Borderline Personality Disorder

When I was practising law many years ago, I had a client who had been diagnosed with Borderline Personality Disorder (BPD).  At the time, I wasn't exactly sure what that meant, but I knew that in her case it involved violent outbursts that resulted once in her breaking her 10-year-old son's arm.  Her two boys, one of whom was 14 at the time, were apprehended by the local child protection authorities.  She was a single mother on welfare who was having extreme difficulty coping.

While I was watching a dvd of Gilbert and Sullivan's 'Iolanthe' operetta the other night, a song towards the end of the production made me think of BPD as the fairies were singing to the members of the House of Lords what basically amounted to: "we really can't stand you, but we love you, so don't go"!

BPD is still considered a controversial diagnosis in some circles.  Decades ago, it was used as a 'catch all' classification for conditions which psychiatrists couldn't quite figure out.

As understood today, BPD manifests as significant emotional instability in which a person has a severely distorted self-image that makes him or her feel worthless and fundamentally flawed.  Anger, impulsiveness and frequent mood swings may push others away, even though lasting and loving relationships are desired.  Fear of abandonment is usually a strong underlying issue, and ironically, the behaviour of someone suffering from BPD usually does result in pushing away those who they strongly desire to be in relationship with.

Signs and symptoms of borderline personality disorder may include:

• Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees, or illegal drug use
• Awareness of destructive behavior, including self-injury, but usually feeling unable to change it
• Wide mood swings
• Short but intense episodes of anxiety, or depression
• Inappropriate anger and antagonistic behavior, sometimes escalating into physical fights
• Difficulty controlling emotions or impulses
• Suicidal behavior
• Feeling misunderstood, neglected, alone, empty or hopeless
• Fear of being alone
• Feelings of self-hate and self-loathing 
• An insecure, unsure sense of self (self-identity, self-image, sense of self rapidly changes)
• Feelings of not existing or of disappearing; of not being thought of or cared about 
• Tumultuous relationships with shifts to fury and hate over perceived slights/minor misunderstandings
• Tendency to view things in either black or white (not seeing the grey areas of issues).

As with most mental disorders, personality disorders may be inherited, or strongly associated with other mental disorders among family members, environmental factors such as child abuse, neglect or lack of proper attachment to caregivers/loved ones, or brain abnormalities.

Certain medications can help, but ideally should be combined with an effective form of therapy and support.  Certain psychotherapies can go a long way towards nullifying some of the symptoms and teaching better coping strategies.

Dialectical behavior therapy was designed specifically to treat BDP.  This method of counselling (which I just recently began to study for use in my counselling practice) uses a skills-based approach combined with physical and meditation-like exercises which teach how to regulate emotions, tolerate distress/discomfort and improve relationships. Other effective treatments include: cognitive behavioural therapy, mentalization-based therapy, schema-focused therapy, and transference-focused therapy.

To be diagnosed with borderline personality disorder, you must exhibit at least five of the signs/symptoms spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  

• Intense fear of abandonment
• Pattern of unstable relationships
• Unstable self-image or sense of identity
• Impulsive and self-destructive behaviors
• Suicidal behavior or self-injury
• Wide mood swings
• Chronic feelings of emptiness
• Anger-related problems, such as frequently losing one's temper or having physical fights
• Periods of paranoia and loss of contact with reality (1)

A diagnosis of borderline personality disorder is usually made in adults, rather than in children or teenagers because acting out during the younger years is likely a phase that will pass. If it doesn't pass, then BPD may be implicated.  Additionally, substance abuse can cause symptoms which look like BPD, and BPD can cause substance abuse.

D.

(1) www.mayoclinic.com/health/borderline-personality-disorder/DS00442

On Children

How we treat our children (what we say to them, how we listen to them) is ultimately what matters to their healthy emotional development…not what we DO for them. Doing for them is important, especially when they are young, but it is simply not enough. They need to be heard, valued, and respected as thinking and feeling individuals. They need to know and to feel that they matter.

D.

Children and Our Values

Even though our children will take on our values as their own while they are young, there is no guarantee that they will keep them. As they mature, they will constantly look at, assess and reassess the rules and values they inherited from us.  This is growth: growth towards becoming separate, complete and whole individuals.

