Surviving an Emotional Storm Sandy | Borderline Personality Disorder & Intense Emotions


While our friends and family on the east coast brace for the effects of Hurricane Sandy, many of us all over the world are coping with emotional / mental health storms within.

For many months, I've been writing about an upcoming work-related meeting. It's finally happening this Wednesday.  Thinking about all of the hours between now and then (and how I'd get through them) was causing me to feel very overwhelmed and anxious.

I realized I needed to get skillful in order to avoid any unnecessary suffering and not make matters worse.

During IOP (Intensive Outpatient Program) today, I realized that instead of looking at all of the time between now and when the meeting commences, I literally need to take it hour by hour.  (There have been times when my anxiety was so severe, I had to take it minute by minute. Can you relate?)

In addition to living in the present and not projecting into the future with speculation and worrying, I will:

  • Keep in mind the serenity prayer: "God help me to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."  Prayer, in whatever form it comes for you, if at all, is listed under the "Improve the Moment" skills of Distress Tolerance -- crisis survival strategies to help you tolerate painful moments when there is nothing you can do to make things better right away.
  • Take my meds as prescribed:  I rarely take the Ativan (anti-anxiety medication) that is prescribed for me, other than at bedtime. I am allowed to take it additional times during the day for severe anxiety or panic.  If my appetite continues to be affected or the agitation increases, I will take this as prescribed to help me.  Taking medication falls under the "PLEASE" skills in the Emotion Regulation section of DBT (Dialectical Behavior Therapy - a proven treatment for the symptoms of Borderline Personality Disorder).  
  • Look at medicine as food: Whether I feel like it or not, I will eat regularly and (for the most part) healthfully.  Balanced eating, regularly and mindfully, and avoiding foods that make us overly emotional (such as caffeine, or lots of sugar) is also part of the PLEASE skill set.
  • Calm my nervous system.  HERE are some of the CDs I like to listen to to help accomplish this. They will definitely be on rotation tonight and tomorrow. 
  • Do something nice for myself... x3: I plan on allowing myself to get in my pajamas early, watching some of my favorite programs, and taking a relaxing shower.  These are all part of the "Self-Soothing" skills, under the crisis survival strategies of Distress Tolerance.
  • Do something nice for someone else: I haven't decided what this will look like yet, though I anticipate it will be in the form of supporting others who are hurting, via my Twitter presence. I will also prepare a nice meal for my significant other.

What are some skills you can use to help you ride out your emotional storm?  In what ways can you take better care of YOU and take a step back so as to prevent making matters any worse than they are?

If you're doing well right now, what type of Emotional Storm survival kit could you put together to help you in times of trouble?  I have this 9-1-1 Emergency DBT skills kit standing by. 


Thank you for reading.
More Soon.





P.S. If you are having stress, depression, or anxiety from the actual Hurricane Sandy or other natural disaster, SAMHSA is there to help support you. Thank you Amanda Smith of Hope for BPD for sharing this resource. 

From Doormat to Bitch In 5 Seconds Flat | Assertiveness: The Happy Medium

 
We are each responsible for our own well-being and boundaries. This is something I wish I had learned at a much younger age so that perhaps I'd be closer to mastering the associated skills to achieve balance around this, but I have made progress in accepting this concept as truth.  
 
 
I've spent a lot of my life so far playing the victim role.  It has come naturally, since I was legitimately victimized so many times a child and young adult.  There does come a time in adulthood, though, when we can no longer hold on to the identity of the victim.  To do so would be to further victimize ourselves.  
 
 
This includes how we allow others to treat us.  A therapist in IOP recently mentioned that we, as adults, show people how it's okay to treat us.  For example, if someone is complaining that his friends always treat him like a doormat and repeatedly take advantage of his kind and giving nature (by taking and taking and rarely offering anything in return), there is some responsibility that falls on the one who is complaining.
 
 
People take cues from us as far as what we will tolerate and how we will be treated.  If you always say yes to requests, even when doing so causes you to resent yourself and/or the other person (perhaps you are tired, not interested in an activity, or just plain don't want to do it -- but you say yes anyway), then people will come to expect you to say yes and will likely have no idea that you are doing so against your own true desires.
 
