Friday, January 4, 2013

Sensitivity to Rejection Can Be Dangerous: BPD, Rejection Sensitivity, & Eating Disorders


The episode where I propose a theory that connects BPD to one of the more widely held Impulsive Habits: Eating Disorders…. And you may have guessed it, it comes down to Rejection Sensitivity. A specific type called Appearance-based Rejection Sensitivity, in fact. The past week I’ve been talking about Rejection Sensitivity and how people with Borderline Personality Disorder have the big markers to make them more prone to being Highly Rejection Sensitive.





By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on January 26, 2007


A series of new studies provide evidence that individuals who have a heightened sensitivity that they will be rejected by others because of their physical appearance, can be at risk. Three studies suggest the sensitivity, if not mitigated, can have serious implications for the individuals’ mental and physical health.

“Appearance-based Rejection Sensitivity: Implications for Mental and Physical Health, Affect, and Motivation” by Lora Park, Ph.D., is currently in press for publication in Personality and Social Psychology Bulletin.

According to the author, appearance-based rejection sensitivity is a personality-processing system characterized by anxious concerns and expectations about being rejected based on one’s physical attractiveness.

When motivation for looking attractive is rooted in anxieties about being rejected by others, the consequences can be deleterious to health and well-being. The research also suggests that there may be ways to mitigate these negative effects, by having people think of their strengths or their close relationships with others.

In the first study, Park developed and validated an appearance-based rejection sensitivity scale (ARS scale) with 242 college students, to measure the extent to which people anxiously expected rejection from others based on their physical attractiveness.

She found that those who scored high in appearance-based rejection sensitivity were likely to have low self-esteem, high levels of neuroticism, insecure attachment styles, to base their self-worth on their appearance and to rate themselves as physically unattractive.

[Sound fairly Borderline-ish to you?]

The study also showed that people who are highly sensitive to appearance-based rejection reported increased symptoms of disordered eating.

[Intro the Eating Disorders]

“Both men and women who reported being sensitive to appearance-based rejection were preoccupied with their body and weight in unhealthy ways. They avoided eating when they were hungry, exercised compulsively and engaged in binging and purging,” says Park.

People with high appearance-based rejection sensitivity also were more likely than people low in appearance-based rejection sensitivity to compare their physical attractiveness with others and to feel bad about themselves when making such comparisons. These results were found regardless of the subjects’ levels of self-esteem, attachment style, general sensitivity to rejection, neuroticism, self-rated level of attractiveness and the degree to which they based self-worth on appearance.

Interestingly, Park found that both appearance-based rejection sensitivity and basing self-worth on appearance independently predicted eating disorder symptoms and the tendency to make appearance-based comparisons.

“These findings suggest different pathways through which people may develop and maintain behaviors such as excessive dieting, compulsive exercising, binging and purging, and comparing one’s attractiveness with others” Park says.

“Some people engage in such behaviors because they are ultimately worried about being rejected by others if they don’t measure up to looking a certain way,” says Park.

“For others,” she says, “the underlying motivation for such behaviors may be less about interpersonal anxieties and more about maintaining and enhancing personal self-esteem.”

In the second study, Park found that people with high levels of appearance-based rejection sensitivity reported feeling more alone and rejected when asked to list negative aspects of their appearance than when asked to think of a neutral topic (listing objects they saw in a room). On the other hand, subjects with low levels of appearance-based rejection sensitivity were not negatively affected when listing aspects of their appearance with which they were dissatisfied.
“Simply having people list what they didn’t like about their appearance, whether it was their weight, their height, having acne or some other facial or body feature, was sufficient for people high in appearance-based rejection sensitivity to feel lonely, rejected, unwanted and isolated,” says Park.

[All things in my Borderline experience, how about you?]

If appearance-based rejection leads to negative outcomes, are there ways to attenuate these effects? Park conducted a third study to examine this possibility.

In the third study, all participants first were asked to write an essay about a negative aspect of their appearance.

Next, they were randomly assigned to one of three intervention conditions: a Self-Affirmation Condition, in which they listed their greatest personal strength; a Secure Attachment Prime Condition, in which they listed the initials of a close, caring relationship partner; or a Neutral Condition, in which they listed an object they saw in the room.


Results showed that those who were sensitive to appearance-based rejection experienced lower self-esteem and more negative mood, but only when asked to think of an object in the room.

“Being reminded of an object in the room did nothing to improve people’s self-esteem or mood following the appearance threat,” Park says.

“However, a reminder of one’s strengths or close relationships was enough to reduce the damaging effects of thinking about negative aspects of one’s appearance,” explains Park.

“These findings,” she says, “emphasize the power of self-affirmation and of having close relationships in helping people cope with insecurities regarding their appearance.”



My own extended hypothesis:

If you have difficulty maintaining close affirming relationships and are even more prone to being highly sensitive to rejection, as is seen in BPD, it can create the condition where these impulsive and compulsive habits used to control and develop body image approval, can become ingrained, lifelong dysfunctional problems.


