Friday, February 15, 2013

Ask Haven: Push Me - Pull Me



Dear Haven,

I’ve been with my BPD boyfriend for almost a year. I love him so much but sometimes he’s really hot, and then artic cold! I don’t understand how he can be so loving one minute and then it can be like that love was never there at all the next minute. Do people with BPD push-pull people they really want to be with?

Help!
Pushed and Pulled



Dear Pushed and Pulled,

I don’t want to say we only do the Push-Pull thing with people we want to be with, but we really ONLY Push-Pull people that we want to be with. Or more accurately, Push-Pull people we want in our life and want to be close to in some way, be it family, friends, lovers, significant others, whatever.
At least that’s my experience.

It’s going to be different for different people and depend on how sensitive they are to the particular situation. We must remember that everything is relative to the individual. However, from my experience, if I don’t like you, aren’t close to you, or just generally aren’t interested in you… you can’t evoke the emotional connection in me that makes me want to be super close, and then freak out at the potential consequences of loss that that closeness could bring. In short, if you’re not someone I’m close to, there’s zero probability that you’ll get the Push-Pull.

That’s not to say that you can’t piss me off or get some kind of emotional response. But unless there’s some kind of major incentive I probably won’t try to reconcile with you, and even if I do, it’s not the same thing as an intense Pull Back, it’s simply a matter of maintaining some aspect of social or professional accord.

For the whole Push-Pull to be an issue at all, it means there has to be some deep emotional connection or a desire for one. The Push is usually inspired by that person reacting to the idea of losing that connection, or feeling suffocated from that connection, because the loss would be heart breaking or they feel like they’re losing themselves in some way b/c the connection is overpowering their tentative sense of identity. But once the Push has occurred and that’s had a minute to sink in: then the realization of that loss is right there in our face, and we feel what it is to not have that person in our lives, and that is a whole new kind of terrifying.

There’s a lot going on with the whole Push-Pull ordeal: Herecheck it out, I’ve written a lot about it. But I’m fairly confident in my assessment that it doesn’t happen with people that we don’t want to be close to.

Disclaimer: this does sometimes occur during the break up process when we know we don’t want to be with someone, but the loneliness is also unbearable. It can be confusing to feel the loss, not understand what’s really going on with your feelings and then reacting to the loss in a way that isn’t actually healthy: returning to the failed relationship. We’ll call that a “negative” Push-Pull… when the Push-Pull is inspired from actually not wanting to be in the relationship.

Communication is key! Also, pay attention to the previous context of your relationship. If it really feels like it’s out of the blue and up until that point their interest has been right with you and intense, then it’s probably a “positive” Push-Pull where they want to be with you, but they’re afraid to be with you.
If they’ve generally been distant, unresponsive, snippy or confrontational, and uninterested… they may just not be that into you. That happens with BPD too. I’ve dated lots of people that I just didn’t connect with, felt really bad about hurting them so I’d stay longer than I should have (Boring-Ex), but ultimately I didn’t want to be with them.

However for you, if he’s being very loving and it feels like he wants to be with you, then all of a sudden he’s a million miles away, it’s probably more along the lines of the “positive” Push-Pull. It happens, the best thing you can do is try to communicate and get to the heart of the issue so you can reduce the occurrence in the future.  Hope this helps! 

Thursday, February 14, 2013

Hurts So Good: Neural Clues to the Calming Effects of Self-Harm


Hello Dear Readers,

You may have noticed I’m having a bit of a difficult week. Lonely, stressed out, [not technically] relationship confusion, internal car explodey massive financial/insurance pain in my ass. One day at a time. One thing at a time. I’m trying to do everything I can to not be overwhelmed. As much as I hate to admit it, I’ve had self-harming thoughts lately when I’ve been extra stressed out. Nothing I’ve acted on or for any one thing in particular, but the thoughts have been creeping in towards the forefront of my mind without any conscious decision. This used to be an everyday thing. Seriously for 18 years thoughts of cutting were just sort of floating around there in my everyday world. I didn’t usually act on them, but they were there. I was used to them. In the past year or two they diminished greatly. I’ve gone months without thoughts of self-harm and that’s huge for me. It’s just lately they’ve been starting to creep back and now I’m not used to it. I won’t act on it or anything. I have more constructive outlets now, but I did find an interesting article explaining one of the reasons self-harm is so prevalent for those emotionally dysregulated among us. This is the condensed version with all the relevant parts syphoned out, but if you’d like the more scientific methodology and whatnot you can find that HERE. So here ya go.  



