Friday, December 7, 2012

Boundaries along the Borderline Personality Disorder: Part 3 – Our Own

For all of you that have Borderline Personality Disorder raise your hand if you can easily identify and communicate your personal boundaries. Go ahead, I’ll wait.


Until I started therapy I had no real sense of my personal boundaries. I’ve said it before here and I’ve said it before in therapy. When I told Therapist I didn’t feel like I really had boundaries she just looked confounded. Like, how could I not have a clear sense of what is and is not okay for me?

I think part of my lack of understanding of my own boundaries comes from the lack of validation I had of my own emotions growing up. Expressing how I was feelings was rarely okay so it follows that expressing what isn’t okay isn’t necessarily acceptable either.

Not to mention that when you have a history of abuse, instead of learning to say “no”, you learn to deal with it. So as long as whatever it is isn’t killing you, then it could be worse, right? Just because that may be true doesn’t make it right. However when that’s what you know, you don’t have an internalized sense of what is right and what is wrong in terms of your own well-being.

“Children are naturally innocent, inexperienced, na├»ve and believe that their caregiver can do no wrong. But in fact, caregivers often attack or abuse children for having the normal traits of imperfection, dependency and immaturity. As a result, the children lose their own sense of value (since they can't see that the fault might lie with the caregivers). Also the fact that abuse is occurring means the parents aren't demonstrating boundaries, so the children don't develop their own boundary systems properly. (This applies to adults in abusive relationships as well).”

Then there’s our friend Abandonment Issues. When you’re in a state of utterly frantic panic to not be rejected and abandoned, that fear is the greater evil. That’s the fear that wins out. Allowing whatever we feel is necessary to not experience that perceived loss (whether real or imagined) is better than Abandonment. The One, Evil-Ex, Friend… I let them get away with treating me in ways that cognitively I knew were incredibly disrespectful, but even that was better than losing them completely. 

“The Borderline is in a very painful world of his or her own. Emotionally, it is a world that exists in parallel to the world of the "averagely healthy". Despite a usually above average intelligence and an often charming initial presentation most borderlines are emotionally vastly different from how they are intellectually. The discrepancy between a borderline's general ability to think and his/her emotional capacity is often an internal schism between self-known and self-unknown that is wider than the grand canyon. It is world that is run by terror and fear and often by the triggered-dissociations from the past of the borderline.”

This doesn’t go away. Even if the loved one in our life isn’t the kind of person that would actually make us feel bad for needing personal boundaries by this point 1. We may not have a concept of personal boundaries because they’ve never been respected and constantly violated, and 2. The trauma of experience and our disposition is already deeply ingrained.  

It’s hard to understand the boundaries of others, when we’ve never really developed boundaries of our own. It’s like trying to deeply feel the significance of a Japanese Tea Ceremony that lasts for hours when you grew up above a Starbucks.  The intellectual recognition of what it is, is there. It’s a curiosity. But it’s also a culture shock to be asked to join in when you take your double shot of espresso with a shot of vanilla syrup in a race to catch a cab. You won’t have internalized the significance if you haven’t lived that way.

So the interpretation of it, from an outsider’s perspective, can be kind of scary. Very scary if we’re having a really bad day. From the outside looking in Boundaries are just like what they seem: A demarcation of where you are and where I am and a fence erected between. It’s a big Stop sign on the road to grandma’s house where you’ve been looking forward to a huge holiday dinner all month. It doesn’t appear to be the natural interaction that it is.

When grandma says take your shoes off before you come in, it feels like: Why? I like my shoes? Are my shoes not good enough? Not fancy enough? Am I not good enough? Well if my shoes aren’t good enough to come into your precious house I must not be good enough to  come into your house either.

It’s okay to laugh. Now think of it in terms of, what do you mean I can’t call you when I’m really hurting? Who cares if it’s 3:30 in the morning and you have a major presentation first thing in the morning. What I’m experiencing RIGHT NOW feels like my insides are boiling and melting through the floor. I need THIS THING, RIGHT NOW, OR THE WORLD IS NEVER GOING TO BE RIGHT AGAIN. If you can’t be there for me when I need you, you must not really care, you must not really have meant anything you’ve said to me before, you must have been lying, what else have you been lying about…. And eventually, whether we admit it out loud or not, those thoughts turn self-deprecating and self-harmful. We can fall into a pit of self-despair,  or overcompensate and suppress the shame by lashing out in anger at you or anything else.