For me, this could explain why one concerned conversation from my parents, triggered a life time of eating disorders which I still struggle with, compulsive exercising, and self-loathing when I consider my body and appearance. Of course this isn’t the only reason why eating disorders develop. There are many hypothesis including a need for control, attempting to fill an emotional void, etc. Personally I think this is an eloquent connection to explain one potential cause.

It also demonstrates just how pervasive a problem that being highly sensitive can be. My example: When I was 12/13 my parents noticed my body changing (thank you puberty) and how of what I’m sure they thought was a standard concern for my health they approached me privately and in a way I’m sure they thought was sensitive and caring. Me? I was heartbroken. I was devastated. I began an almost 20 hear nose dive into bulimia. Every eye, every comment, every compliment has been suspect to my mind and feels like a judgment, and not merely what they are; human interaction. Don’t get me wrong, some things have been quite malicious. Evil-Ex used to play off of my body sensitivity. A few of his comments still stick with me to this day and make me self-conscious. They don’t stop me, but I have the awareness of them in situations where they’re relevant. My poor body image has had an enormous impact on my life. At times it’s completely incapacitated my ability to function socially. The mere thought of going out in public would reduce me to a puddle of panic attacks and hyperventilation. I don’t blame my parents for this. I know they meant well.

The effects of something so seemingly meaningless, delivered in a careful way, can have a massive impact. It’s not maliciously intended, but the perception and reception… how it affects the person receiving that information, is vast. I think this could be very meaningful for our loved ones to keep in mind when, and meaningful for us to keep in mind when we interact.

For them: That our hypersensitivity is an issue, and that what we are reacting to, could be different than what they intended or assume.

For us: That what we perceive may not be what was meant.  

Something to consider anyways. 

Thursday, January 3, 2013

Rejection Sensitivity and the Defensive Motivational System

In a Research Article published between Columbia, LI University, University of California Berkley and University of Washington the subject is Rejection Sensitivity and the Defensive Motivational System. Now this study isn’t specifically tailored for Borderline Personality Disorder, but as I discussed yesterday, people with BPD are particularly prone to Rejection Sensitivity. I’ve extracted the more relevant passages for this post and interpreted them in blue for easier reading (I’m going to skip the Methodology section because while I find them fascinating, I recognize that not everyone likes scientific minutia the way I do, hah!), but you can read the whole article: HERE.


Research Article

Rejection Sensitivity and the Defensive Motivational System:  Insights From the Startle Response to Rejection Cues

By: Geraldine Downey, Vivian Mougios, Ozlem Ayduk, Bonita E. London, and Yuichi Shoda

ABSTRACT––

Rejection sensitivity (RS) is the disposition to anxiously expect, readily perceive, and intensely react to rejection. This study used the startle probe paradigm to test whether the affect-based defensive motivational system is automatically activated by rejection cues in people who are high in RS. Stimuli were representational paintings depicting rejection (by Hopper) and acceptance (by Renoir), as well as nonrepresentational paintings of either negative or positive valence (by Rothko and Miro, respectively). Eyeblink startle magnitude was potentiated in people high in RS when they viewed rejection themes, compared with when they viewed nonrepresentational negative themes. Startle magnitude was not attenuated during viewing of acceptance themes in comparison with nonrepresentational positive themes. Overall, the results provide evidence that for people high in RS, rejection cues automatically activate the defensive motivational system, but acceptance cues do not automatically activate the appetitive motivational system.

Rejection sensitivity (RS) is the disposition to anxiously expect, readily perceive, and intensely react to rejection. Essentially this study used a series of upsetting (negative) and pleasant (positive) pictures and sounds to trigger a startling response in people that have been screened to have either a typical sensitivity or a High Rejection Sensitivity. From here they should be able to determine how much higher (or if it’s higher) the response is in people with high Rejection Sensitivity when they view negative rejection themes. Comparing this to when they view non rejection themes. The results of this provide evidence that rejection cues automatically activate the defensive motivational system. In an interesting twist it should also demonstrate that positive acceptance themes do NOT automatically activate positive feelings of motivation and acceptance.

So while the negative defensive system automatically responds to perceiving negative stimuli, the positive reinforcement area of the brain does not automatically respond to positive stimuli.

Everyone experiences rejection. Whereas some people respond with equanimity, others respond in ways that profoundly compromise their well-being and relationships. To help explain such maladaptive reactions to rejection, we have proposed a specific cognitive-affective processing disposition, rejection sensitivity (RS; Downey & Feldman, 1996). At the core of this disposition is the anxious expectation of being rejected by people who are important to the self, an expectation developed through exposure to severe and prolonged rejection. Our research has shown that individuals who anxiously expect rejection have a tendency to readily perceive it in other people’s behavior and then react to it in ways that undermine their relationships; their behavior thus leads to the feared outcome (see Levy, Ayduk, & Downey, 2001). We have applied the term high-rejection-sensitive (HRS) to describe people who show a heightened tendency to anxiously expect, readily perceive, and intensely react to rejection (Downey & Feldman, 1996).

Everyone experiences rejection. Whereas some people respond with equanimity, others respond in ways that profoundly compromise their well-being and relationships. The purpose of this study is to explain this maladaptive reaction to rejection. Research shows that people who anxiously expect rejection have a tendency to readily perceive it in other people’s behavior and then react to it in ways that undermine their relationships; their behavior [could contribute to] the feared outcome. This is believed to stem from the exposure to sever and long prolonged rejection by people who are important to the self.