... from universities, journals, and other research organizations

Aug. 30, 2010 — The notion that cutting or burning oneself could provide relief from emotional distress is difficult to understand for most people, but it is an experience reported commonly among people who compulsively hurt themselves.

Individuals with borderline personality disorder experience intense emotions and often show a deficiency of emotion regulation skills. This group of people also displays high prevalence rates of self-injurious behavior, which may help them to reduce negative emotional states.

Niedtfeld and colleagues studied the effects of emotional stimuli and a thermal stimulus in people either with or without borderline personality disorder. They conducted an imaging study using picture stimuli to induce negative, positive, or neutral affect and thermal stimuli to induce heat pain or warmth perception. The painful heat stimuli were administered at an individually-set temperature threshold for each subject.

In patients with borderline personality disorder, they found evidence of heightened activation of limbic circuitry in response to pictures evocative of positive and negative emotions, consistent with their reported emotion regulation problems. Amygdala activation also correlated with self-reported deficits in emotion regulation. However, the thermal stimuli inhibited the activation of the amygdala in these patients and also in healthy controls, presumably suppressing emotional reactivity.

Dr. John Krystal, Editor of Biological Psychiatry, commented, "These data are consistent with the hypothesis that physically painful stimuli provide some relief from emotional distress for some patients with borderline personality disorder because they paradoxically inhibit brain regions involved in emotion. This process may help them to compensate for deficient emotional regulation mechanisms."

The authors note that these results are in line with previous findings on emotional hyperactivity in borderline personality disorder and suggest that these individuals process pain stimuli differently depending on their arousal status.

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I don’t know about you, but I find this easily relatable. I didn’t really need neurological imaging and a battery of scientific tests to tell me I feel better emotionally after the experience of physical pain, but it really is a concept that is incredibly misunderstood by people. I personally have (had) a number of different reasons for why I turn to self-harm, but ultimately I think the main goal was to simply find some relief. I’ve always known that I experience pain differently that many people. For one, I’m not afraid of it and I actively seek it when I’m in distress, which seems counterintuitive to basic survival instincts. I also know that my pain tolerance is exceptionally high. Hell I sat through a 22 hour rib tattoo without batting an eye. I’ve long thought the brains of those of us that seek self-harm to relieve that emotional stress may have slightly different hardwiring in our brains. It’s nice to see that my instincts appear to be correct.

Something’s a little crossed in there so that physical pain actually inhibits the experience of emotional turmoil. I find this kind of fascinating, especially when you think about it from an evolutionary standpoint: in situations of extreme duress and injury when most people would panic, it actually has a calming effect for some of us. That could be pretty helpful. Not that I am in any way encouraging this as a means to become more clearheaded. There are certainly more constructive ways to achieve this without risking life and limb, but it’s interesting none-the-less.

What do you think? 

Wednesday, February 13, 2013

Personal Confliction




Sometimes I just wish I could be drunk permanently. It feels better than how I feel normally sometimes.
I’m so conflicted. I so badly want to connect and have my problems taken away. But at the same time I have no concept of turning them over to anyone else. It’s mine to deal with.

The dumbest shit… the dumbest! It's just life stuff!

We had a bad blizzard here. I was out visiting friends who got nearly 3 ft. of snow. My car was not happy with me. No accidents or anything, but just the fact that it took me 5 times longer to get home, with all the people around me driving like they’ve never seen inclement weather before, I was riding my clutch b/c traffic moved at 2 mph and people were sliding and falling off the road everywhere, it was just ridiculous. My car was not happy.

I drove it once yesterday, and then to work today. Straight from there I took it to the shop garage because I knew something was wrong with it. Turns out my clutch needs to be changed… for $1000.

About 4 hours later I got another call, my transmission is shredded. The guys at my garage are stand up guys. Called me in, took me into the garage to look at my transmission. I’m well versed in mechanical engineering and automotive issues. My transmission looked like shit. After I watched him call around and get quotes turns out… another $4000 worth of repairs. $5000 worth of damage! From zero accidents, just inclement weather driving! And the parts wouldn’t be here until maaaaaaaaaybe Friday. So I wouldn’t get my car back until Tuesday.

::Cue heart attack::

I was supposed to drive me, xRoommate and her BF to a convention this weekend. I’m getting all costumed up. A costume I’ve been working on for months. (I’m a Star Wars geek, we know this, I get really into this shit). My car is my only way to work too. To get food, to the gym. Fuck. How am I going to get around? I really just didn’t need this right now.

