Friday, October 18, 2013

Don't Be Ambivalent About Ambivalence

Ambivalence is always a funny subject for me. Ever since my psychiatrist attempted to medicate it out of me the topic amuses me to no end, however that doesn’t make it any less of an important one. For those of us with Borderline Personality Disorder, making decisions, especially about important things in our lives, can be very difficult. Not because we don’t want to make a decision, but because we feel too many different ways about one thing. Overwhelmingly. What can we do about it though? That’s the question.


Don't Be Ambivalent About Ambivalence
Michael S. Broder, Ph.D.


Ambivalence is a feeling that we all have experienced at one time or another in some important aspect of our lives -- I know I certainly have. But if you're ambivalent often or in a lot of areas of your life, the feeling of ambivalence itself can actually destroy your quality of life more than you know. Theoretically, if you had everything you could possibly want going for you, but were ambivalent about the decisions you make -- particularly with respect to your life direction -- no matter what you did have going for you, no matter what you choose to do, you could be dwelling on the fact that you should be doing something else. Thus, no matter what kind of life you have made for yourself, being chronically ambivalent could ruin the quality of it all!


So let's first acknowledge that we all have at least some degree of ambivalence. Since life itself is such an extremely complex process, and certain aspects of it often get more complicated as they evolve, a certain amount of ambivalence is actually normal. In fact, a tiny amount of ambivalence might even serve to protect you sometimes from being thoughtless about certain things that need to be reasoned out more carefully. But the problem is with the degree that you allow yourself to operate under the all-too-common myth -- that there is one and only one absolutely right answer that will contain no shades of gray. The myth continues when you believe that by being indecisive and holding out long enough, some indisputably certain and absolute answer will come to you. And when it does -- you fantasize -- it will come with the ironclad guarantee that you will never have any regrets, nor will you ever second guess yourself. Since this standard is so incredibly high (not to mention cartoonishly black and white), it then follows that you will resist making tough decisions at all that you are the least bit ambivalent about.


Some people actually have a fear of making decisions altogether. If that's you, it is likely you have many regrets about things that may have passed you by, simply because you didn't act decisively when you had the opportunity to do so. If you think my statement that "ambivalence can ruin your life" is a little too strong, perhaps you may even take comfort in the ambivalence. But my stand on ambivalence is rather unambivalent; to the extent that ambivalence exceeds prudent caution it will generally serve to hold you back, and that can be in any area of your life. Here are a few ways to attack this problem that I have offered for people who have ambivalence about love relationships in my book Can Your Relationship Be Saved, but these simple tips can be applied to absolutely any area in your life.


Remember that just about all of your important decisions are, to one extent or another, educated guesses. And most of them have factors that would pull you in the opposite direction. After all, a decision without conflicting factors -- to one degree or another -- is simply a no-brainer.


Forget about certainty. The concept of certainty itself is a myth. Instead believe in yourself. Hindsight -- as we all know at least intellectually by the cliché -- is 20/20. There are many things every one of us would do differently "if only we knew then what we know now." But that's never an option. So stop pretending it is! Where do you have unlimited power (even if at times you are not in touch with it) is in making changes that will affect you from today on, and for the rest of your life -- beginning right now. By focusing on your power you can start looking upon decisions not as burdens, but as empowering challenges.


Think of some significant important life choices you have made in the past -- recently or even a long time ago -- of which you are most proud. Make a list of them and continue to expand the list. Make sure to include those choices that may have led to major life changes. Keep this list as a frame of reference that you can refer to for a shot of empowerment, anytime you find yourself thinking that you're incapable of bypassing that ambivalence.



Regardless of which area of your life where you find yourself most ambivalent, you won't move forward until you allow yourself to take charge and make the best decision you can with the information you have available to you. So resolve not to waste another moment with the decision to not decide.


Thursday, October 17, 2013

Impaired Brain Activity Underlies Impulsive Behaviors in Women with Bulimia

Here’s an article I found that is near and dear to my heart (yanno, in a sarcastic kind of way). Surprisingly one of the things I haven’t looked into is less obvious psychological origins of eating disorders. It's exceptionally relevant though because what we're talking about is Impulsive Behavior in one of the criteria designated as an impulsive qualifier for Borderline Personality Disorder. I do wish it took men into consideration, but what can you do.