Why do people who anxiously expect rejection behave in ways that lead to the realization of their worst fears? Our view is that the RS dynamic functions to defend the self against rejection by significant others and social groups. To the extent that the individual has experienced the pain of rejection, protecting the self from rejection while maintaining close relationships will become an important goal, and a self-defensive system such as RS will develop to serve it. However, this system becomes dysfunctional to the extent that it gets elicited automatically with minimal rejection cues and sets in motion the precise actions that ultimately lead to the fulfillment of expectations of rejection (Downey, Freitas, Michaelis, & Khouri, 1998).

Why do people who anxiously expect rejection behave in ways that lead to the realization of their worst fears? It’s believed that the purpose of this Rejection Sensitivity is to defend the Self against rejection from significant others and social groups. Protecting the self from rejection while maintaining close relationships is an important goal and a self-defensive system will enable this to develop. However, if the system becomes dysfunctional, as it does in the Highly Rejection Sensitive person, so that it triggers automatically with minimal rejection cues it can cause a person to behave in ways that actually lead to fulfilling the expectation of rejection. It becomes a self-fulfilling prophecy of rejection.

The present study tested our guiding assumption that RS is a defensively motivated system that gets elicited by rejection-relevant stimuli and that this elicitation occurs automatically, at an early, nonverbal stage in the activation of the RS dynamic.

Converging evidence from neurological and behavioral research suggests that two primary affective-motivational systems organize behavior––an appetitive system that responds to positive stimuli (i.e., rewards), motivating approach and consummatory behavior, and a defensive system that responds to negative, aversive stimuli (i.e., punishments, threat), disposing the individual toward active avoidance, and fight-or-flight (Gray, 1987; Lang, Davis, & O¨ hman, 2000; Metcalfe & Mischel, 1999).

Neurological and Behavioral research suggests there are two primary affective-motivational systems that organize behavior –

1.      An Appetitive system to responds to positive stimuli (rewards), which motivates positive interaction and fulfilling relationship behavior.
2.      A Defensive System that responds to negative, aversive stimuli (punishments, threats), which motivates people towards active avoidance, and fight-or-flight behavior.

This study tests that assumption that Rejection Sensitivity is a Defensively Motivated System that is triggered by stimuli that is personally association with rejection. What’s more, this study shows that this defensive system is triggered at an early stage of interaction before actual statements of rejection are even made by taking non-verbal cues. In essence, it’s not even something that needs to be said, non verbal cues, body language, demeanor or interpreted in a way that triggers self-defensive systems.  

DEFENSIVE MOTIVATIONAL SYSTEM (DMS)

Lang et al. (1990) proposed a model of human emotions that is consistent with this literature. In this model, human emotions are viewed as action dispositions that organize behavior along an appetitive-aversive dimension. Valence determines which system is activated (i.e., defensive vs. appetitive), but arousal determines the intensity with which the system is activated. According to this model, when negatively valenced and highly arousing stimuli are encountered, the DMS becomes activated to prepare for rapid execution of a set of automatic behaviors aimed at self-protection. What constitutes athreat can be biologically based (e.g., an instinctive threat reaction to seeing a snake) or socially learned (e.g., an expectation of rejection in certain social situations).

Lang organizes emotions along a spectrum from desirable to avoidant. The capacity of a person to react with or affect another person in some way (as by attraction or the facilitation of a function or activity) determines whether the positive or negative system is activated, but the height of arousal determines the just how intensely the reaction will be. When negative experiences are coupled with highly arousing stimuli, that defense motivational system kicks into high gear to prepare for rapid, automatic response behaviors meant as self-protection. What constitutes a threat is biologically based or learned during development based on personal experience.

Research on both animals and humans suggests that when the DMS is activated by the potential of danger, physiological responses to newly encountered threat-congruent cues are amplified, and physiological responses to threat-incongruent cues are attenuated. That is,the organism is oriented to detect cues that are congruent with a state of threat and to act when confirmatory cues are detected (see Lang et al., 2000). The model also indicates that when the appetitive system is activated, there should be a relative dampening of physiological responses to threatening cues.

Research shows that when the Defensive Motivational System is triggered that primal response to danger is amplified and heightened, while the natural responses that tell you something is not a threat is diminished. So when you’re in Danger Mode, you’re ability to tell the difference between Threat and Not A Threat is minimized. It’s all danger.

CONCEPTUALIZING REJECTION SENSITIVTY AS A DEFENSIVE MOTIVATIONAL SYSTEM

Our phenomenological description of the operation of the RS system closely parallels the operation of the DMS. According to our conceptualization of RS, in situations in which rejection is a possibility (e.g., meeting a prospective dating partner, asking one’s friend to do a favor), people who are high in RS are uncertain about whether they will be accepted or rejected, but the outcome is critical. Thus, for HRS individuals, such situations incorporate cognitive appraisals of threat under conditions of uncertainty––the specific conditions known toactivate the DMS (Fanselow, 1994; Lang et al., 2000; Lazarus, 1999; LeDoux, 1996; Metcalfe & Mischel, 1999). Low-RS (LRS) individuals are less likely to experience heightened DMS activation in these same situations because they typically deem rejection less probable and of less concern.