Talked to New Girl a bunch. She majorly freaked me out with her crazed reaction not being able to travel during the blizzard. The next day she was really remorseful and totally admitted she was over-emotional and actually reassured me quite a lot that she really wasn’t that kind of person. She told me regardless of weather or not I wanted to go out on a date with her, she still wanted to be friends, and I was someone she really wanted to get to know. No matter what. That actually reassured me a lot. She’s a really cool chick. I had almost forgotten how emotional women can be, because even the last few women I’d dated weren’t overly emotional types.

At work today I took my car in at 7:30a. By noon they called me with the original quote. They called back at 4p after they discovered the greater problem. The shop owner wanted me to come in and actually look at the problem though because it was easier to show me the severity of the problem then just describe it. Roommate Monroe was coming to pick me up a bit after 4 so I needed to get out there right away. My office mate was out, everyone I could have asked wasn’t around, so I called Tech Boy and he picked me up right away, waiting while I was in the shop, and brought me back to my office. No questions, no problems, no grief.  

Roommate Monroe picked me up. A short while later I got the official quote from the garage. I relayed it back to Tech Boy b/c he wanted me to keep him updated. He made sure I had a ride home and all that. I was freaking out about what I was going to do. Tap my retirement, take out a loan, trade in my car and hope the dealership takes over my payments…. He suggested I actually talk to my insurance company, which for some reason I hadn’t even considered. So I did. I explained the situation. They had many similar claims due to the weather. And it’s being taken care of! He totally saed my butt and my bank account.

As soon as I got home I opened a bottle of wine I was so stressed out. I had to call the bank, the dealership, manufacturer, the garage, my insurance company…. I hate talking on the phone. HATE. It makes me so anxious. Wine is the only way I could deal with it. By the time I was done I was a glass and a half in and tipsy b/c I didn’t have my car all day and couldn’t go out to get food for lunch so I had no food in my stomach.

New Girl texted me a couple times. But she’s still being cautious because she doesn’t want to pressure me and scare me off. Which is sweet because I can tell she really wants to get to know me. Tech Boy and I have been texting constantly though because he’s been helping me think through my car bullshit and I seriously miss him right now. He even shaved off his awful beard for me.

I just don’t know what I want at all. I’m so confused. I miss him. I know we don’t work, but I miss him. He’s so sweet and he just wants me to be happy. I’m so sensitive sometimes though and I don’t feel I can be completely myself with him.

I haven’t even been on a single date with New Girl yet but I feel like I’m cheating on her because I still have some feelings for Tech Boy. Especially because right now I just really want him in my bed. I miss sleeping with him. Not even just the sex, but the cuddling and falling asleep with him. There were so many problems…

… but times like this I just think maybe I want too much. But do I really? He’s so sweet. And he so obviously still cares about me. I’ve told him twice in the past couple weeks that I didn’t want to be with him and he still is okay just picking me up and helping me out without a second though or question.

Maybe it’s the alcohol talking, but I miss him a lot and I’m seriously thinking about “cheating” on New Girl… even though I haven’t been on a single date with her and she’s already freaked me the hell out and put me in tears. I’ve already felt like I wanted nothing more at all to fucking to do with her, but now I’m okay with seeing her again, and I haven’t even met her in person yet!  I feel like such a nut job sometimes. 

Tech Boy is so tempting. He’s so easy to cuddle up with. He cares about me. I just miss having someone close. It’s hard for me.

Breaking the fourth wall and all, but no one in my real life would notice or knows because I don’t vocalize or verbalize it. For all intents and purposed my friends think I’m fine. I hide it all, but I’m sad and lonely. I’m not mired in darkest depression or anything, but I don’t want to be alone. I don’t want to be alone, but I don’t want to be in a committed, solid, monogamous relationship either. Everyone I meet seems like they either want all of the relationship only me right now forever, or treats me like shit. I don’t know how to tell people I need to take it slow, I’m not ready to be monogamous. I don’t know how to justify to myself that it’s okay to not be sure. I always feel guilty for not being sure. It’s hard and I hate it.

It’s been a rough day. Some days I really don’t mind that I have wine. I’m sure I’ll regret it tomorrow though. I’m fighting so hard the urge to tell him to come over. I give myself very good advice, yet I very seldom follow it… because following my own advice is so bleeding hard!

Get through the night. One night.  