Science Update • January 12, 2009

Women with bulimia nervosa (BN), when compared with healthy women, showed different patterns of brain activity while doing a task that required self-regulation. This abnormality may underlie binge eating and other impulsive behaviors that occur with the eating disorder, according to an article published in the January 2009 issue of the Archives of General Psychiatry.


Background 


In the first study of its kind, Rachel Marsh, Ph.D., Columbia University, and colleagues assessed self-regulatory brain processes in women with Bulimia without using disorder-specific cues, such as pictures of food.

In this study, 20 women with Bulimia and 20 healthy controls viewed a series of arrows presented on a computer screen. Their task was to identify the direction in which the arrows were pointing while the researchers observed their brain activity using functional magnetic resonance imaging (fMRI).

People generally complete such tasks easily when the direction of the arrow matches the side of the screen it is on—an arrow on the left side pointing to the left—but respond more slowly and with more errors when the two do not match. In such cases, healthy adults activate self-regulatory processes in the brain to prevent automatic responses and to focus greater attention on resolving the conflicting information.


Results of the Study 


Women with Bulimia tended to be more impulsive during the task, responding faster and making more mistakes when presented with conflicting information, compared with healthy controls.

Patterns in brain activity also differed between the two groups. Even when they answered correctly to conflicting information, women with Bulimia generally did not show as much activity in brain areas involved in self-regulation as healthy controls did. Women with the most severe cases of the disorder showed the least amount of self-regulatory brain activity and made the most errors on the task.


Significance 


Altered patterns of brain activity may underlie impaired self-regulation and impulse control problems in women with Bulimia. These findings increase the understanding of causes of binge eating and other impulsive behaviors associated with bulimia and may help researchers to develop better targeted treatments.


What’s Next 


The researchers are currently conducting further studies on brain functioning in teens with Bulimia, which would offer a closer look at the beginnings of the illness. They also recommend studying people in remission from an eating disorder. Comparison studies with impulsive people who have healthy weight and eating habits could also provide more information about which patterns of brain activity are most directly related to eating disorders.


fMRI data showing self-regulatory brain activity in healthy controls (left) and women with Bulimia (right). Red areas show increases in activity while answering correctly when given conflicting information. Blue areas show increases in activity while answering correctly when given matching information. In both cases, women with Bulimia showed less activity than healthy controls.

These differences in brain activity patterns may account for problems with impulse control and similar behaviors related to Bulimia.



Source: Rachel Marsh, Ph.D., Columbia University
Reference
Marsh R, Steinglass JE, Gerber AJ, Graziano O’Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS. Deficient Activity in the Neural Systems That Mediate Self-regulatory Control in Bulimia Nervosa. Arch Gen Psychiatry. 2009 Jan;66(1):51–63.



I found this to be spectacularly interesting. First, this is why eating disorders are classified as Impulsive Behaviors in the DSM portion of Borderline Personality Disorder. Then again, I don’t think anyone that has struggled with bulimia would argue with the intense feelings of needing to consume to fill that void, or eat our feelings, or distract our mind…. And then the inevitable instantaneous panic and need to get rid of the shame we just consumed. Both aspects are impulsive. The inability to regulate the intake, and the inability to not purge are impulsive.

For me, regulating my intake is incredibly difficult. Unless I fall into almost obsessive compulsive levels of regulation (which is how I typically live my life in order to keep myself healthy and NOT binging and purging), I easily fall into unhealthy patterns. This is also why holidays and parties are so bad for those of us fighting with bulimia and other eating disorders. The ability to regulate isn’t there.

I imagine this translates into other aspects of an eating disordered persons life as well. In general it’s safe to say that people with bulimia nervosa and other binge eating disorders are often more impulsive in other areas.

I’d be extremely interested in seeing studies done on recovered bulimics. Hell, I’d be interested in participating. It’s been months (yay me!) since me last bulimic episode. I don’t think brain imagine will see much improvement though. Honestly I imagine it would be triggering. To recover from bulimia takes a concerted decision can be a nearly constant battle. It’s not so simple as, “well just stop eating so much and throwing up.” Even when we have been able to successful change our bulimic behaviors, that doesn’t necessarily mean that the mindset has gone away. It just means that we have learned to recognize the triggers of those impulsive cues that make us want to binge, and are able to mentally step in and stop ourselves. So the origins of the behavior are still there, and maybe even the desire is still there. I’ll be honest, I still think about it quite often, even when I haven’t eaten nearly enough to warrant a purge! But that doesn’t mean I allow myself to engage in that behavior. So I wonder if the results of the fMRI would be any different. Curioser and curioser.