In situations where there is a possibility of rejection (e.g., meeting a prospective dating partner, asking one’s friend to do a favor), people who are high in RS are uncertain about whether they will be accepted or rejected, but the outcome is critical. For individuals high in Rejection Sensitivity these situations use cognitive appraisals for potential threat, all the while their own emotional conditions are uncertain, more anxious, more on edge. These emotional conditions are the ones known to activate the Defensive Motivational System. This is in contrast to low-Rejection Sensitivity people who are less likely to experience heightened DMS activity in the same situations because they don’t enter the situation expecting rejection or assess rejection to be less probable and less of a concern.

As we have described, when the DMS is activated, it facilitates monitoring and detection of threat-relevant cues and prepares the individual for swift response once cues of danger are detected. We hypothesize that in rejection-relevant situations, this system is automatically activated in HRS individuals.

So when the DMS is triggered, it puts you on the lookout for potential threat-relevant cues. You become hypersensitive to what might occur and the body/mind prepares itself for a quick response if threatening or emotionally dangerous situations are detected. In rejection-relevant situations this response is automatic for high-RS people.

Given our assumption that RS develops specifically to defend the self against rejection, we hypothesize that the system is biased primarily toward dealing with threats of rejection. We do not expect acceptance to elicit the appetitive system in HRS people to a greater extent than in LRS individuals. Thus, RS should predict indicators of heightened DMS activation in the presence of rejection cues but should not predict heightened activation of the appetitive system in the presence of acceptance cues.

Since Rejection Sensitivity is believed to have developed specifically to ward against rejection it’s believed that this will only predict heightened DMS activation in situations which present negative rejection cues, but not heightened activation of the positive reward system when positive acceptance cues are given. Perception of the bad, is REALLY FREAKING BAD, but perception of the good is still just, meh, it’s good.  

RESULTS & DISCUSSION

When viewing art depicting rejection themes (Hopper’s paintings), people who were high in RS showed an amplified eyeblink following a loud noise, relative to their eyeblink response when viewing each of the other types of artwork, whereas people low in RS did not. This finding indicates that when HRS individuals are viewing rejection related stimuli, they show heightened DMS activation.

Unsurprisingly when people who are highly Rejection Sensitive viewed the rejection stimuli, they did show heightened DMS activation.

We propose that the activation of this system helps explain the readiness with which HRS individuals perceive rejection in otherpeople’s behavior and contributes to the intensity of their responses tothe perceived rejection. The adaptive value of the DMS comes from its ability to trigger quick defensive responses under threat without the individual needing time to think (Lang et al., 2000; LeDoux, 1996; Metcalfe & Mischel, 1999). Such an emergency system can become maladaptive, however, if activated when reflective, strategic behavior is required, when the threat is minimal, or when efforts to prevent the realization of the threat occur at the expense of other personal goals.

This leads to the conclusion that the activation of this system helps to explain why high RS people are at thee ready to perceive rejection in the behavior of other people and it contributes to the intensity of their responses to that perceived rejection. This was evolutionarily advantageous because the DMS system has the ability to trigger quick defensive responses when under threat without the individual having to waste time to think.  [Unfortunately when this system becomes maladaptive it remains on continuously, instead of turning off when the threat has been removed.] This emergency system can become maladaptive though, if it activates on reflex when more advantageous behavior would suit the situation better, like when a threat is minimal, or when efforts to prevent the realization of the threat (when your actions cause the threat to take form when it normally wouldn’t have otherwise) occur at the expense of higher priority personal goals.

[It’s easy to see how this is an evolutionary advantage in the wild, or say, in an abusive household… unfortunately our systems don’t de-evolve or let go of the past rapidly at all and we still have these systems solidly in place long after our environments have changed.]

We found no evidence that acceptance cues elicit a positive, appetitive motivational state to a greater extent in HRS individuals than in LRS individuals. These findings support our view that acceptance and rejection are not of equivalent importance for HRS individuals and that the RS system develops specifically to protect the self against the threat of rejection.

As expected, while the rejection cues produced the defensive state, there was no evidence seen that positive cues of acceptance produced a corresponding positive motivational state. This supports the conclusion that acceptance and rejection hold different levels of importance for highly Rejection Sensitive people ( It’s more important to not be rejected, than it is to be accepted) and that this system develops specifically to protect the self against the threat of rejection.

(Even when positive acceptance is given, it doesn’t necessarily trigger a positive reaction in the brain. Here’s an exaggerated example: Hearing the phrase “I love you” is important but it doesn’t give you that gut feeling of internalized safety.)

This is only the first study of its kind and the paper acknowledges that it should be followed up with a broader range of stimulus events.