We don’t violate personal boundaries because we don’t care or respect you. We violate personal boundaries because we don’t truly have an internalized sense of what they are because we’ve never had our own properly developed and respected.

Is it perfectly reasonable for a loved one to not pick up the phone at 3:30a.m.? Absolutely. That’s a very reasonable personal choice that they’ve made in order for them to function as a human being.

Does it mean they don’t care? Does it mean everything they’ve done before is negated because they’re exercising their personal boundary? No, it really doesn’t at all. Of course they care. This is where we need to take responsibility for our own dysfunctional thinking.

Is the world really going to end if someone doesn’t pick up the phone?  For as many times as I’ve felt like my world would fall apart, I have yet to experience a single apocalypse. Not one.

Something Therapist says about me a lot is that I am EXTREMELY tolerant, way more tolerant than I ought to be, but when I’m done, I’m done. I do and I do and I do. I let people. I let people. I let people. And I never say no. I never express my displeasure until I’m finally at the point where it’s way past too much and I have been spinning down into a self-hate spiral and I just can’t take it anymore. Usually by then I’m not at the peak of my communicative control. My anger is at the breaking point. I just want people to KNOW. I want people to SEE that I’ve been uncomfortable with something. I want people to TAKE MY NEEDS INTO CONSIDERATION, not to the exclusion of theirs, but just acknowledge them… without me having to say something.

“Without me having to say something” …. Is completely unreasonable. I’d be willing to say that this goes beyond being a Borderline thing to just being a female thing. This is completely unreasonable. If you don’t express in any way and if you don’t communicate, another person doesn’t know that there’s anything to be guessing about. Let alone how to guess. Say something.

There’s also fear. Fear of setting our own boundaries. Fear of expressing the boundaries that we recognize. Afraid that if we set boundaries, express what we’re not okay with, if we’re not all open and completely accessible, it will be taken negatively.  If I express that I don’t like something, well, then what’s to stop that person from just leaving and finding it somewhere else?  Mutual love, trust, and respect? Psh. Those things aren’t tangible. If I can’t provide everything than clearly I’m the one that’s deficient and they have no reason to stay. They’ll find what they want somewhere that’s not me.  

Hell, you saw this with me when Tech Boy had that night where things got too rough during sex and he hit me in the face. That is a HUGE boundary. You do not hit me. Granted I threatened to rip his balls off, but bringing it up to discuss it a day or two later?  I was worried he’d be mad at me for getting upset about it! I had a steady stream of panicked adrenaline coursing through my body by just the mere thought of bringing up the subject because I was worried at how he would react. We recognize this as being a little ridiculous right? Now, his reaction was completely appropriate. He was horrified at himself and that he did something that made me so upset. As soon as I realized he wasn’t mad at me though? Yeah, I was fine. Over it. 

Getting to that point for me to express that something isn’t okay is very difficult and it usually takes completely surpassing the point of acceptable behavior for me to speak up for myself.

Guilt is another problem. I don't know about you, but I often have an gnawing sense of guilt when I should say no because I need to act differently than someone wants in order to function. 

Sadly, boundaries are also tied up with our sense of self-worth as well. If our self-worth is low, and let’s face it this is extremely common, if we don’t feel that we’re worth protecting or being treated well because we have a very poor self-image, then defending ourselves via imposing personal boundaries is not going to occur naturally. If we can figure them out at all.

But that’s the problem. Having lived for so long not having solid boundaries, how do you even know how to recognize what your boundaries are? Let alone communicate them?

These are great questions if I do say so myself. Questions that I will answer… tomorrow!
Before I wrap it up for today though….

One phrase to keep in mind: This makes me uncomfortable.

During your day, your night, when you’re out on the town, or with a loved one…. If something happens that makes you uncomfortable, say to yourself: This makes me uncomfortable. You don’t have to say anything if you’re not ready, but make a mental note of it. Write it down. And keep writing those situations down.

Don’t associate people (you don’t want to start targeting anger or holding a grudge), just note the situation or the event that triggered that uncomfortable feeling.
Try it. 

Thursday, December 6, 2012

Boundaries along the Borderline Personality Disorder: Part 2 – Boundaries of Others

Boundaries of Others? Why do we need them? 