BPD and Game Theory: Brain Differences Related to Disruptions in Cooperation in Relationships

Hello Dear Readers! You may have noticed my absence the past  couple days. We had a major snow storm here in NY (and all of the North East/New England area) which knocked out my internet. Quick Rant: New Yorkers around the NYC and LI areas cannot drive in the snow. At all. I’m from the Midwest originally. What they’re calling a freak blizzard here, we just call winter. But enough about that. I’m back now!

While researching, as I am wont to do, I came across this little gem. I’m posting this because 1. I disagree, but 2. This research was from 4.5-5 years ago, and I think it demonstrates just how far research in Borderline Personality has come in just 5 years.

Borderline Personality Disorder: Brain Differences Related to Disruptions in Cooperation in Relationships

Science Update • August 12, 2008

Brain activity during investment game
Different patterns of brain activity in people with borderline personality disorder were associated with disruptions in the ability to recognize social norms or modify behaviors that likely result in distrust and broken relationships, according to an NIMH-funded study published online in the August 8, 2008 issue of Science.

Borderline personality disorder is a serious mental illness noted by unstable moods, behavior and relationships. Each year, 1.4 percent of adults in the United States have this disorder, which is widely viewed as being difficult to treat.

Using brain imaging and game theory, a mathematical approach to studying social interactions, the researchers offer a potential new way to define and describe this mental illness. They conclude that people with borderline personality disorder either have a distorted sense of generally accepted social norms, or that they may not sense these norms at all. This may lead them to behave in a way that disrupts trust and cooperation with others. By not responding in a way that would repair the relationship, people with borderline personality disorder also impair the ability of others to cooperate with them.

A generally distorted sense of social norms? I’m going to start by saying that this study was entered into with a conservative bias that believed social norms means absolutely anything at all. Social norms, are a median view of cultural living. Culture which, in this country, varies IMMENSELY between geographic areas, political views, religious views, personal values, ethnic backgrounds, etc. The idea of a social “norm” is meaningless. Furthermore, social revolution and progress is defined by going against the norm. I realize this isn’t what they’re referring to here, but it means something to me. I have zero sense of needing to conform to social “norms” when and where they don’t suit me. This is probably more a result of being raised in a liberally politically active household than my Borderline Personality Disorder though. Social norms are mean to be progressed beyond. < ~~~ My slogan for the day. For instance, Mental Health issues are generally hushed, stigmatized, and not talked about… personally? I’d rather increase my voice, speak out, and raise awareness.   Social norms my ass. 


          
Brooks King-Casas, Ph.D., Baylor College of Medicine, and colleagues evaluated cooperation among pairs of participants playing an investment game. Each pair comprised a healthy “investor” and a “trustee,” who was either another healthy participant or a person with borderline personality disorder. In total, 55 people with borderline personality disorder participated. An additional 38 healthy trustees paired with healthy investors served as a control group. The investors and trustees interacted through linked computers, but did not meet or speak with each other at any point.

In each 10-round game, the investor started every round with 20 “dollars” and could invest any amount between 0–20. Clicking a button to send the investment offer automatically tripled the amount, at which point the trustee decided how much to return. If the amount returned was less than the amount invested, the investor was likely to offer smaller amounts in future rounds, signaling a breakdown in trust and cooperation in the relationship. Trustees could try to “coax” their investor partner by returning a large portion of the tripled investment, even when the offer was low—for example, returning all 15 dollars on a 5-dollar offer. Ultimately, coaxing resulted in generous payoffs in later rounds.
Compared with the control group, trust and cooperation faltered over time in pairs that included a person with borderline personality disorder. People with the illness tended to behave in ways that caused a breakdown in cooperation with their healthy partners. Moreover, they were half as likely as healthy trustees to try to repair the relationship through coaxing.

Because, yanno, people with a history of abuse and trauma would totally be likely to trust random, faceless, strangers, whom we have zero idea if they have our best interest in mind. Is this really a BPD problem or a “healthy” person problem?  Who in their right mind trusts someone with zero knowledge of their background or intent? What they call a breakdown in trust, I call common sense for my investment.

To determine whether a neural basis exists for this behavior, the researchers analyzed brain activity in the bilateral anterior insula. In addition to other functions, this region responds when we sense unfairness or violations of social norms.

In healthy participants, insula activity increased as offers or returned amounts decreased. For example, healthy trustees had high levels of activity if they received low offers from the investor or if they returned low amounts to the investor. If the offer or return was high, insula activity was relatively low. By comparison, in participants with borderline personality disorder, insula activity increased only in response to low amounts they sent back to the investor; insula activity remained at an average level regardless of the amount offered to them by investors.