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All in all I find this quite enlightening. It certainly makes a little more sense of the seemingly baffling behavior we have sometimes. You know that look. That expression of complete and  utter What the Fuck? It’s often been stated that people with BPD are hypersensitive to the emotional states of those around them. However our failing is in the interpretation of those states. Our fear of rejection leads to a self-centered interpretation of the cues we perceive, which can in turn trigger our less favorable behavior, and actually lead to the fights, emotional throw downs, and flaring tempers that bring about the rejection and abandonment we fear. Hmmmmmmmm.

Learning to sit on our own behavior until we’ve had time to settle our emotions, control the impulsive reactions, and think through what actually happened vs. what he perceive to have happened is an important skill to develop. Breathe. Think. Then determine the course of action we should take. Of course this is so much easier said than done when you’re in the midst of an emotional maelstrom, but if we practice it does get easier and become more natural. 

Wednesday, January 2, 2013

Rejection Sensitivity and Impulsive Aggression: Part 2


The act of being rejected, for people that are Rejection Sensitive, begins before the act has even occurred. People that are Rejection Sensitive are already on the alert for even the smallest sign of rejection. Not only do they fear it, but they expect it. Ironically the act of being on the alert can alter a person’s own actions and behaviors enough to actually insight the rejection they fear and are trying so desperately to avoid.

Thinking about it another way. Say, you come home one night from a fabulous evening on the town. You walk through the door and into an armed robber trying to steal your television. Immediately and automatically your fight-or-flight defense system kicks in. This is how a “regularly sensitive” person reacts. A more acutely sensitive person would be constantly on the alert, installing advanced security systems, locking and relocking their doors compulsively to ensure they don’t forget to lock them, getting a gun just in case and still, STILL, coming home every night as if they’re going to walk in on an armed robber stealing their television. That flight-or-fight system is almost constantly active. Hypersensitve. Quite some time ago I discussed the nuero-biology of Borderline patients and the results clearly indicated that those neural and chemical systems in our brain are triggered much more sensitively than is typically seen.

Regardless of the how, when a rejection actually occurs it’s like walking into your home with your own gun locked and loaded, ready to fire.  A fully automatic gun. And it doesn’t take into account whether the person is actually an armed robber or just an unexpected relative needing a couch to crash on. All the brain senses is an unexpected shadowy figure before the lights are turned on. Actual threat or perceived threat, it’s all still threat.

Unfortunately the fallout can be just as explosive, abrupt, and unexpected regardless of which it is.

I can’t tell you how many times I’ve been on edge, wondering, worrying, that something would go wrong, that I would do something wrong, that would trigger the displeasure or rejection of someone I care about. I’m a compulsive prepper. I put the boy scouts motto of preparedness to shame. I worry that by failing to properly anticipate the potential needs of people that I could upset someone, or at least, not make them as happy as they could be, and thereby gaining the greatest amount of acceptance as I could.  This may be controversial to say, but like many things, it’s really more about me than about their reaction. It hits me in my sense of self-worth. It feels like a failure. Like I’m a failure. Which triggers my self-loathing, my depression, and in the past, like I didn’t deserve to live if that failure was large enough (Not an exaggeration).

When you look at it from that point of view, it almost makes sense that fight-or-flight defense mechanism would kick in to counteract those awful thoughts. If the brain can push back, lash out, blow up, in a way that makes it feel like it’s the other persons fault, and therefore not a personal failure… our sense of self-preservation is maintained.

Of course this all tends to take place on a subconscious level. No one thinks this through ahead of time or in the moment. It’s not a self-aware way to live. Often, people are unaware of how severely rejection sensitivity impacts their lives until they start to receive treatment for it, causing their perception of the world to radically shift.

Karen Horney was the first theorist to discuss the phenomenon of rejection sensitivity. She suggested that it is a component of the neurotic personality, and that it is a tendency to feel deep anxiety and humiliation at the slightest rebuff. Simply being made to wait, for example, could be viewed as a rejection and met with extreme anger and hostility. This concept was later refined and described as the tendency to anxiously expect, readily perceive, and overreact to social rejection. 

 As in so many areas of the psyche, causes for this are often traced back to childhood (though of course you can become more sensitized to rejection throughout your life). Rejection by a parent or caregiver in early childhood could make someone rejection sensitive. Even peer rejection in children is associated with increased rejection sensitivity. Teasing and other forms of bullying appear to be especially likely to cause later difficulties. Now consider how deeply the impact would be if you already had an inborn characteristic prone to sensitivity, like say, someone with BPD.

Even dear old Wikipedia notes that due to the association between rejection sensitivity and neuroticism, there is a likely genetic predisposition that makes people more vulnerable to rejection experiences and more likely to develop rejection sensitivity.

Rejection sensitivity impacts all kinds of areas in a person’s life. Rejection Sensitive people can be reluctant to express opinions, tend to avoid arguments or controversial discussions, are reluctant to make requests or impose on others, are easily hurt by negative feedback from others, and tend to rely too much on familiar others and situations so as to avoid rejection.

“Tend to rely too much on familiar others to avoid rejection.” This explains why the people closest to us, can often trigger our sense of rejection even stronger than strangers. To be perfectly honest, I’m not incredibly concerned about the rejection of people I’m not close to. Or concerned at all. Heh, I pretty much assume it, and it doesn’t really phase me. It’s only the people that I truly care about that concern me.  My self-worth is intermingled with the strength of my relationships.  Not that I have relationships, but the strength of them (Epiphany moment. Also, I recognize this as not being completely healthy. Meh.).