Boundaries exist to safeguard one another. In therapy it’s to safeguard the therapeutic relationship of both participants. It shouldn’t be any different for anyone else though. Boundaries operate at various levels, including role, time, place, money, gifts, services, clothing, language, self-disclosure, and physical contact (Gutheil & Gabbard, 1993). A boundary at any of these levels is either maintained, crossed, or violated. The problem though, is that boundaries rely heavily on context, and thus may be fluid and difficult to firmly define (Gutheil & Gabbard, 1998). 

Dr. A.J. Mahari says it well, “The importance of setting boundaries for your BPD loved one is explained as being an issue of survival.  The non-Borderline needs to decide what their personal limits are with regards to the Borderlines’s behavior; what they will and won’t tolerate and how they will communicate these ‘boundaries to the BP, along with the way they will deal with attempts to cross these boundaries. It stresses the importance of speaking only of your (the non-bp’s) experience NOT the behaviour of the BP, I interpret this (as it does not explain) as being about explaining why these boundaries are important to you and how it hurts you if they are not respected rather than coming across as a ‘dressing’ down of the BP, treating them like a child or making them feel bad if you put it across in terms that basically scream at the BP “I don’t like your behavior; you are a bad person; you must not do these things or else!” which is quite easily the way a BP could take it, and even if you are really careful how you put it across you still won’t be able to control the reactions of the BP (which may well be as if you had said it in this mean way, even if you didn’t) because they (we) can’t control our own reactions to what ultimately will feel like ‘bad’ news to us. “

 As Borderlines it’s important for us to understand that boundaries are a commitment to the Self, not an attempt to change or control another person.  Boundaries aren’t set to push us away or reject us. They’re not a precursor to being abandoned. Though this is how they can feel. When boundaries begin to feel like this, it’s important to do a self-check. As Borderlines our flexible and uncertain sense of identity is often muddled up with the people we’re closest too, so boundaries can feel like we’re losing a part of ourselves as well. However we should recognize that we are not actually a part of another person. We are autonomous beings that don’t actually share internal organs. Healthy people have a sense of self that is not dependent on the people around them. This is what we should strive towards, even though it may not be familiar to us. I think this is a big part of the problem. Our lives are so interdependent on the other people in our lives it strikes us as foreign and strange and frightening when we recognize that this need for interdependence isn’t necessary for other people. Because they don’t want to be in our space the way we need to be in their space it’s like they don’t need us. But this is not true. Healthy people merely have an identity that is their own and not dependent on us. That’s what boundaries are about. Maintaining their sense of Self and this is okay. It doesn’t mean that they don’t care or that they don’t love us. All it means is that they have their own lives and don’t need to live with someone else inside their own skin. Which is kind of creepy visual.

Below is a piece written by A.J. Mahari called TheBorderline Personality Dance and The Non-Borderlines’ Dilemma:

The Dance of those with Borderline Personality Disorder (BPD) can be defined as the “projective-identification” and “transference” of their identity to the extent that they do not know it, on to someone else. What does this mean? It means that when the borderline in your life is sad, or hurt or afraid, rather than feel those feelings, as the non-borderline would, the borderline will turn on you in an effort to have you hold, act out and be the very feelings that they cannot hold, handle or cope with. It is a subconscious way to have mirrored back to self all that one feels but refuses to feel. It is essentially, the borderline trying to put distance between him or herself and his/her own unresolved and abandoned pain.
Little do most borderlines realize, that in effect, what they are really doing when they act out and push people away and erect walls to 'protect' themselves, is wall themselves in with their own unaddressed psychological pain. There is no relief from pain to be found in casting it out to those [around you] or to the world around you. The walls that a borderline builds will wall that borderline in and threaten to drown him/her in his/her pain. The non-borderline who does not have any boundaries is at risk of being sealed into that borderline wall of agony with a family member, parent, adult-child, friend, or partner with BPD.
From what I’ve been told this is in fact what can happen. As Borderlines that love the Non’s in our life, we should recognize that this can happen and think to ourselves: Is this really what we want for our loved ones? Do we really want them to feel the shit-tastic-ness of what we’re feeling? Probably not.
It is through this dance that the borderline often sets him/herself up to continually re-experience what feels familiar. [Pain.] Because most borderlines have a tremendous fear of abandonment. The behavior that they engage in often is the reason why people have to distance and/or disengage or turn away, sooner or later, to maintain their own sanity. Yet when it is reasonable to leave or to take space (for a non-borderline - BPD Loved One) the borderline (usually not taking any personal responsibility) will blame you and will experience your “taking space” or your leaving as abandonment.
It doesn’t take much to invoke this fear!
The person with Borderline Personality is in a very painful world of his or her own. Emotionally, it is a psychological world that exists in parallel to the world of the "averagely healthy". Despite usually having an above average intelligence and an often charming initial presentation most borderlines are emotionally vastly different from how they are intellectually. The discrepancy between a borderline's general ability to think and his/her emotional capacity is often an internal schism between self-known and self-unknown that is wider and deeper than the Grand Canyon. It is a world that is run by terror and fear and often by the triggered-dissociations from the past of the person with BPD.
The Dance of the Borderline is experienced by the non-borderline when all of sudden, yet again, they have become the focus of the borderline's pain, rage, anger, unmet needs, wants, demands, helplessness and so on. Questions I've been asked a lot of late in email and by clients include, "How do I not go there?" "How can I set a boundary?" "What do I do when he/she starts it all over again?" "Why is this happening?"
So there is the borderline prone to repeatedly engaging in a deceptive dance of demanding devastation and the non-borderline who cannot get into the head (understand the motivation) of the borderline. Herein lies the central dilemma of the non-borderline (BPD Loved One).
The Non-Borderline's Dilemma is realized when he/she comes to the inevitable conclusion that he/she has to effect some change for themselves. There comes the realization that a choice has to be made. The choice is one that most often feels like, and is, a choice between equally unfavorable and disagreeable alternatives. This is the projected out predicament in which the borderline (to a degree) has lived within all of his/her life without knowing if fully. It is this similar dilemma/dynamic or predicament that is the fuel of the borderline dance in the first place. So, you see the borderline and the non-borderline, in some ways, are not so far apart. The experience of each is very painful - often riddled with conflicting emotions. The experience of each is real. The experience of each has its roots in BPD (for the borderline) and the effects of BPD for the Loved One. And yet each lives on a different side of understanding - sharing something in common - yet not connecting with each other as to what each experiences. What each non-borderline must realize within this dilemma however, is that they have the tools necessary to take care of themselves. And that it is up to each and every person with BPD to get help, therapy and/or coaching to learn the skills and tools to help them cope and get on the path to recovery. A BPD Loved One cannot rescue someone with BPD no matter how much one cares. It just isn't possible.
It’s our responsibility to heal ourselves, not wait for someone to save us, even though it may take a long time to get past this thought process.
So, you are in a relationship with a borderline and you have reached this stage of dilemma. You want the relationship to survive. You have all sorts of mixed feelings toward this borderline in your life, what are you to do? The first thing you must do is decide what it is that you cannot live with anymore. Once you've identified that, you will then have the rather difficult task of communicating that to the borderline in your life. Before you communicate what your limits and boundaries are make sure that you are prepared to back them up. If you are not, or you do not you will experience the dance times one hundred and the borderline in your life will generate more chaos than before.
You will need to identify the core problem, decide what your limits and boundaries are, you need to develop a plan of action and be ready to implement and consistently stick to it. At this point it's time to talk to the borderline in your life. As you do this -- remember, you must speak only to your experience and not to his/her behavior. [ Avoid placing blame! This is a sure fire way to start a fight.] This will be the beginning of a difficult and painful process whether things work out or not. As with any dilemma know that your pain is real and that pain is a natural part of change. Your pain does not have to cause you to doubt that you are doing what you need to do for yourself.
