self imposed control .
- Clothes not fitting right – remind of control lost.
- Not getting enough sleep.
(I’m sure there’s more I’m forgetting)
- Finding something from friends lost. Thoughts/situations that remind me of them...  

Causes me to drink. Causes me to eat more. Causes me to obsess about my weight. Causes me to indulge my bulimia (purging and exercise). Causes me to feel like I have failed myself. Lost control of the structure I’ve imposed on myself to fix my body image. Making me so self conscious of my mistake that I can’t bear to let anyone else see me. Compounding my loneliness. Restarting the cycle. Once I’ve lost control for the night, it feels like the entire day has been ruined. That there is no point continuing to try. I might as well continue to indulge the spiral. Spinning down into the dark recesses of my mind. A black hole of cyclic thinking. Nothing solid to hold onto to pull myself back from the horizon of events about to unfold. Sucking me into a vortex from which there is no escape.

I drink to escape my own mind. I want it to dull the racing that pushes me towards the edge faster. I've begun to realize that this has exactly the opposite effect. It may slow my thoughts, but it doesn't change their nature. Knowing this, I've been able to suffer this less often. I look to more healthy means of escapism (discuss more here) to distract myself.

I don’t weigh myself everyday or almost ever. I can’t bear the thought of the scale. I measure my waist. I go by how my clothes fit. If they don’t give me what I want to see, I obsess. Every time I renew my promises to work on it. My dedication is restored, but in the mean time, I am more depressed because I’ve let my goal slip from my grasp. I work on it, but everything seems hopeless. Failure.
I have the unfortunate tendency to see myself as either all good, or all bad. If I maintain my structure for the day I have done well. I am good. If I’ve slipped off the path I want to travel I feel worthless. Lost my control. I don’t even have the strength to get through one more day on track. I am bad. I am either white or I am black. There are no shades of grey when it comes to myself. This something my therapist has me working on. I remind myself that one day does not destroy the progress that I’ve made.

I’ve learned to look at every day as a new opportunity. One day does not determine the rest of my life. Does not end my world. I may not have been exactly what I wanted the day before. I may have messed up, but the next day is a new chance. I remind myself that if something is really important to me, I have to work on it. I have to put in real effort. There is no immediate gratification when I am trying to change my lifestyle. For as much as I want change right now I need to remind myself that some things take time, but as long as I am willing to push myself, I will reach my goals. There’s always another opportunity to reaffirm what I want for myself, and to work towards it.  

It also helps me to set longer term goals, giving me something to aim for. This allows me some room to be more flexible, to be less rigid in my thinking. Less black and white.

- Seeing bloody images.
- Friends complaining about tiny injuries.
- Beautiful scars.
- Needing attention - Being so alone, removed from the world, that I can’t/won’t be out with friends.

I also have a tendency to punish myself. To remind me that what I did was not acceptable. Traditionally this has manifested as self harm or damaging thoughts. Over the last few months though these thoughts have disappeared. Self harm is almost always on my mind even though I very rarely act on it. My control has gotten very good and I only act on it maybe a couple times a year. But the thoughts are always there at the back of my mind. Until a couple months ago. That I haven’t had these thoughts, is something new, something good. I didn’t even realize that they were missing until yesterday. I felt I messed up, but instead of wanting to punish myself I reminded myself that I could start again in the morning. That this one incident wasn’t a permanent mark. At least, not as long as I didn’t leave one (I mean this figuratively as much as literally). I still feel like yesterday was an all bad day for me, but I have hope that today will be better. That I can have the will power to set me back where I want to be.  There are still days I’m so lonely and really need friends, but the other three no longer seem to hold any power of me. That’s an accomplishment all on its own.

If I can overcome some of the more destructive triggers I have, there’s hope that I can overcome the rest.  

Monday, February 14, 2011

What is a Trigger?

 The dictionary will define this as: anything, as an act or event, that serves as a stimulus and initiates or precipitates a reaction or series of reactions.

Pulling the trigger on a gun causes the release of a bullet. Hitting a button on a machine sets it into motion.

For someone with BPD anything number of things can set of and emotional chain reaction. Something big or something done as an afterthought can be emotionally triggering. It all depends on your deeper afflictions.

For someone that self harms it might be pictures of wounds or scars, a preferred knife, the departure of a friend and a return to loneliness, some criticism thoughtlessly given making the person feel worthless, deserving of punishment.

For someone that is eating disordered it might be a picture in a magazine, hanging out with a friend that has a more idealized figure, indulging in a treat that was off limits, a comment made about how someone else is lovely {in a way they don’t feel about themselves}.

Etc.

Whatever the thing is, a trigger is something that initiates a series of destructive thoughts or tendencies; whether it is a simple demeaning thought, or a spiral down into self perpetuating cycles of destruction. The trigger may be innocuous but the result can be emotionally devastating. Setting off feelings of not being in control. Something that creates a need to control themselves, mentally correct a loss of control in some situation. Harsh reminders that they are not good enough, that they could be better, different. Leading to punishment in order to regain a sense of purpose, focus, and control towards becoming the more idealized picture of themselves that they hold.

Whether the thought is acted on is almost irrelevant. If something provokes an internal response, that thing is a trigger.

Tripping a trigger is not anyone’s fault (unless they happen to know what someone’s particular triggers are and push them intentionally). It’s not even the person suffering with BPDs fault. Even people without BPD have triggers. It’s a symptom of a larger problem and it’s very common. It’s almost impossible to avoid them completely but there is hope. 

It’s important to recognize what your personal triggers are. Recognition allows you to step back and begin to process rationally. From here there are a couple things you can do. First, once you understand what causes particular responses, you can learn to avoid situations that create these problems.  At the least you can let those around you know that these things are hurtful to you and ask them to be mindful. Second, even if you can’t avoid all situations you can recognize that the trigger is not healthy, irrational, and begin to work through it in a constructive manner. Once you know what triggers, it is possible to look for alternative means of dealing with it. For example, instead of going to a restaurant which may cause binging and then purging, it is possible to preemptively ask for smaller portions and make plans to exercise.  Be proactive in a way that is not harmful.

Learning what triggers you is important for taking care of you.
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