 
It is not until you shift your way of responding that other will consequently and inevitably be forced to change how they interact with you and what they come to expect of you.
There are many causes and reasons for putting others first, including not wanting to be rejected, not wanting to be seen as mean, fear of abandonment, and even not believing we have a right to turn down a request.  There is cause for everything -- including the way we currently respond to others. 
 
 
The key is in what was modeled to us early in life.  According to Anne Katherine, author of  Boundaries: Where You End and I Begin:
 
 
"[w]e learn about boundaries by the way we are treated as children. Then we teach others where our boundaries are by the way we let them treat us. Most people will respect our boundaries if we indicate where they are. With some people, however, we must actively defend them."
 
 
Assertive people with few boundary issues fascinate me. I was with a friend yesterday when he brought in his vehicle for a body estimate. During the course of the quotation process, the auto shop owner offered all types of discounts, which excited my friend; however, when the employee suggested that my friend lie to his insurance company to get a discount on his deductible, my friend politely sat up in his chair, and in a firm but not mean voice, said, "I just want to make something clear.  I'd love to save some money, but I am not willing to lie to my insurance company, and I am not comfortable with you lying to them either."  "Got it," replied the owner.
 
 
I was in awe.
 
 
It's not that I would lie to my insurance carrier either, but I'm not sure I would have stood up to the employee, especially when he was being so "nice" offering me various discounts.  Even though lying to my insurance company would be against my values and ethics, I'm not so sure that I would have been so direct, firm, and honest with the owner -- at least not initially.  I think I would probably feel like I needed to be polite, nod and acknowledge him, and led him on that I'd be going along with the deal. I'd then leave, knowing full well I had no intention of doing business with the company under those circumstances, and then either let them know after the fact or not at all. Somehow, I'd place my need for him -- a man I didn't know and who was suggesting doing something dishonest -- to like me rather than standing up for myself.  That's a real problem, and I'm ready to face it. 
 
 
I used to be quite the opposite.  Those of us with Borderline Personality Disorder often think in black or white terms (all or nothing), or dialectics. In the case of being passive versus assertive, in the past, I saw no middle ground.  I'd either respond in a completely passive way, allowing others to take advantage of me, or I'd turn into a complete and total bitch, full of anger, hostility, and judgment. I would go from feeling like a doormat to exploding in response to the resentment, and I could be quite cruel. There is a middle ground, and the journey there is paved with learning boundaries and self-care.
 
 
 
 
Here are some quotes from an excellent book I've just read. I've selected it as the first book in an upcoming BPD Book Club, date to be determined.  The book is called, "Boundaries: Where You End and I Begin," by Anne Katherine.
 
 
Perhaps reading these will help to better understand boundaries and why we have issues around them - and being assertive - to begin with.
 
  • "A boundary is a limit or edge that defines you as separate from others. A boundary is a limit that promotes integrity (3)
  • Boundaries bring order to our lives. As we learn to strengthen our boundaries, we gain a clearer sense of ourselves and our relationships to others. Boundaries empower us to determine how we'll be treated by others (5)
  • Our emotional health is related to the health of our boundaries (8)"



Another quote from the book is one that I found very relevant in my life right now. Being that I am very active on Twitter, I encounter others who are at many different points on their own personal journeys. At times, things others say can be triggering. I set my limits by asking kindly if "TW," the code for "Trigger Warning" could be placed at the the beginning of such tweets. If someone declines, I choose to "unfollow" them to take care of my own personal boundaries and engage in self-care.  I used to forgo using Twitter during those times, but I no longer want to handle it that way, missing out on something I enjoy.