What do you think? 



Wednesday, October 16, 2013

Think About It: Do You Only Know How To Exist When You're Wanted?


I stumbled across this today and I found it superbly relevant. It's sad, but it's beautiful, and ultimately a message of empowerment though I am including a trigger warning because it does touch on topics many of us deal with to cope with the struggles of our lives. I think all too often one of our greatest struggles, is that we never learned how to love ourselves. We never learned to properly appreciate that we are human, and we are good. So we spend our lives fighting desperately for someone to tell us this, when really it's something that we have to find from within.


Have a listen. What do you think? 


""

Once my mom said to me: "Ari, why worry about how you look? Do trees ask themselves what they look like?" Trees, with their roots, trunks, branches, and leaves, are powerful symbols. As humans, we can be swayed by all the negativity in the wind of life to feel like we're just not good enough — good enough for love, for life, for ourselves, for anything.

I hope you never, ever feel that way. For a reminder that you are indeed good enough just as you are, listen to this song by Mary Lambert.

Trigger warning: Lyrics including self-harm and eating disorders

""




Lyrics - Body Love by Mary Lambert 

I know girls who are trying to fit into the social norm like squeezing into last years prom dress.
I know girls who wear low rise, MAC eye shadow, and binge drinking
I know girls that wonder if they are disaster and sexy enough to fit in
I know girls who are fleeing bombs from the mosques of their own skin playing Russian roulette with death
Never easy to accept that our bodies are fallible and flawed
When do we draw the line?
when the knife hits the skin isn’t it the same thing as purging because we’re so obsessed with death
Some women just have more guts than others.
The funny thing is women like us don’t shoot, we swallow pills
Still wanting to be beautiful at the morgue still proceeding to put on make up
Still hoping that the mortician finds us fuckable and attractive we might as well be buried with our shoes and handbags and scarves
Girls we flirt with death every time we etch a new tally mark into our skin
I know how to slit my wrist to reveal a battlefield too
But the time has come for us to reclaim our bodies
Our bodies deserve more than to be war torn and collateral offering
This fuckdom is a pathetic means to say I only know how to exist when I am wanted.
Girls like us are hardly ever wanted, yanno?  
We’re used up,
 and sad and drunk
and perpetually waiting by the phone for someone to pick up and tell us that we did good.


Well, You did good.
So try this:
Take your hands over your bumpy loved body, naked, and remember the first time to ran your hands over someone with the sole purpose of learning all of them
Touch them because the light is pretty on them and because the dust in the sunlight dance the way your heart is
Touch yourself with a purpose
Your body is the most beautiful royal
Fathers and uncles are not claiming your knife anymore
Are not your razor, now put the sharpness back
Lay your hands flat and feel the surface of scarred skin.
I once touched a tree with charred limbs. The stump was still breathing but the tops were just ashy remains.
I wonder what it’s like to come back from that because sometimes I feel a forest fire erupting from my wrists
And the smoke signals sent out of them are the most beautiful things I’ve ever seen.

Love your body the way your mother loved your baby feet
And brother arm wrapping shoulders and remember this is important to our worth more than who you fuck
You are worth more than a waistline
You are worth more than beer bottles displayed like drunken artifacts
You are no less valuable as a size 16 than as a size 4
You are no less valuable as a 32A than as a 36C
You are worth more than any naked body could proclaim in the shadows
More than a man’s whim or your fathers’ mistake
Your sexiness is defined by concentric circles within your wood
It is wisdom.
You are a goddamn tree stump with leaves sprouting out.
Reborn. 