D.

From the book, "It's not fair, Jeremy Spencer's parents let him stay up all night!", by Anthony E. Wolf, Ph.D., HarperCollinsCanadaLtd., 1995.

(As an aside, I get a real kick out of the title of another book by Anthony Wolf: "Get out of my life, but first could you drive me and Cheryl to the mall?")

Belonging

A sense of belonging can be an important source of happiness and life satisfaction.  Social identity theory hypothesizes that fitting in with a group is integral to an individual's identity, influencing his or her feelings of self-worth and life satisfaction.

D.

Scientific American Mind, September/October 2011, "The Many Faces of Happiness", Suzann Pileggi Pawelski, p. 53.

The Power of Creating 'Flow' in Your Life

There are so many things that I enjoy doing that don't make me any money, but put me in the state of 'flow' which is so essential to good mental health. Things like taking photos, keeping up my various blogs, writing, researching, gardening, and more, thoroughly nourish me. I can wile away hours in something I would term the 'zen zone' and the time spent during these hours is so much more gratifying than say, zoning out in front of the television.

Finding intense engagement and absorption in the things that you do creates tremendous satisfaction in daily life. According to studies carried out by Mihaly Csikszentmihalyi, professor of psychology at Claremount University in California, flow experiences lead to positive emotions in the short term. In the long term, those who reported more flow experiences were generally happier people. People vary in their ability to enter flow, and this ability can vary from day to day depending on a number of factors. Also, recognizing how flow occurs in your life - or doesn't occur - and working to create more opportunities for experiences of flow can be a precursor to feeling increased happiness.

While you are in flow, hours can pass like minutes; hence, the old saying about how time flies when you are having fun! Something you love - something you can lose yourself in - is key. You aren't preoccupied with yourself, but focused on whatever it is that you are doing.  Some people can experience flow just folding laundry or washing dishes, provided they focus on the task at hand. Flow and mindfulness go hand in hand. You aren't wondering how others are perceiving you, but rather your awareness of yourself is only in relation to what it is that you are doing. Extraneous thoughts don't invade your mind. The activity itself, rather than what you wish to ultimately accomplish by the activity (the goal), is in itself rewarding.  Flow activities are not passive, (like zoning out in front of the tv), and you have at least some control over what you are doing. Although flow activities require effort, when you achieve flow, everything seems to click so that it feels effortless. Flow is intrinsically rewarding, so you have the motive to recreate it when you have the opportunity to do so.

For flow experiences to occur, there must be a balance between the challenge of the activity and the level of skill you need in order to perform it. The activity must fully engage your mind in order to avoid creating feelings of boredom, so must be challenging enough to do so. Conversely, a project or task too challenging for your skill set will create anxiety.

D.

Source:  "Positive Psychology:  Harnessing the power of happiness, mindfulness, and inner strength", Julie Corliss (writer), Ronald D. Siegel, Psy. D. (medical editor), Harvard Health Publications, Harvard Medical School, Harvard University, 2013.

Six Human Virtues

According to University of Pennsylvania psychologist, Martin Seligman, there are six human core characteristics (so-called virtues) that seem to be universally valued and are worth nurturing/developing in yourself with a view towards living a satisfying or happy existence. They are: wisdom, humanity, courage, justice, temperance and transcendence.  

Wisdom encompasses the following strengths: creativity, curiosity, open-mindedness, love of learning and perspective. Use your imagination to develop new ideas and objects and also to invent solutions to practical problems. Show interest in, and be eager to learn about, a wide variety of topics. Have new experiences.  Explore. Examine issues from each side as fairly as you can. Don't let preconceptions get in the way. Let new evidence change your mind, if it sheds a different light on things. Build knowledge and master new skills and subjects. Perspective provides you with the ability to give wise counsel to other people.  You make sense of the world in a way that makes sense to yourself and to others.

Humanity sees a person exhibiting strengths which promote and nurture friendships and other relationships.  It involves social or emotional intelligence, love and kindness. Become aware of your motives and feelings as well as those of others. Develop your ability to fit into various social situations, to give and receive love, to maintain close relationships, and to nurture and care for others while exhibiting generosity, compassion and altruism.