The non-borderline must communicate honestly, fairly, and consistently with the borderline knowing full well that you cannot have any control, effect, or say over how the borderline in your life will choose to react or behave, or even punish because when setting your boundaries the person with BPD may well feel abandoned. It is important to not enable or rescue the person with BPD even though their emotions are often so intense. Intensely angry and distancing or intensely painful which can pull on your heart-strings. People with BPD need to learn that they cannot re-play their past abandonment trauma or their present abandonment fear out on you. [The people in our lives now, hopefully, are not actually the people that caused the origins of our trauma in the first place. Therefore they do not deserve to be treated as if they were the ones that caused the problem.] You will benefit from being neutral in the face of these alternating and intense emotions from a person with BPD in your life.
The only way to not be engaged in the dance of the borderline is to identify, clearly and consistently communicate, and follow through with your boundaries. Pick a quiet time when there is no high intense emotion or conflict, a time when you can talk, calmly to your BPD Loved One.
Your message in words and in action must be clear and consistent. If for example, the borderline in your life is demanding something from you that you cannot give, it is reasonable that you answer the demand calmly with a statement about how you feel and why you cannot do what you are being asked or manipulated to do. Then make a clear statement that you are not going to continue to engage in the conflict or issue. If the borderline continues to press or escalates his/her behavior then you have to disengage in whatever way you have set out as the way that you will do this. For example, if you made it clear you will leave the house for an hour or that you will take a half hour alone somewhere in the house then you must do this.
If you are finding that you have set boundaries and limits and that you have communicated them and acted upon them only to meet with more and more conflict, abuse, punishment (silent treatment) and/or hostility then it is time to consider space. In order for you to take care of yourself and have your needs met, your boundaries and limits need to be respected. This is often next to impossible for many borderlines (not yet in therapy or refusing to get help). If the borderline in your life is not getting help, won't go get help, is in total denial, and will not respect your personhood then the choice you have to make in order to maintain your own sanity is one of space and distance, for a time, or altogether.
As someone who has gone through this from the side of having borderline personality disorder, before I recovered in 1995, I can honestly say that it took my losing people from my life before I could incorporate certain changes. I had to want to make those changes. I had to want to go to therapy. I had to want the help. No one could rescue me - though many people had tried. If you are staying in a relationship or continually caving or surrendering to "have peace" only to find that is not "right", or "good enough" for the borderline in your life either - you are doing no one a favor by staying in that situation. You have to decide whether you are willing to remain a hostage anymore or not. Do you want your freedom enough? What will this freedom that you seek from pain and emotional turmoil mean? Does it mean you can stay?
Does it mean you have to go? Yes, in the pursuit of your disengaging the dance and your attaining your emotional freedom you will hurt. The borderline will hurt. If life and recovery have taught me anything it's that you cannot grow and change without feeling and working through pain. Let your pain motivate you to learn the lessons, whether you are a borderline or a non-borderline. Sometimes we cannot learn those lessons without experiencing loss. Sometimes the only way is to let go.
Often we, borderline or non-borderline, have to lose in order to gain. We have to grieve in order to grow. We have to say good-bye in order to say hello to ourselves and to subsequent others in our lives. No one of us can change for another. No one of us can control another. Relationships are complicated and hard enough. For the borderline they are not truly possible until the borderline finds his or her lost self and then connects to that self and learns to relate to that self.
Until the borderline learns to relate to "self" he/she will always be relating over and over again to "self" through "other". This reality pushes the "other" away. It also is why the borderline tries to take hostages. If the borderline (in throes of BPD) only knows "self" through "other" and "other" goes away the experience is one as real and painful as "death of self" -- annihilation. The end of a relationship to a borderline can be like a death of "self" as was known in "other". The end of a relationship for a non-borderline or averagely "healthy" person is a very sad, painful loss, but, it is not the loss of self. In fact, when a non-borderline leaves a borderline they often experience a very healthy and welcoming "re-birth" of "self" - a coming home to a self that to one degree or other there was some separation from.
If you have BPD it is up to you to take responsibility for yourself and to learn to respect the limits and boundaries of others. If you are borderline you need to find yourself and to live through that "self" and not project that lost "self" onto others. If you are a non-borderline you need to be realistic with yourself and not accept anything less than basic human courtesy and respect. Where courtesy, respect, and mutuality - healthy give and take - are absent so too is healthy love. What you end up with is a toxic-love dynamic.
The Dance of the Borderline, the tune of which can only be heard by a borderline is music that a non-borderline cannot truly hear or appreciate. You live in one world, separated from itself, worlds over-lapping, yet not touching, worlds in parallel. Borderlines need to stop the dance and the non-borderlines need to end their dilemmas. Whether this can be done in tandem or whether you have to let go and do it alone, only each one of you can decide. Each one of us in this world has a responsibility to ourselves. We cannot extend any real love to another until we learn to love "self", borderline or not.