This should come as no surprise. As I recently discussed in my Attachment Disorder studies, it was discovered that people with BPD tend to react significantly to negative experiences, but do not have a correspondingly intense reaction to positive experience. Where negative situations are experienced there is a heightened negative response. Where a positive situation is experienced, there’s almost no reaction change or response. That’s what we know now, however the conclusion of this study is….

The findings suggest that either people with borderline personality disorder are not persuaded by rewards of money in the same ways as healthy people, or that they do not regard low investment offers as a violation of social norms.

It does appear true that we are not persuaded by rewards as “healthy” people are. However, regarding low investment as a violation of social norm has nothing to do with anything. Social norms have nothing to do with our issues. The issue is a matter of attachment and heightened sensitivity to negative situations.


The researchers also found that people with borderline personality disorder reported lower levels of trust in general, compared with healthy participants. In other words, untrustworthy behavior by the investors would not be seen as a violation of social norms because the participants with borderline personality disorder had less trust in their partners to begin with.

Lower levels of trust in general. Shocking!?! People with Borderline Personality Disorder often have a history of trauma and abuse. We’re hypersensitive to the potential for future trauma and abuse and come complete with a built in developmental defense mechanisms to protect us from such. This isn’t a matter of not registering the violation of social norms. It’s a matter of self-preservation. 


Using concepts from game theory, this study offers a new way of studying and understanding interpersonal relationships and mental illnesses that impair social interactions.

My conclusion: Using game theory to study Borderline Personality Disorder makes zero sense. We do not typically act in socially predictable ways, and in the end we will always act for self-preservation…. In situations where we are dealing with complete strangers that we could have no chance of developing any kind of trusting relationship with. Who trusts a complete stranger? The whole premise is flawed if you ask me.

In addition to NIMH, the researchers also received funding from the Child and Family Program at the Menninger Clinic, National Institute of Neurological Disorders and Stroke (NINDS), and National Institute on Drug Abuse (NIDA).

Left: In healthy participants, brain imaging scans show activity in the bilateral anterior insula in response to the amount of offers in an investment-style game. The graph shows an inverse relationship between insula activity and investment amount—high levels of activity in response to low offers, perceived by this brain region as unfair; decreasing response as the investment offer increases.
Right: In participants with borderline personality disorder, activity in the bilateral anterior insula does not have a direct relationship with investment amounts.

Probably because we don’t trust strangers and don’t expect anything good to begin with so high or low the investment amounts don’t mean much. It’s been my experience that I need an emotional investment in something for it really get to me. Relationships, being on time, performing well at work… these things might get a response from me. Pretend investments depending on trust between myself and a complete stranger? Not so much. I think the whole premise is flawed. Game theory doesn’t work for us. Our personal investment and emotional history in the other person determines how we interact with them. If there’s no personal investment, there’s not much of a game.  

References
King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The Rupture and Repair of Cooperation in Borderline Personality Disorder. Science. 2008 Aug 8;321(5890):806-10.
1 Lenzenweger MF, Lane MC, Loranger AW, Kessler RC.DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Sep 15;62(6):553-64.


So why did I go through all of this if I’m just going to argue with the whole thing? Well, besides the fact that I just like to argue, I think it’s interesting on many levels that have very little to do with the subject of the research.
It shows how little was understood about BPD even just a few years ago. It also gives a glimpse into where some of the social stigma comes from. It was assumed that people with BPD had a disregard for social norms to explain why we were so “difficult”. Which contributes to the idea that perhaps we’re just not trying hard enough to “be normal” making our BPD our own fault. Which we now know is a different case entirely.
Just 5 years ago, researchers were looking at Borderline Personality Disorder from a perspective of social norms. Studies like this that measure neurological responses began to note the biological differences in neuro-functioning of the BPD brain.  I’m not sure if this was one of the first studies to do neuro-imaging for Borderline Personality Disorder or not, but the more imaging that was done, the more apparent it became that our brain functioning was different.

This article demonstrates just how far research has come in a handful of years. That, I find heartening. The material in this particular article may be outdated and a little ludicrous, but it was accepted at the time. Now, we know that this is outdated research and where potential issues actually lie. Comprehensive and accurate research is progressing by leaps and bounds. Accurate research leads to more accurate diagnosis, treatment, and healing.

Personally I think it’s neat to see how much progress is being made and that signs point towards better understanding and greater hope for healing.  
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