Courage is acting in the face of fear, rather than the absence of fear. Carry out strengths of will that assist you in the face of internal or external obstacles. Show integrity by speaking truthfully, sincerely and presenting yourself authentically. Be responsible for your actions, thoughts and feelings. Bravery involves not shrinking from challenges, difficulties, threats or pain. Involve yourself fully in life: vitality, wholeheartedness, enthusiasm, energy. 

Justice involves the ability to use your strengths to foster a healthy community. The key here is fairness: dealing with people while having an open mind, so as to treat them fairly and justly without letting personal feelings bias your decisions. Teamwork and leadership are essential.

Temperance involves protective traits such as self-discipline and willpower that help you stay on track in the face of temptations. Avoid excesses. Practice forgiveness and nullify hatred and anger. Humility tempers arrogance: let your accomplishments speak for themselves. Take care in what you say and do, so as to avoid later regret.

Transcendence takes you beyond yourself and connects you to others, to the world, and possibly to something greater than yourself. It allows you to appreciate beauty, skill and excellence, whether it be expressed in nature, performance, profession or in everyday things. Spirituality, gratitude, hope and humour are essential in your quest to reach beyond the self. Laugh, play, and bring a smile to another's face.

D.

Source:  "Positive Psychology:  Harnessing the power of happiness, mindfulness, and inner strength", Julie Corliss (writer), Ronald D. Siegel, Psy. D. (medical editor), Harvard Health Publications, Harvard Medical School, Harvard University, 2013.

  

Positive Psychology

The field of positive psychology has grown tremendously in the past few years. Methods of positive psychology are now widely used by mental health professionals to help a variety of people with a wide array of problems.

Psychologist Martin Seligman, of the University of Pennsylvania, kicked the field of positive psychology into high gear in the 1990's with his ground-breaking concept of "learned optimism".  Seligman found that optimism is a trait which most happy people seem to have.  He also found that optimism - if a person does not seem to be naturally prone to it - can be taught, learned, and utilized to change a person's life for the better.  Optimism can be nurtured by teaching people to challenge their patterns of negative thinking and to appreciate, and focus on, their strengths.  The idea that people can become happier by building upon and growing their natural, inherent strengths is central to positive psychology.

In 2011, Seligman developed the concept of "PERMA":  positive emotion, engagement, relationships, meaning, and accomplishment. He submits that these components allow us to flourish because they are the building blocks of a fulfilling life. (By the way, his 2011 book, Flourish is a very interesting read.)

Positive psychology does have its share of critics who contend that it ignores suffering and denigrates sadness and that it forces people to suppress their anxieties, worries, stresses, and traumas. Furthermore, it encourages people to just "put on a happy face" while discomforting and damaging issues are suppressed and never properly dealt with so that healing can take place.  Additionally, they argue that not allowing negative emotions to be expressed is demoralizing and damaging to individuals suffering very real anguish.

Most of the previous mental health research has focused on alleviating suffering by treating disorders while doing nothing to enhance an individual's life beyond lessening the effect of the disorder.  At best, a neutral state of mind was the aim. Positive psychology, however, focuses on previously ignored ideas of positive emotion and meaning that are important to a person's quality of life.  It embraces the full array of emotions, including sadness, pain, and grief and attempts to help people get passed these emotions towards building a more resilient nature or response in the face of adversity.

D.

Source:  "Positive Psychology:  Harnessing the power of happiness, mindfulness, and inner strength", Julie Corliss (writer), Ronald D. Siegel, Psy. D. (medical editor), Harvard Health Publications, Harvard Medical School, Harvard University, 2013.

On Fear and Resilience

For some people, fear is constricting and can even be paralyzing.  For others, fear can be energizing and can serve as a catalyst for growth.  Whether we allow fear to diminish us or we find a way to enlist it as an ally, it has an enormous impact on how we conduct our lives.

We have to face our fears as boldly as we can in order to become resilient or more resilient.

D.

(From the book titled "Resilience: The Science of Facing Life's Greatest Challenges", by S. Southwick and D. Charney, Cambridge University Press, 2012.)