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Friday, July 23, 2010

Understanding and Coping with Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health diagnosis with a wide spectrum.

There are people who have borderline personality traits who are considered high functioning (i.e., they are able to hold a job and might even be very successful in their careers; they have intense emotional upsets, including intense anger, but they are able to recover from them relatively quickly; and their relationships are usually chaotic, but they're not extremely chaotic).

Understanding and Coping with Borderline Personality Disorder

However, someone who has intense borderline personality traits often will not be high functioning (i.e., they might have problems maintaining a job; they usually have very intense emotional upsets and it takes them longer to recover; their anger can turn to rage very quickly; they might even become violent; and they tend to have extremely chaotic relationships).

If someone who is usually high functioning is under an inordinate amount of stress that leads to a feelings of emotional fragility, their symptoms can worsen very quickly.

In order to understand borderline personality disorder, it's important to understand BPD traits. Although each person is unique, the following traits are usually associated with BPD:

Relationships and Fear of Abandonment:
People with BPD tend to have intense and chaotic relationships with a lot of conflict. These conflictual relationships often include ongoing cycles of breakups and reconciliations with the same people. People with BPD also often go from idealizing a loved one to completely devaluing him or her and this change can be very sudden.

Borderline Personality Disorder and Fear of Abandonment

Underlying these emotional dynamics is a strong fear of being abandoned by loved ones. Understanding this fear, which might not be apparent when the person with BPD is angry or rageful, is one of the keys to understanding his or her behavior. Often this fear originates from an early history of emotional abandonment, neglect or abuse making the person with BPD vulnerable to real or imagined threats of abandonment as an adult.

Loved ones are often shocked and bewildered at the ability of a person with BPD to do a "180" with sudden mood shifts. This might involve a sudden change from this person being loving and kind to being angry and rejecting, often with little provocation.

People with BPD will often alternate between wanting to be "rescued" emotionally, where they might be very clingy with their loved ones, to severing ties with their loved ones due to a real or imagined slights.

Emotions:
People with BPD often experience strong emotional instability, especially when under stress. BPD is associated with intense feelings of anger, rage, sadness, and feelings of emptiness, which can be extremely overwhelming.

People With Borderline Personality Disorder Are Often on an Emotional Roller Coaster

They are often on an emotional "roller coaster" with frequent "ups and downs" for no obvious reason. There are often frequent and sudden mood shifts which might frighten the person with BPD as well as their loved ones.

Sense of Self:
People with BPD often do not have a stable sense of self. They might experience themselves as being happy one moment and then sad the next moment for no apparent reason.

Behavior:
Borderline personality disorder is usually associated with impulsive behavior. People with BPD might engage in impulsive shopping sprees, sexual behavior, alcohol or drug abuse, gambling, cutting themselves, bingeing and purging food, violence or they might make impulsive suicide attempts.

People With Borderline Personality Disorder Often Engage in Substance Abuse

Aside from being impulsive and engaging in risky behavior, people with BPD frequently engage in "cutting off" or severing relationships precipitously. They also have a low tolerance for frustration which can lead to angry outbursts or violent behavior.

Thinking:
For people with BPD, their thinking is usually as chaotic as their emotions which, of course, go hand in hand. They might become highly suspicious or paranoid. They might also dissociate (i.e., "space out" or get numb) as a defense against intolerable feelings. Often, their thinking and perceptions can be distorted. Also, they tend to think in "all or nothing" terms.

What Causes Borderline Personality Disorder?
Research has shown that there seems to be both genetic and environmental components to the development of borderline personalty disorder. With regard to genetics, it's often the case that a person with BPD has at least one parent who also has BPD. In terms of the environment, there is often emotional neglect or abuse in early childhood.

What to Do if You or a Loved One Has Borderline Personality Disorder:  Get Help
If you or a loved one has BPD, it's important to get help. Since BPD is often confused with bipolar disorder and ADHD, it's important to start with an evaluation by a psychiatrist who is a good diagnostician. If a person who has BPD is drinking or abusing drugs, the substance abuse problem needs to be addressed and stabilized in an appropriate dual diagnosis program.

For people with BPD, Dialectical Behavioral Treatment (DBT) is often the best form of psychotherapy either in a group setting or in individual treatment. Although I am not trained in DBT, I have heard from many colleagues and clients that DBT is often very effective. In NYC, you can contact the American Institute for Cognitive Therapy (http://www.cognitivetherapynyc.com/) for a referral to a DBT therapist.

For loved ones who are struggling to deal with spouses or other family members who have BPD, it's important to understand that BPD is a mental health disorder and to try to have some compassion for the person with BPD. However, it's also very important that you take care of yourself at the same time. And if there is the potential for violence, first and foremost, you must have an escape route to ensure your safety as well as the safety of your children.