As Borderlines we need to recognize that in order to keep the people in our lives that we love, we need to let them be themselves. We need to find a way to get past only seeing our own desperate needs and learn to respect their needs as well. Our needs can be mind-numbingly painful, but that doesn’t negate that our Loved Ones have their own needs. They’re there for us as much as they can be, but sometimes they need to take care of themselves too. This doesn’t mean they don’t love us, it just means that they matter too. Which is something we already know, unfortunately it just gets a little lost sometimes when our own trauma takes over. Respect for each other as individual people. That’s the heart of what boundaries are. Boundaries are an act of self-love, not a lack of love for us. 

Wednesday, December 5, 2012

Where's my Post?

Hey Everyone, 

I was about halfway through writing my post on Boundaries: Part 2 for today when a whole bunch of life happened. 

Instead I'll leave you with how I coped with my weekend! 

1. I channeled my excess energy into 3 really great workouts at the gym. 

2. I stopped my obsessive ruminating thoughts and kept my boredom in check by engaging my creativity. I pulled out a few canvases and my acrylics and spent about 10 hours painting while trying to stop the kitten from adding her own helpful creative inspirations (read: paw prints) to my work. 


This is actually still an unfinished version. I cleaned it up A LOT and added more depth. 

3. Then I managed to round up a handful of friends for a Sunday evening Dr. Who Marathon. Sorry Mr. Tennant, I think Matt Smith has my heart as The Doctor. As has been typical of me these last few weeks I've been obsessed with making breads. Sunday I made Parmesan Scones with Caramelized Onions. I made a lot. They were absolutely irresistible. Keeping busy always helps me. 

Parmesan Scones with Caramelized Onions

Week Before: Cheesy Casatiello Bread stuffed with cheddar and gouda

Week Before That: Cranberry-Walnut Celebration Bread

What do you do to keep you mind occupied and in a better place? 

Tuesday, December 4, 2012

Boundaries along the Borderline Personality Disorder: Part 1

Boundaries. People have them. People should have them. People need to respect them. 

Those of us with Borderline Personality Disorder have a less than favorable reputation for not understanding or respecting people’s boundaries.

As far as I know this is true for most of us. However it’s not necessarily the same for all of us?  Wait, what? I’m actually very adept at recognizing the boundaries of other people. It’s actually typical that I’m hypersensitive to their needs and concerns…. To the detriment of my own healthy needs. The boundaries I’m not good at recognizing, understanding, and respecting the most? Are my own. Not those of other people. In fact, when I defend my boundaries I often feel extremely guilty because by defending my boundaries, I’m denying the wants or desires of someone else.

When I do violate another person’s boundaries it’s not because I’m trying to purposely hurt them or control them. It’s usually a direct reaction to a way I’m feeling. A direct reaction to my need for comfort and security. A direct need to be in some way soothed. It’s not about the other person, it’s about me. It’s not about disrespecting someone else, it’s not about purposely wanting to step on their needs, it’s about trying to stop some turmoil that I’m going through. Which is kind of narcissistic, but when I’ve been in the kind of emotionally volatile state when I’m desperate for the kind of attention that comes with violating another’s boundaries, it’s usually b/c I’m in a state of intense distress.

 Hold on for a second. I’m getting ahead of myself. What exactly do I mean by boundary? What is a personal boundary?

 Definition: In psychology and psychiatry, the term “boundary” is used to refer to one’s sense of personal space and separation from other people. People with borderline personality disorder (BPD) have a difficult time establishing and maintaining their own personal boundaries and respecting others’ boundaries. 

There are two Main boundaries that I’m concerned with:

1.    Our own boundaries

2.    The boundaries of others

Boundaries are actually one of the most misunderstood concepts for the loved ones or those involved with someone with BPD. The problem is that most people don’t understand to whom the boundary applies.  The one big mistake people make when they think about boundaries is they think they’re about:

Mistake: Setting up “boundaries” and “limits” that are really rules for someone else’s behavior.

Nope, wrong. Boundaries are not rules to be followed. Boundaries are about you and can only be applied to your own behavior. Your boundaries are for you.  A supporter of a person with BPD can set boundaries for themselves, not for the person with BPD. Likewise someone with BPD can set boundaries for themselves, but they can’t try to set boundaries, create rules, or dictate the behavior of someone else. 