Remember when I was hosting my LOTR party and xRoommate said they’d be late and I automatically panicked? To me, this smacks of it. She’s my comfort zone in an arena where I’m not completely comfortable (i.e. in the presence of people I’m not completely comfortable with). Knowing I have one person I can rely on makes everything else easier. When that aspect of safety is removed, it’s like being bludgeoned over the head with uncertainty.  I was able to calm myself down by reminding myself that her reasons for being late weren’t directed at me, it wasn’t a result or an attack towards me, it was just life stuff that she needed to do. But I had to actually talk myself through it. Fortunately I’m getting better and quicker at being able to do this so I didn’t blow up in the moment.

 
When dealing with someone who has rejection sensitivity, like many if not most of us with BPD, it can be useful to remember that seemingly innocuous actions can be perceived as slights. It is sometimes helpful to stress that something is not a rejection if you sense that someone appears upset by it. 



Tuesday, January 1, 2013

Rejection Sensitivity and Impulsive Aggression: Part 1


Rejection is a natural part of the human experience. One most of us try desperately to avoid, but a natural part none-the-less. Rejections span the gamut of little disappointments to an epic sense of failure that can damage your self-worth.



Example 1: You’re a 6 year old boy that wants to share your blocks with the cute girl in the flower dress. You approach her with blue block in hand but instead of graciously accepting your gift, she punches you in the shoulder and goes back to her own Lincoln logs. Not what you hoped for but there’s another cutie pie in pigtails you can ask, so you move on.

Example 2: After years of emotional trauma and trying to make it work for the kids, you finally divorce your wife in a painful devastation of your sense of self-worth as you question your purpose in life and whether you will every be good enough for anyone ever again.

Now imagine having the emotional experience of Example 2 with the event experience of Example 1. That about sums up the Borderline experience. Good night folks, please tip your waiter. Just kidding. (You got that right?)

Being rejected is much more traumatic for some people than others. People who are highly rejection-sensitive have had painful experiences of rejection that make them concerned with how likeable and accepted they are. Or, if an expression of rejection, no matter how small it may seem, will ultimately result in abandonment.

One of the frustrating things for both Borderlines and our loved ones alike is that an apparently inane statement or “rejection” of just, nah, not today… can make our minds run away with themselves and wonder if we’ve done something wrong in a way that will lose us your love. This can produce a variety of responses from almost codependent clinging, trying to overcompensate by doing even more for you, avoiding what we may want in favor of only things we believe you want to avoid that “nah” again… to anger, that “Well I can’t do anything right now can I?!?” response, pushing away in the form of “Never bothering to try ever again because clearly we aren’t good enough,” and so on.

None of it is really rational, and it can be rather blind siding because who expects that reaction when you’re just not in the mood to go out for ice cream in sub zero temperatures, but depending on the fragility of our mental state, even small rejections can make us wonder if we’re succeeding or failing as human beings. For me I tend to respond with either: 1. I’ll be SO MUCH BETTER in the future, or 2. If I don’t try I can’t be rejected again…. Sometimes pushing away to an extreme of 3. If I leave/make them leave they can’t reject me at all, ever again. That’s the not-so-fun Push-ing of ye old Push-Pull cycle…. Here we begin to see the markings of that impulsive aggression.

But I’m rambling away with myself. Let’s break this down:

Rejection sensitivity is a psychological condition which is characterized by oversensitivity to rejection. It typically appears in people with various neurotic conditions like borderline personality disorder, and it can be extremely debilitating for people who suffer from it.

Someone with rejection sensitivity tends to be extremely sensitive to rejection, often perceiving rejection where there is none. For example, upon hearing that a group of friends has gone out without her, a woman with rejection sensitivity might think that the friends didn't like her, when this is not the case. Her perception of rejection, however, might lead her to be angry or aggressive, thereby putting stress on her relationship with her friends.

Individuals who suffer from rejection sensitivity also suffer from an abnormal amount of dread in situations where rejection is a possibility. They might be extremely distressed at the thought of asking someone out on a date, for example, or at the idea of meeting new people. This anticipation can set up a self-fulfilling prophecy, where the person with rejection sensitivity behaves strangely, thereby creating a situation in which he or she is rejected, confirming previous fears. [1]

When you have BPD not only do we fear rejection with the accompanying emotional turmoil, but we tend to expect it too. With all those emotions sort of prepped and at the ready, yanno, just in case.

Does this experience sound familiar?

“I have a constant edge-of-your-seat alertness for little clues that might mean someone hates me or doesn’t want me to be with them anymore. With my boyfriend, when we would be together doing something quiet like reading, every so often I would interject with a pleading and submissive, "Are you mad at me?” until it annoyed him so much he really would get angry! For me, though, the impression he was displeased with me was so real--all it takes is silence to make me feel like I’ve been rejected, and this fills me with panic.”