Recently, a person on Twitter with whom I've interacted many times (who is usually quite kind, fun, and helpful), was evidently dealing with some painful issues of her own.  Her tweets about her eating disorder and cruel comments about body image made me feel upset.  I let her know this firmly. She responded in sarcasm and passive aggressive tweets.  I remained kind and asked if the person would like to continue to be connected because I did not have time for immaturity or games. I was SO proud of myself.  I wasn't trying to be mean. Instead, I was practicing this:


"I set my emotional boundary by choosing how I'll let people treat me. One way I do this is by setting limits on what people can say to me." (15)
How are your boundaries and assertiveness?  What skills do you practice to get stronger in these areas?  What examples can you think of that demonstrate a need for better boundaries or for being more assertive? How about example so implementing effective boundaries or being assertive?
 
Thanks for reading.
More Soon.
 

Appropriately Experiencing & Letting Go of Anger (Free Podcast) | Borderline Personality Disorder


Anger. It's one of those emotions that is usually judged as "bad" or "unacceptable." According to the therapist in my IOP group yesterday, it's actually a sign of mental health to experience a full range of emotions, including anger. 

Why does anger scare us so much?

In my personal experience, I did not have anyone model appropriate experiencing and expressing of anger when I was growing up.  My father would often become angry, and this would soon be followed by him acting out in violent ways.


I learned to suppress my anger very young.  I was afraid of becoming like him.  Anger seemed quite dangerous to me.  Because of that, all of those moments when my gut intuitively knew that anger would be the cleansing emotion for the situation -- the emotion that would help me process through a situation and motivate me to make changes to help me through, I unconsciously suppressed it.  I bottled it all up inside.

That can only work for so long, as I've recently found out.

In my early to mid-twenties, anger showed up for me in many inappropriate ways.  My words to others could become very cruel and even abusive. I broke things. I drove recklessly. It was so important for me to be right that I would carelessly use words to hurt others, thinking that somehow, in being vicious and tearing others down,  I had "won."  I eventually came to hate myself for behaving this way.  I would experience self-loathing that often led to suicidal thoughts, and I would choose behaviors that were self-destructing or sabotaging, justifying that I deserved it because of the terrible person I was.

I look back at that girl in her twenties with compassion now.  She didn't know any better. She had been taught that anger was a dangerous emotion, so she suppressed it.  When she finally began allowing herself to express it, she had no model for appropriately doing so and was destructive, just as she had learned from the people closest to her when she was a child.

She then retreated in shame and suppressed her emotions again.  This past summer, now in my mid-thirties, I experienced a resurfacing of the emotion of Anger.  It peeked it's head out once again, hoping to find safety.  It sensed that now might be a safe time to reappear.  It wanted to be noticed, validated, and processed.

Emotions give us information.  Anger is no exception.  According to Dr. Marsha Linehan in her book Skills Training Manual for Borderline Personality Disorder, there are many reasons why anger may show up, including:

  • "Having an important goal blocked or prevented
  • Having an important or pleasurable activity interrupted, postponed, or stopped
  • You or someone you care about being attacked or physically or emotionally hurt by others
  • You or someone you care about being threatened with physical or emotional pain by someone or something
  • Losing power
  • Losing respect
  • Experiencing physical pain
  • Experiencing emotional pain"

Can you relate to experiencing anger due to any of the above examples?

Why do emotions, like anger, show up in the first place?




I am learning that the best way to deal with my anger is to take a break, calm down a bit, and then try to resolve the issue that is causing me to feel angry. If resolution is not possible (and even sometimes when it is), I practice Opposite Action by:



  • Gently avoiding the person I'm angry with, rather than attacking them in any way. During this time, I take a break and slow down my breathing
  • This one really gets me, but it is suggested by Dr. Linehan (and has actually worked): Do something a little bit nice. This can be something simple, such as using a calm, gentle tone of voice.

I'm finding that holding on to anger is like punishing myself. It's not as if the other person is affected or the situation changes by me suffering and holding onto such an intense emotion.  I wanted to find a way to help calm and even release some of the anger appropriately.  In my search, I came across this free podcast on Anger and Forgiveness.

Click HERE to listen to it. I found it really calming and ended up falling asleep during the affirmations part last night. I look forward to your thoughts.



What are your experiences with anger?  Did you have good role models for experiencing and expressing this emotion?  How do you express your anger when it shows up?

Thank you for reading.
More soon.