Only you can respect your own boundaries. Trying to dictate the behavior of someone else is almost a guaranteed sure-fire way to inspire a rebellion. Especially with BPD. In fact,  I would say the more you attempt to control someone with BPD, the more they will lash out. At least that’s how I would react. And have. Often. Much to the dismay of the person attempting to control me. When I feel at a loss of control, I no longer care. I do what I have to do to get back in control. I do what I have to do to make sure the other person realizes they can’t control me like that. One of the things that we with BPD have a big problem with is feeling out of control and working so, so hard to create some kind of control in our lives. When someone else tries to impose rules onto us? We feel trapped, we feel even less understood, we feel the need to re-exert our control and lash out. And we will. Probably with dynamite and fireworks.

Now that doesn’t mean you shouldn’t discuss triggers and let someone know when something they are doing is hurtful. It is important to convey your concerns. But you can’t actually expect to dictate the behavior of another person.

So how do I know if I’m setting boundaries or trying to create rules? Here’s an example I found:   

“A popular book for Non-BPDs uses the example of telling the person with BPD that you will not take phone calls after 9PM. This “boundary” (or limit as it’s called in this book) is supposed to be “respected” by the person with BPD. However, when emotional dysregulation gets a hold of a person with BPD, it is unlikely that the boundary will be remembered and respected. The problem with this boundary is that it really is a rule that governs the other person’s behavior. With BPD, rules are made to be broken.

Only you can respect your own boundaries. If you decide not to answer the phone after 9 PM then that is a boundary, because you are applying it to your own behavior, not expecting the person with BPD to comply with your rule. The misunderstanding of boundaries and to whom they apply causes much confusion and leads to frustration. The frustration is born out of trying to control another person’s behavior with a rule, which is impossible.”

Everyone has a personal code of values.  We all have codes with respect to finances, romance, parenting, lifestyle preferences, personal safety and faith.  Boundaries are what we communicate as reasonable and permissible ways for other people to behave around us and not violate our code.   For example, a recovering alcoholic may communicate that he doesn't want to participate in group events involving alcohol or a women may communicate the she doesn't want any kind of physical touching during an argument. These are boundaries that a person can define for themselves, that only effect their needs, not dictate or violate the rights and freedoms of others (… and if anyone tries to argue with my that setting the boundary of no physical contact denies the other person the right to express their physicality I’m going to glare at you silently.)

So do we have a reasonable idea of what boundaries are? In the coming days I’ll discuss 1. The Boundaries of Others, 2. Discovering and Understanding Our Own Boundaries, 3. Different Kinds of Boundaries, and 4. Identifying and Setting appropriate Boundaries. 

Monday, December 3, 2012

Thinking Clearly About Personality Disorders

Good Morning Dear Readers!

Today I thought I’d share an article written for The New York Times a couple days ago. It addresses the difficulties clinicians are having in terms of simplifying personality disorder diagnosis. There are a few things I like a about this article. But there are also a few things I don’t appreciate at all.

You can always tell when something is written by someone that hasn’t been affected by mental health issues and/or doesn’t actually work in the field. Simple statements that seem innocuous to the outsider are actually harmful and perpetuate dangerous stigma. I think it’s good to know what is being shared with the world. If you don’t know what is being said about something that you yourself deal with, it becomes difficult to refute and share more accurate information.

So here you go. Tell me what you think:

Thinking Clearly About Personality Disorders
Published: November 27, 2012

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe's, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal - part of the psychiatric association's effort of many years to update its influential diagnostic manual - is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it's allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: "All I can say is that personality disorders were one of the first things we tackled, but that doesn't make it the easiest."
The entire exercise has forced psychiatrists to confront one of the field's most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn't supposed to be this difficult.

Personality problems aren't exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues' gallery of vainglorious, murderous dictators.
Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of "confounded identities" that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling - in who they were.

"These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired," said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. "They had problems that were neither psychotic nor neurotic. They represented something else altogether."

Several prototypes soon began to emerge. "A pedantic sense of order is typical of the compulsive character," wrote the Freudian analyst Wilhelm Reich in his 1933 book, "Character Analysis," a groundbreaking text. "In both big and small things, he lives his life according to a preconceived, irrevocable pattern."

Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association's third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.
These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. "Personality Disorder-Not Otherwise Specified," a catchall label meaning little more than "this person has problems" became the most common of the diagnoses.