If you’re like me you don’t actually ask “Are you mad at me?”, you just wonder ceaselessly until the ruminations drive you a little more neurotic than usual. I’m not sure if it’s worse to express the concern on my mind, or just let it run away with itself.

Meh. I’ve been in this state of hyper-awareness for rejection/for whether I’m doing something to screw up, in regards to K and Twiggy lately. It’s very important to me that we’re able to rebuild our friendship, and I really am afraid of screwing it up, doing the wrong thing, not taking something into account that will make them more comfortable, saying something not perfectly which could be interpreted in a way that might possible be taken wrong, yanno, anything that might mess this up and make them realize I don’t actually deserve to be in their lives anymore.   I know, cognitively I know, that I would never purposefully do something to hurt them, especially I’m on constant alert, but, the fear is still there. Frankly, I don’t trust myself entirely even though I’ve been working very hard to be more mindful of myself and everyone else.  


Caring for people is frightening when you’re constantly on the alert for them to leave you.


And that’s just for perceived rejection! Actual rejection in life is pretty much impossible to avoid. And in a pretty unsurprising twist of fate, perceived rejection can lead to an almost self-fulfilling prophecy of actual rejection. But we’ll get to that tomorrow.  

Monday, December 31, 2012

Myth and Stigma – Emotion vs. Intelligence: BPD & Rational Thought

EDIT: I feel I have caused a bit of a stir citing forums (there are many I check out) outside of my own. My goal was not to take away the space or to say that you don't deserve a place to work through everything you've been through. You certainly do. My goal was also not to attack or diminish the hurtful things you have experienced in your relationships with the Borderline(s) in your life. I know all to well the impact we can have on our loved ones (and believe me I've done my fair share of venting). Expressing and working through your pain and experiences deserves just as much support as anything else. My personal grievance is with the generalization of "everyone with BPD" or "if you have BPD than..." that undermine the individual as a unique person. Of course it's no fun to hear yourself be spoken about, but everyone is entitled to their opinion and if I wasn't willing to deal with criticism or didn't feel I could handle it, running a public blog is probably a bad lifestyle decision ::smiles::. I take my life experiences and I write about them. It's what I do. Some people are very understanding, some people aren't. All I'm trying to do here is start the conversation and provide one new perspective (my own, which clearly can be quite different from any other singular person). While things happen to me as an individual, I try to address things that many others have also experienced. END EDIT.


Hello Dear Readers. Now that all my holiday travel and movement is over, I’m back and ready to get rollin’ again. In the past couple weeks I’ve been doing something I shouldn’t have. I do this because I have this cognitively rational, though emotionally irrational, need to know. Occasionally I visit forums for the loved ones of Borderlines that are there to support each other, and rationalize the actions of their Borderline loved ones from their own perspectives, but not really understand their Borderline loved one in a way that is functionally consistent with the experience of the Borderline themselves. I get it, it’s difficult to perceive a different experience than one you understand. I also do this because it's important to remember how we affect our loved ones and they do give me new things to consider that are applicable for learning to function in a way that is healthier and more productive in our relationships. 

The thing that gets me, is how limited and single minded these perspectives can be (not all of course). It’s human nature I suppose. You can’t internalize the lifetime of experiences another has had, which makes the understanding essentially alien. And when you’ve been wounded (as I know many of our loved ones have been by us and our actions) it’s difficult to see past their own experience and pain. I get it. It doesn’t really make it any less hurtful to see yourself talked about though. When it's specific to me I can take this personally, because my blog, and therefore myself, are often referenced in these forums. Being as public about my experience as I am I am in a unique position to reach out and connect with people that so often feel alone, confused, and conflicted and hopefully provide some clarity. However it also opens me up to a lot of criticism and ridicule. Not only that, but my heart also aches for us as a whole, not just for myself. I’m pretty good about it because I know better than anyone my own experience and I try to keep in mind that when you don’t have BPD it’s extremely difficult to put yourself in our shoes (not too mention I'm no saint and I know how I've hurt the loved ones in my life but that's why I am actively working to change). 

One thing that really bothers me though, is when I receive a certain criticism, or I hear this criticism applied to anyone else… And they go something like this:

“He/She has great insight,” or, “He/She is really smart…. BUT, you know [they] have Borderline Personality Disorder, right?”

…As if having a problem with emotional dysregulation means our cognitive functioning is somehow inhibited.

Myth and Stigma: Because we are emotional, clearly we can’t also be rational in an intellectual capacity. Because we have a personality disorder, because we have a mental illness, etc., clearly we can't also be rational in an intellectual capacity. 

Categorically False.

Amusingly when I first started to research BPD I kept coming up against the same information over and over (hence why I started my own in depth research). One of the things I consistently saw in the introduction to BPD was:

- A person with this disorder is often be bright and intelligent, and appear warm, friendly and competent…

- Borderline Personality Disorder often takes the form of a whip-smart, dead-sexy woman with ferocious impulses…

- Someone with BPD is typically very smart, very articulate, very personable…

- ….And the truth is, most people with this disorder are smart, and they can really be very funny.


Yet it’s almost immediately negated and forgotten once people move on to take a look at that good old DSM checklist.