Trusting Your Intuition: Invasion of Boundaries



There are some moments that just make you stop and ask, "Really? Did that really just happen?"  I've had many moments in my life like that, especially as a child and young adult.  Most were right after someone had chosen to abuse or violate me in some way, and I very rarely had the courage to stand up for myself and my rights.  All too often I was low in self esteem and even compliant with the offender.
Those days are gone.  As a result of having pent up all of my anger at the wrong doing inflicted upon me by others in the past...as a result of stuffing it down, pretending it didn't happen, and not standing up for myself, anger is coming to the surface and sometimes spilling over. 

It's only natural.  These feelings had to come up sometime. Now, as an adult in my mid-thirties, due to a recent incident at work where I was sexually harassed, I decided once and for all that I would no longer be a victim.  I would not behave like one and would not let someone treat me like one. 
If someone showed some type of offending behavior, I'd confront it, and I certainly wouldn't stick around for a repeat offense.  Gone is the scared girl who would put up with most anything due to fear, not knowing any better, or some sick, twisted ideas around my deserving the treatment. 

I have compassion for that former part of me.  Being a victim is what she knew. It started in childhood, and without enough proper intervention, it continued into adulthood. 

This time was different.  I've been taking good care of myself around this recent issue.  Although I have mixed feelings coming up around my self-advocacy, I overall feel empowered and supported.
I am currently in IOP (Intensive Outpatient), which is my "safe place" aside from home right now.  When something happened today to threaten my sense of safety, I freaked. 

The rest of this - the situation that triggered me - may be too triggering for some readers. Please exercise caution and discretion and take care of YOU.

Last week, a new person entered IOP - a young male, probably in his early twenties.  I tried to be friendly with him, but he was very standoffish and kept to himself. I decided that was okay with me and moved on. 

This morning, as I was registering for IOP, he came up to about 3 feet away from me and just started staring intently at me.  Needless to say, I was uncomfortable.  There he was, in my personal space, and the man wasn't blinking.  At first I pretended not to notice, but I felt so uncomfortable that I decided to look up at him, hoping he'd be embarrassed and stop. He wasn't, and he didn't.  He said, "Hello," softly and with a flat affect -- no real facial expression.  I said, "Hello," smiled, and looked back at my wallet to finish the transaction.  In a soft voice, he then said, "Good Morning."  Harmless enough, right? I repeated it back and smiled and then got back to my transaction.  

The whole time, my gut was telling me something was wrong. I was afraid. I thought he was going to hurt me in some way.  Then I started to doubt my reaction and thought perhaps he was just trying to be friendly.  He seemed a little "off," but I didn't have to be so judgmental, right?

I sat down next to another girl from IOP in the waiting room. He sat across from me diagonally, rested his head on his arm, and said to me, "What's your name again?"  I told him.  He asked, 

"Are you in school?"
"No."
"What do you do?"
"I'm a writer, and I work. Are you in school?"
"No."

Then he got up and started pacing around the room, getting closer and closer to the other girl and I.  I didn't notice, but she said he became aroused. I was so frightened by the pacing, the flat affect, and the weirdness of it all that I kept saying to the girl in a whisper, "Something bad is going to happen. I know it. I'm so scared right now. I'm freaking out."

We all got called back to the IOP session, and he followed behind us. Suddenly, walking alongside me, the other girl was thrown forward. "What just happened?" I asked?  I kept asking because no one was answering.  A therapist saw the incident from in front.  "Did he just push you"" I asked.  "No, he grabbed my ass!"

Oh no. No he did not.  At that point, I could feel the adrenaline rushing through my system. I became furious, frightened, and anxious all at once. The therapist took the boy aside and talked to him. I could hear her asking what happened.  The girl and I each checked in with another psychologist.  She seemed unaffected.  When asked why she wasn't upset, she, an attractive young woman about the same age as the boy said, "It happens all the time. I'm used to it." The doctor told her that this doesn't mean that it's okay.