Monday, October 14, 2013

Unpleasant Words Trigger Strong Startle Response in People with Borderline Personality Disorder

I found this little article and I immediately related to it. I’ve mentioned something like it before. Do you remember in this post when I discussed when our non BPD Loved Ones could be unintentionally triggering us without even knowing it? I mentioned a story about a guy I knew in high school that would try to get me drunk at parties and take advantage of me sexually. He always used to call me “kid” or “kiddo”. So now, whenever anyone calls me kid or kiddo I’m automatically triggered into feeling and remember him trying to rape me.  Just hearing the word, even if the person doesn’t know that it’s a problem and is being completely innocuous about it, makes me incredibly angry and defensive. They can instantly change my mood. Cognitively I know that these people don’t mean anything by it, and I make a real effort to not show my discomfort now, but even so much as a couple years ago, my startle and impulse control over my tongue was not so, well, controlled. I have quite a few triggering words like this. This is why I always reiterate that it’s important for us to discover and know our own triggers, so that we can effectively communicate and alleviate people in our lives tripping them.


Potential physiological marker for a severe mental disorder
Science Update • August 22, 2007


Adults with borderline personality disorder (BPD) showed excessive emotional reactions when looking at words with unpleasant meanings compared to healthy people during an emotionally stimulating task, according to NIMH-funded researchers. They also found that people with more severe BPD showed a greater difference in emotional responding compared to people with less severe BPD. The study was published in the August 1, 2007, issue of Biological Psychiatry.

This study recorded responses during stimulating tasks, but personally I’ve found that it doesn’t have to be during a task at all really. It can be over tea, watching television, or just during a normal conversation. But hey, they’re scientists, they always have to have people doing something.

Borderline Personality Disorder is a serious mental illness characterized by intense fear of abandonment and/or rejection, problems controlling emotions, troubled relationships, impulsive or reckless behaviors, and other symptoms. The disorder affects roughly 1.4 percent of adults ages 18 and older in the United States.

Erin Hazlett, Ph.D., of the Mount Sinai School of Medicine, and colleagues measured the startle eyeblink response, a measure of emotional reactivity, in 27 people with BPD and 21 healthy people. Past research shows that people are generally more startled during unpleasant situations than during emotionally neutral ones. During the study, each participant was shown a random series of words, some with neutral emotional meaning (such as "collect," "regular," "actually") and some with unpleasant meanings, particularly for people with BPD (such as "hate," "lonely," "abandon"). The participants would hear a brief startling burst of static noise at unpredictable intervals—sometimes while a word was shown, sometimes between words, and sometimes not at all.

Abandon, abuse, shame, and words like are often typically stressful for those of us who have experienced these kinds of trauma. However, as we’re mostly individuals with unique personalities, our trigger words will tend to be highly personalized as well.

The researchers found that both groups of participants had similar startle reactions when viewing neutral words. But people with BPD were more startled than healthy adults by the static burst when looking at unpleasant words. Also, people with more BPD symptoms showed a greater difference in startle reaction when viewing unpleasant words vs. neutral words compared to people with less severe BPD. This finding suggests that unstable emotions and impulsiveness in people with BPD may be related to an exaggerated startle reflex. The researchers' study presents an objective way to measure the problems with mood and emotional responses that are hallmark symptoms of BPD, suggesting a potentially useful adjunct to self-reported information when diagnosing and treating the disorder.

I do like having the startle words and noise effect presentation of Non-BPD vs. BPD persons as a controlled way of seeing how the two groups of people respond differently for comparison. I don’t think it should come as a surprise that those of us with BPD would respond with greater reactions at all, but it’s also nice to see that it’s reflexive. Many people think that our reactionary responses are a cry for attention or done on purpose to intentionally hurt the people in our lives. The more and more of these studies I find the more obvious it becomes that the things we do are a product of our neurology and the defense mechanisms our brains have created to counter (albeit maladaptively) the abuse and trauma we’ve experienced in our lives. 


What do you think? Do you have any triggering words? It’s important to know your own.








Citations:

Hazlett EA, Speiser LJ, Goodman M, Roy M, Carrizal M, Wynn JK, Williams WC, Romero M, Minzenberg MJ, Siever LJ, New AS.Exaggerated affect-modulated startle during unpleasant stimuli in borderline personality disorder. Biol Psychiatry. 2007 Aug 1;62(3):250-5.
1 Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV Personality Disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Jan 8; [Epub ahead of print]

2 Lang PJ, Bradley MM, Cuthbert BN. Emotion, attention, and the startle reflex. Psychol Rev. 1990 Jul;97(3):377-95.
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