It's a murky area, and in recent years many therapists didn't have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.
"The diagnoses simply weren't being used very much, and there was a real need to make the whole system much more accessible," Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person - personality - still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.

The panel proposed a system based in part on a failure to "develop a coherent sense of self or identity." Not good enough, some psychiatric theorists said.

Later, the experts tied elements of the disorders to distortions in basic traits.

For example, an interim proposal for narcissistic personality disorder involved rating a person on four traits, including "manipulativeness," "histrionism," and "callousness," and the final proposal relied on just two, "grandiosity" and "attention-seeking." The current definition includes nine possible elements.
The proposed diagnostic system would be simpler, as well as "responsive to the array of diverse and sometimes contradictory suggestions made by other" personality disorders experts, wrote Dr. Andrew Skodol, a psychiatrist at the University of Arizona and chairman of the group proposing the new system, in a paper published last spring.

But since then the outcry against the proposed changes has only grown louder.

Some experts argued that throwing out existing definitions was premature and reckless. Others insisted that the diagnoses could not be simplified so much. And some complained that the effort to anchor the disorders in traits had not gone far enough.
"You simply don't have adequate coverage of personality disorders with just a few traits," said Thomas Widiger, a professor of psychology at the University of Kentucky.

Dr. Widiger compares the process of reaching a consensus on personality to the parable of the six blind men from Hindustan, each touching different parts of the elephant. "Everyone's working independently, and each has their perspective, their own theory," he said. "It's a mess."

"It's embarrassing to see where we're at. We've been caught up in digression after digression, and nobody can agree," Dr. Millon said. "It's time to go back to the beginning, to Darwin, and build a logical structure based on universal principles of evolution."

At least for now, then, the misfits will remain in their colony, part of mainstream psychiatry but still in the back country.

And if a unified theory can be devised to explain them, most agree that it will be some time in the making - perhaps requiring the efforts of an obsessive-compulsive narcissist with some political skills.

Correction: November 30, 2012, Friday

This article has been revised to reflect the following correction: An article on Tuesday about efforts to adopt a new diagnostic system for personality disorders misstated the number of traits included in the proposed criteria for narcissistic personality disorder. The final proposal involves rating a person on two personality traits, not four.


So what did you think?

For obvious reasons I’m a bit more sensitized to things said about Borderline Personality Disorder so this statement, “Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide,” did not thrill me.

It’s a gross simplification that is not accurate. Can you imagine if someone who has never heard of BPD before took this as their introduction to it? What must they think? It’s ridiculous. This guy didn’t even bother to Wiki the subject and find out that BPD is not characterized by extreme neediness, but of emotional dysregulation. Neediness is one, only one, potential aspect in the form of co-dependence. But then you have people like me that are almost aggressively counter-dependent. It’s also characterized by the urge to self-harm often including thoughts of suicide? Does this guy know anything about self-harm at all? I realize they’re classified together in the DSM-IV but these things actually tend to indicate opposing views of life and death. Not to mention, NOT everyone with Borderline Personality Disorder self-harms and NOT everyone that self-harms has Borderline Personality Disorder.

It’s detrimental to simplify something so complex as a personality disorder into one catch phrase of a sentence.

And I’m sorry, but “misfits”?  First off, this is just insensitive. Second. What kind of investigative journalist doesn’t fact check the fact that an estimated 26.2% of Americans ages 18 and older (About 1 in 4 adults) suffer from a diagnosable mental disorder in any given year. Those that suffer from a serious mental illness are a little more concentrated to about 1 in 17 people, or about 6% of the U.S. population (Sorry I don’t have world-wide statistics here).  This is an absolute enormous chunk of the population. Many, if not most, of which function fully to the best of their ability, to the complete ignorance of anyone around them that anything is wrong inside.  I personally have a laundry list of diagnosis, which yes of course have impaired my life a great deal, but no one that doesn’t know me on a very intimate level would be able to point it out.

For a lot of people the indication that they have mental health issues is a point of shame. It shouldn’t be, just like you shouldn’t be ashamed if you get the flu or a cold, but for many of us it is. Calling us misfits is simply alienating. Not to mention rude.  When people feel alienated they feel like hope and help is even further out of their reach. And that is something we need to avoid.

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