I, on the other hand, became triggered, tearful, and angry.  I asked if the person was still in the group, and we were assured that he is no longer in the program. Deep breath. I kept asking the girl if she was okay, before the group therapist finally redirected me back to myself, "Are YOU okay, Debbie?"
I was once I knew he was out of the group, but I felt very unsafe and scared in the lobby.  I was getting ready to have to go kung-foo on this person.  My goal was to get safely into the IOP section, sit by a doctor, and express my concerns. I wasn't going to let it go.  He escalated things, obviously, and the problem was resolved by staff.

What did I learn?  

  • Always trust my gut instinct. There are times when we are kind of/sort of sure, and then there are those times when our gut, or intuition, lets us know we are in danger, and that instinct turns out to be right.  I'm getting better at recognizing that self-protective mechanism. It was right this time.
  • Think about my surroundings, the context, the people around me. If I feel scared or unsafe, take care to get myself to a safe place and around safe people. 
  • Nothing anything anyone does is about me. It's about them. Think about that for a moment. Not personalizing another's action releases us from unnecessary additional pain and suffering.


Thanks for reading.
More Soon.

Do You Have "Mother Hen" Syndrome? | Boundaries & Borderline Personality Disorder



Do you have "Mother Hen Syndrome*"?  I sure do.  As someone with Borderline Personality Disorder, a combination of issues around my sense of identity and my sometimes blurry experience of boundaries in relationships cause me to take on more than my responsibility when it comes to others.
Let's see if you can relate.

Mother Hen Syndrome Quiz:


1. When others share their issues/problems with me, I tend to...

A. just listen, be present, and allow the person to vent.
B. become so immersed that I literally feel what they feel and become consumed with emotion.
C. be compassionate, but not take it on as my own.
D. shy away from helping.


2. If a friend told me she could not longer afford to pay her cell phone, I'd probably...

A. encourage her to look into more affordable plans.
B. help her look into more affordable plans.
C. immediately offer to cover her phone bill each month.


3. You're tired and have a headache, but a relative asks you to babysit. You'd probably...

A. politely tell them you don't feel well and decline.
B. feel their needs are higher than yours and head right over.
C. tell them they have a lot of nerve calling you on Sunday.
D. just let the machine take the call.


4. You're very hungry and a coworker asks if he can take his break first. You'd probably...

A. say yes -- he probably needs it more than me if he's asking. 
B. gently tell him you're going to have to go on break because you're very hungry.
C. pretend you don't hear him and hope he goes away.
D. tell him that you're in no mental state to answer him.


5. You're tired after group therapy. Another member wants to chat afterward about her extensive emotional issues. You'd likely...

A. let her know you're sorry, but you feel drained and need to head home.
B. stay and listen for hours on end despite your needs. (correct)
C. stick around in the room pretending you have a question.
D. hide in the bathroom.



End Mother Hen Syndrome Quiz.



Mother Hen responses:  1-B, 2-C, 3-B, 4-A, 5-B
How many did you get?  Are you a Mother Hen?



Here are a few examples of how Mother Hen Syndrome manifested in my life in the past week:
  1. I had a therapy appointment and was very anxious about the topic, which was past trauma.  I worried that I wouldn't be able to speak about it or that I wouldn't be able to handle the discussion.


    Mother Hen Red Flag: In addition to concern for myself, I worried about my therapist holding the information I would share.  It didn't occur to me to consider that she has a Ph.D. in Psychology and that she underwent years of learning how to implement boundaries to protect herself emotionally. Nope. The night before my appointment, I had a dream that I went to the session.  My therapist was panicky because she had to get to the airport on-time to go on vacation with her husband. Concerned, I shifted the focus to her and offered to call the rest of her patients for the day and reschedule them. I also offered to clean the dishes in her sink and to take her to the tram. In the dream, she accepted all of my offers, and I felt like I had sufficiently taken care of her. (What is your interpretation of the dream?)