Dr. Leland M Heller states that intelligence is not affected by this disorder, though the ability to organize and structure time may be severely impaired at times of extreme emotional distress. Our cognitive functioning is perfectly intact. In fact, if you have a set of afflictions like I do, it’s even enhanced, because my fear of failure, compulsive nature, and anxiety makes me push myself even harder to know and understand.

From the Personality Disorder Institute: 

Two experiences in growing up are very common in borderline disorders. One is the experience of being seen as apparently competent. Because these people often are in fact very competent, very smart, sensitive, clever, insightful, it is extremely difficult for others to take them seriously when they collapse in despair at a minor frustration, burst into rage over nothing, make terrible errors of judgment. When a psychotic person acts that way, people are inclined to be sympathetic—"He can't help it"—but a borderline person is told, "It's not that bad." "Shape up—grow up—don't be such a wimp—you know better." Their behavior is often regarded as willful, manipulative, "just looking for attention."


The second experience is linked to that of being an apparently competent person—and that is the experience of being invalidated: "It can't be that bad." "Your headache—your PMS—your anxiety isn't any worse than anybody else's—why make such a fuss?" Being invalidated compounds the borderline person's self-hatred. The majority of cases of borderline personality that come to the attention of psychiatrists are women. We don't know why this is, but researchers speculate that it reflects the combined effect of more girls than boys being subjected to sexual abuse in childhood, and of the tendency of males to express emotional instability via outward aggression toward others rather than via self-destructiveness. Borderline men, therefore, are more likely to show up in jails than in psychiatric hospitals or psychiatrists' offices.

That’s the thing, in A LOT of my research one of the things I see very often is that people with Borderline are often very intelligent, clever, smart, etc. And yet, because we are also emotional, that cognitive intelligence is automatically discredited. 

I find this noteworthy because this is a phenomena that I ONLY experience with my blog and the people that try to downplay my relevance and insight specifically because of my personality disorder. In my personal life, with my friends and family that know of my BPD, they may question my relationship or emotional choices, but when it comes to issues of survival, academics, books, reading, hobbies, math, science, engineering, astrophysics (this was my University minor btw)… no questions. In my professional career where my emotional dysregulation and BPD are not known at all and therefore not a factor, I am held in high regard for my research, work, and intelligence.  But when someone that doesn’t know me personally starts off knowing that I’m Borderline… well, clearly I must not have the capacity for standard intelligence or rational thought. False.  And yes, I do find it offensive when you judge me based on an incomplete perception and an irrelevant stigma. I imagine anyone would.

This is why so many people don’t seek help. Because once people know that you have a problem or struggle with something that affects one aspect of your life, ALL OTHER ASPECTS of your life are called into question. It’s frustrating.

I do understand that as a human being, especially one that is writing about my own experience, I can’t be 100% objective because it’s very rare that any human being is objective to their own existence. Our experience is subjective to our own perspective. I can get pretty close though, especially as I use my therapist as a sounding board. I’m harder on myself than she believes I should be, but it’s true to my experience, which is what I attempt to convey, coupled with supporting research to strike as accurate a representation and balance as I can portray.  Personal experience includes all things that occur coupled with perception and emotion. Once the event is over, it’s possible to take perception and emotion out of the equation and view the occurrence itself. From there I can extrapolate what is rationally relevant and what is emotionally [ir]relevant. I’m getting to the point where I’m able to do this more and more in the moment as well, not just in retrospect. Go, go therapeutic progress.

Part of what contributes to my ability to do this blog the way that I do, is my scientific approach to pretty much everything.  I am simultaneously subjective to my own self-centered experience and merely a singular specimen in a greater puzzle (I find ego to be more of a distraction than a necessity, except in matters of survival).  The effect is compounded when I dissociate since I don’t always experience the self-centered aspect of my world and I’m not always the center of my own perception. This makes taking the subjective experience out of my research even easier…. Except when it’s specifically relevant: Studying the personality disorder without the “person” makes no sense.  Not to mention people, in general, are not simplistic. We’re dynamic, complicated creatures with a variety of variables, interests, motivations, beyond the disordered aspect of our functioning.   Often I see others talking about people with BPD as if the BPD aspect of us is the only relevant aspect of us, which is extremely unfair as well as unkind.

My personal perception is different than that of other people. Not surprising. No one else is me. I am no one else. However, as a human whole we share many common experiences. Especially when we have a contributing variable like BPD.

Anyways, my point is… just because we have an issue that affects our lives as a whole, it does not mean that the problem occludes all our singular abilities as people. I don’t care how angry, or upset, or wounded I am, my ability to do calculus remains. I may not want to analyze the structural integrity of an irradiated structure at the moment, but that doesn’t mean I can’t do it just as well as anyone else that’s having a better day.

Mental health stigma helps no one. Problems in one area doesn’t mean the whole breaks down completely.

While my Cognitive Intelligence may be greater than my Emotional Intelligence; emotion and intelligence can and do coexist. Intelligence isn’t just one or the other either. A system incorporating more than one frame of reference often has a greater resource pool to pull from. Emotion as inferior to intellect is a Western ideology that is neither factually supported nor experientially relevant.

In the human experience everything is contextual. Existence is subjective. 




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