Being in a relationship with someone who has BPD can be very challenging. It can often lead to feelings of anger or despair. Only you can decide if you want to remain in the relationship or not, and you might need the help of a licensed mental health professional to decide what's best for you. In a future post, I'll write specifically about people who are in relationships with loved ones who have BPD.

I am a licensed NYC psychotherapist, hypnotherapist EMDR and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006.

Tuesday, July 20, 2010

Overcoming Habitual Negative Thinking

Have you ever taken the time to observe your thought patterns? Stepping back to observe how you think and the kinds of thoughts that might be dominating your conscious mind can provide an interesting window into what might be driving your attitudes and behaviors about yourself and others as well the types of decisions you're making.

Overcoming Habitual Negative Thinking

Very often, we might not notice these patterns in ourselves and we might not think about it until someone else, usually a person who is close to us, points it out to us. That person might point out that we are compulsive worriers or that we tend to engage in a lot of negative thinking or some other type of habitual thinking.

How to Develop the Ability to Observe Your Own Thoughts:
Developing the ability to observe our own thought patterns might sound like it would be easy. But it assumes that you have developed a certain awareness in yourself and that you're able to step back from your own habitual ways of thinking to look at your own thought process. For most people who are learning to do this, initially, they might find it easier to recognize their thought patterns after the fact.

For instance, a person who has just had an argument with his or her spouse, might think about what lead to the argument in the first place once the situation has calmed down. In one situation, a husband might realize that he was already feeling irritable when he snapped at his wife. In another situation, a wife might realize that she was anticipating that her husband was about to say something that would annoy her, so she reacted with anger. Whatever the situation might be, it requires an ability to temporarily let go of your reactions and the content of whatever you reacted to in order to turn inward to observe what's going on inside you.

Overcoming Habitual Negative Thinking: Developing the Ability to Observe Your Thoughts

Many people develop this ability of turning inward with relative ease. Usually, these are people who tend to be psychologically minded and curious about their own thought process and how if affects their behavior. They might have learned to do this as part of their own psychological development while they were growing up. Perhaps their parents taught them to think about their behavior when they were growing up. Or, if they didn't grow up with this ability, they might have learned it as part of their psychological development in psychotherapy or through a meditative practice. However this ability is developed, it's very useful to help us grow and develop within ourselves as well as in our relationships.


What is Habitual Negative Thinking?
Well, first of all, habitual means that it tends to be a recurring pattern. These thoughts aren't the occasional, random thoughts that might pop up in your head. They're ongoing and persistent ways of thinking that tend to be negative without any objective or verifiable evidence to substantiate them.

Examples of habitual negative thinking might be: "Nothing ever goes right." "Whenever I try to do something, something always goes wrong." "I'm never going to amount to anything, so why bother to try." And I'm sure you can think of many others. As you can see from just these few examples and others that you might think of, it's a negative way of looking at yourself, others, and the world in general.

Why Is Habitual Negative Thinking Harmful?
If we think of our thoughts as determining our action, we can begin to see how habitual negative thinking can become a major obstacle in our lives. So, if your particular habitual thought pattern is that "Nothing ever goes right," you can begin to see how this would affect you if you're thinking about making changes in your life, in your relationships, your career, and so on. Before you can even take the first step to make changes that might be necessary and important, you'll feel discouraged because "if nothing ever goes right," why bother? These habitual negative thoughts keep you stuck in whatever situation you might find yourself in, leaving you feeling hopeless and without a solution.

The following fictionalized scenario is an example of how habitual negative thinking is a problem, how it developed, and how it can be overcome:

Tom:
As an only child, Tom grew up in a household with two very angry parents. His parents were constantly arguing with each other, hurling accusations at each other and, after their arguments, often not talking for days at a time. When Tom was a young child and his parents began arguing, he would go into his room and put his pillow over his ears. But, try as he might, these arguments were so loud that he could still hear them.

Whenever this happened, Tom would get very frightened, but there was no one to talk to about it because his parents were consumed with their anger for each other. Even after the loud arguments stopped, each of his parents would be smoldering in separate parts of the house. When the loud arguing stopped, Tom would open his door a crack and listen for a minute, and if he didn't hear any more arguing, he would tiptoe out of his room gingerly, hoping to go unnoticed. His parents never hit him or physically abused him in any way. They provided for his basic needs. But they were totally unaware of how their heated arguments affected Tom.

Once Tom felt the coast was clear, he would come downstairs. Often, he would sit at the kitchen table and watch his mother cook. After one of those loud arguments, his mother would often bang pots on the stove and slam cabinet doors, making Tom wince. He would sit quietly, waiting to see what happened next before he dared to say anything. Often, at those times, his mother would say, "Life stinks" or some other similar comment. Tom was never quite sure if she was talking to him or talking to herself because his mother had a far away look in her eyes. At the same time, his mother would put a glass of milk in front of him and encourage him to drink it so even though she wasn't looking at him, he knew that she was aware of his presence.