    My therapist, in real life, has incredible boundaries. Her ability to be compassionate and in the moment without appearing to take on "my stuff" amazes me. The next day at my appointment, I told her about the dream. We both think that I was concerned that I needed to take care of her.  She, of course, assured me that I did not. During the session, we spoke on the phone with another advocate of mine, and when, at the end of the call he only thanked me, I piped up and said, and Dr. Smith, too! After we hung up, I made up excuses for him not thanking her, and Dr. Smith said, "You're trying to take care of me again."
  2. In IOP there is a younger woman who is going through a lot of emotional turmoil. She just found out her diagnosis and is on medication for the first time.  At the same time, she continues to drink alcohol and had stopped taking one of her medications.


    Mother Hen Red Flag:  After our group, when she told me she had to have one of her medications filled, I walked with her to the pharmacy to make sure she followed through.  You may see this as supportive, but we were advised by one of the doctors in IOP that it's best to not socialize after group with other members until after each person has graduated. My need to protect her superseded the desire to follow that rule.


    When we got to the counter, the pharmacist said they were all out of the medication and that they could call around to find a pharmacy that had it in stock.  When they found one, they just said the city it was in.  I asked her, in front of the clerk, "Now, do you know where that is?  Do you need an address? Directions?"  I also asked her to text me that she was sober later in the evening. Inappropriate much?  I am a caring person, but my challenge with appropriate boundaries is causing me to take on more than my fair share -- and I'm the one who needs to learn how to rein it in.
  3. Lately, when others are experiencing their emotions, I notice that something that used to happen before is happening again.


    Mother Hen Red Flag:  I become so engrossed in their experience - so entwined in their emotions that I lose track of where they end and I begin and vice-versa.


    If someone gets sad, instead of just noticing their sadness, letting them have their experience, and being supportive and present, I become so emotional for them. I want to fix all of their problems, comfort them, and love them.  It's not that I think I actually have the answers and can solve their problems. It's more that I want to reassure them, offer them some hopeful perspective, and help them in any way I can.


    I am currently reading a book, aptly named: Boundaries: Where You End And I Begin, and I am beginning to have some insights as to why this is.  I'll keep you posted. I've also selected this book for an upcoming BPD Book Club that I'll be hosting, so be sure to pick up a copy and start reading if you'd like to participate.

In the meantime, one of my goals and focuses in IOP is to keep watching the boundaries issue and work on it with the support of my clinical team. It's complex!  Practicing Interpersonal Effectiveness and Emotion Regulation DBT skills are two of the methods that I am using to work on this and cope.

Can you relate to being a mother hen?  In what ways?  Can you think of any skills that can help you with assertiveness, self-care, and boundaries in the moments that you are tempted to take care of others beyond your reasonable responsibility or desire?




Thanks for reading.
More soon.


* I'm sure you know this, but just for clarity's sake, "Mother Hen Syndrome" is not a real condition. I'm not a therapist. This post is about my experience with identity and boundary issues due to BPD.  If you can relate, please check with a qualified, licensed therapist to discuss your concerns and get the help and support you need.

5 Ways to Not Act Like a Mental Patient


I love this quote by Dr. Linehan. When I've posted it on Facebook and Twitter in the past, it's gotten lots of "likes," "favorites," and comments.  It came to mind this morning, and it made me think: What does it mean to "act" like a mental patient, and how can we change such behaviors if we so desire?

The answers to these questions are going to look different for each person reading this, so I'll give you my take on it.  Let me know what you can relate to and where you differ.

What does it mean to "act" like a mental patient?

When I picture someone being referred to as a "mental patient," warm fuzzy thoughts do not come to mind, nor do images of a person simply sitting calmly and filling out forms in a waiting room. No. "Mental Patient" carries stigmatized, often frightening imagery, say, of someone being restrained in a straight jacket, as in the retro image below.  When someone uses the term, it's not one of endearment. They are saying that the person is "crazy." The person is probably outwardly acting in ways that seem abnormal or even frightening to others.

{via}

Here's an example of when I acted like a mental patient:

Due to feeling highly triggered a few months ago, I ignored warning signs to take care of myself and was astounded by my out of character (and out of control) reaction to a very small conflict -- over bread.  In the middle of a crowded grocery store, I yelled out, "F*&k you" and gave someone I cared about a very rude hand gesture.  People were looking. I felt enraged. Moments later, I felt frightened and highly embarrassed.  I broke down and cried.  

Did people think I was crazy? Probably.  I didn't stay in control.  I lost my temper, which happened so quickly.  I didn't resist the intense and sudden urge to say and do hurtful things.  I caused a scene in a public place. This is, for me, what acting like a mental patient has looked like in my life.

Here's a situation where I refrained from acting like a mental patient:

Have you ever had one of those "off" days where you're anxious and/or thinking that it's written all over your face that you're stressed and losing it?  I had that today.  I went into my new cell phone carrier's store, and having brought in all the energy from therapy session into the store, I felt like just one look at me and the clerk would be see right through me. She'd think I was nuts. 

I walked in with some residual anger and hurt -- but I knew this. I became conscious of it.  The clerk was kind, attentive, knowledgeable, and friendly.  If anything, she picked up that I was a little bit stressed because I dropped cues (facial expressions, deep breaths and sighs, a tense brow), and she was even kinder. I got lucky!

When I realized how worked up I really us, I had the opportunity to practice Opposite Action and engage with her in a kind way. (Being kind is actually an Opposite to Emotion Action for anger. It can help reduce it!)

To me this is an example of not acting like a mental patient. even though the perfect storm had brewed right before my visit to the store -- I was vulnerable and triggered. 

How can we act less like the stereotyped mental patient, at least some of the time?

My 5 Ways to Not Act Like A Mental Patient

1. Be aware of my feelings and acknowledge them.  I find that denial and suppression can have huge consequences. The thing is, sometimes our mind and nervous system do this for us automatically and without our knowledge, and the pieces or fragments of the story come back to us at a later time.  This can be frightening and upsetting.  I'm learning to notice and experience the feelings when they surface without allowing them to overtake me. I am also quick to reach out for support from my therapist or psychiatrist when the pieces are too heavy to carry alone.

2. Decide how I want to behave and have a plan before I am next triggered. I made a decision to consciously redirect my energy when I notice anger due to triggers coming on.  I take deep breaths. I excuse myself if I need to and take a short time out.  I drink some water.  I then come back and willingly and intentionally extend kindness to whoever is in my company at the time.  It may sound bizarre, but there's something about doing this that calms the nervous system.  We begin to feel the effects of our choice to take on a softer stance, speaking gently, and smiling. Our nervous system senses that we are not in danger - no need to be on the attack. We calm down.

3. Engage in LOTS of self-care.  We tend to act outwardly in inappropriate ways when our inner needs aren't being met.  If I feel tired, vulnerable, and irritated, this can manifest in the ways I engage with others.  Taking the time to swaddle up in a blanket with my cats, sip on some decaf tea, and unwind with a good TV show, movie, or book, can help to take the stress level down a few notches.   Being aware of how I feel and engaging in self-care even when it's the last thing I may instinctively think to do, really help. Basic self-care (eating, staying hydrated, and sleeping) are essential and first on the list, but then picking up a little treat for myself or taking a nap start making it on there as well.  Will buying a lipstick at the drugstore solve my problems? Of course not. Will it help me to feel a little better even for a little while? You bet. And, it's a reasonably small investment.

4. Take care of my physical health. The DBT PLEASE skills are so important, because when we slack on our basic self-care, as mentioned in item 3, we become so much more vulnerable emotionally. I must push myself to eat, even when I don't feel like it, drink plenty of water, and take my medication as prescribed.  Taking walks also help so much.  Our doctor in IOP today actually suggested that all of the patients in the group start walking regularly.  We have such natural ways to release stress and feel calmer available to us.

5. Love myself through feeling crazy, without judgment.  If I notice feelings of overwhelm and mental chaos coming on, I've also noticed judgment, both of myself and how I expected others to treat me.  The truth is, no one knows what's going on inside of you unless you tell them or act out.  I intend to watch my feelings and to then extend compassion around the fact that I "feel crazy" in that moment.  I can acknowledge it, experience it, and let it go. I don't have to act on it. I can engage in Opposite Action and Self-Soothing.  I can let the feeling pass and go and wait on interacting with others until it does, if possible.