Afterwards, he usually went down to the basement where his father had his tool shop to see what his father was doing. His father would usually retreat to his tool shop after one of these arguments and tinker around. Tom would sit at the edge of one of the steps and watch his father work. When his father realized that Tom was there, he would often say to him, "Don't ever get married Tommy. You'll regret it. Nothing you do will ever be right, according to your wife. "

These scenes occurred with such frequency that Tom grew up to be a very anxious child and a pessimistic young man. Not only were his parents giving him these ongoing negative messages, but they were so consumed and angry with each other that they weren't present for Tom emotionally. They were so overburdened by their own unhappiness that they didn't take the time to encourage him in any way or to give him hope about his future.

Without realizing it, these constant arguments and negative messages formed Tom's way of thinking about himself, others and the world in general. Tom went through life just "getting by." He was an average student in school, and he made a few friends along the way, but he had no hopes or dreams for the future. His expectations for himself and for others remained low. He didn't try out for sports or initiate any projects on his own because his thought, "Why bother? It's not going to work out."

All of this came to a head when he was in his mid-20s and he met Carol. He was attracted to Carol and sensed that there was something special about her, but he was too anxious to ask her out. Being an outgoing and confident young woman, Carol liked Tom and she asked him out on a date. As they continued to see each other, Carol was the one who continued to initiate steps to take their relationship to the next level. But, after a while, she became frustrated with what she sensed was Tom's ambivalence and fear to develop a relationship with her. She also began to see how pessimistic he was and how he held himself in general. So, she talked to him about it and suggested that he start psychotherapy.

The idea of participating in psychotherapy was daunting to Tom and, at first, he brushed it off by telling Carol that he didn't believe in psychotherapy and he didn't think it would make a difference for him. But Carol persisted and, after a while, Tom realized that his relationship with Carol was on the line and he didn't want to lose her. So, very reluctantly, Tom sought out a psychotherapist for individual therapy.

At first, Tom's motivation was external and was driven by his fear of losing Carol. But as his therapy progressed and Tom learned to observe his own thoughts and how they affected him and his relationship, he became more internally motivated. This didn't happen over night. It was more of a gradual process. But as he began to realize that he had particular negative thoughts that were habitual, he became curious about his internal world. He also began to realize why he often felt anxious and fearful much of the time.

As he became more self observant and curious, he started questioning his perceptions about himself, others and about life. He began to see the distortions in his thinking and that, often, there was no objective evidence for why he thought the way that he did.

Overcoming Habitual Negative Thinking

It was hard, at first, to make changes in his thought patterns because they were so ingrained in him. As he did this, he began to open up to new experiences, both emotionally in his internal world as well as externally in his relationship with Carol and his attitudes about the world around him. He found it to be a liberating experience as he let go of the thoughts and attitudes that he internalized from his parents and developed his own way of thinking. This, in turn, helped to improve his relationship with Carol and enabled Tom to venture out more into the world to take risks. Overall, he felt happier than he had ever been.

The above example is one way that a person can develop negative habitual thinking. It's relatively easy to see a connection between Tom's home environment when he was growing up and how formative it was in his development. However, often, it's not as obvious to see. Sometimes, the factors that influence of the development of negative habitual thinking are much more subtle and not as obvious to see. Often, these connections are hard to make on your own without the help of a trusted friend or partner or the help of a licensed mental health professional.

Overcoming Habitual Negative Thinking:
The first step in overcoming any negative habit is to become aware of it. Often, it takes courage to step back from your own ingrained way of thinking to question yourself about whether your way of thinking has distortions and if, objectively, they're accurate.

Often, people wait until there is the potential for some loss, either involving a relationship or a career before they seek help to overcome habitual negative thinking. Sometimes, it takes a crisis or the threat of a crisis to bring people into therapy to work on this issue. It's not ideal in terms of overcoming a problem but, for many people, it's what finally motivates them to get help.

Many people learn to overcome habitual negative thinking. They might start out with a lot of mixed feelings about the process, but if they have a sense of curiosity and a willingness to look at their own thought process to make changes, they're often successful.

Getting Help in Therapy
If you think you engage in habitual negative thinking, you could benefit from working with a licensed mental health professional to overcome this problem. Often, just starting the process of talking to a psychotherapist can begin to open up your mind to new possibilities. It takes a certain amount of courage and hope that you might not readily feel, but often taking the first step can lead you to take other important steps along the way.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, and Somatic Experiencing therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006 or email me: josephineolivia@aol.com.



photo credit: ~Sage~ via photopin cc

photo credit: Venu Dharmaji (a bit busy...) via photopin cc