I'm curious. What does acting like a mental patient look like to you?  How can you work on maintaining composure and shifting from Emotion Mind to Wise Mind enough so as to not "act" like a mental patient?

Thanks for reading.
More Soon.

Beware of Energy Vampires: Boundaries and Borderline Personality Disorder (BPD)


I've been blogging about my experience with Borderline Personality Disorder and DBT for about two years now.  I intend to continue doing so, as the process is quite therapeutic for me, and my readers from around the world are so kind to let me know that they feel helped and encouraged by witnessing my journey.


One thing that is shifting is I realized this week that I needed to take a look at my boundaries.  As someone with BPD, I have often struggled with boundary issues such as over-disclosing personal information, getting too close and clingy too soon, and revolving my world around others' acceptance of me. I am sure that many of you, my dear readers, can relate.

It's been quite a while since these particular aspects of the disorder have been troubling to me, but since they have been lately, it was time to look at them and come up with an action plan.

We all know what it feels like to lose our sense of boundaries.  We may regret telling too much about ourselves. We may feel vulnerable because we latch onto someone and make them our world only to feel disillusioned when we realize this can't be.  We may expect too much from others or give in to others' unreasonable requests all in an attempt to avoid being rejected or experiencing perceived abandonment.  This is all part of the disorder, and it's part of why there is an entire module in Dialectical Behavior Therapy (DBT) devoted to Interpersonal Effectiveness.

Rather than beat myself up over it, and rather than you doing the same, it's much more effective to just notice the behavior like an interested observer. Then, come up with an action plan that keeps you safe and allows you to practice skills that keep your self-respect and relationships intact. 

Before my book came out, my mentor, who is a well-known author herself, warned me about how people would be coming out of the woodwork once my book was out. She mentioned "haters," which I had not yet experienced, as well as people who were not at the same point on the path as me. Granted there will always be some ahead of you on the path, and there will also be some that are still in a place of dysfunction from which you've graduated and moved on. It's not about judging anyone else or yourself -- it's about accepting where everyone is while also considering your own limitations around how you will connect with others -- your boundaries.

I took my friend seriously in the sense that I did some grounding work to allow myself to stay separate from others' issues and energies, but I suppose I didn't fully realize the gravity of how putting out very intimate, deep personal details in my first book would affect me.

I talked about this in IOP yesterday and gained some really helpful insights from the group psychologist and my peers. Of course one would feel vulnerable sharing her story in such a public way. Of course this would mean exposure to a wider audience, many of them hurting people who are looking for hope like the rest of us.  Being this much in the spotlight has surprisingly been a bit stressful, but our group therapist let me know that the feelings around this will fade, and it will get better.

I must remember my intentions with the book: to share my story to give others with BPD (and their loved ones) HOPE. Nothing more, nothing less.  take some responsibility and not make myself the "victim" here. Let's talk about what an Energy Vampire is and how we can protect ourselves.

What is an Energy (or "Psychic") Vampire?

"A psychic vampire is a term used to describe a living person who "drains" others emotionally either empathically (draining the auric life force) or metaphorically (someone who takes emotionally without giving anything back; a "user"). These so-called "vampires" are not to be confused with the blood-sucking vampires of folklore and movieland. Every person has unknowingly drained someone else's energy at one time or another. Chronic psychic vampires generally are not aware that they are stealing energy from others. Fair and balanced energy exchanges make for healthier relationships. Also Known As: energy drains, energy suckers"



Reference:
psychic vampire. (n.d.). Holistic Healing Definitions at About.com. Retrieved October 16, 2012, from About.com website: http://healing.about.com/od/glossary/g/psychic_vampire.htm


We Have All Done It


Notice from the definition that every person has unknowingly done this at some point. That means me. That means you.

There was a time in my life when I was in so much despair and terrified of being alone that I would create one crisis after another and seek others to rescue me.  I didn't give much in return because my cup was not full.  I was seeking others to rescue me to fill my cup.  In order to give to someone else, your cup has to be running over: full for you, with plenty of extra to offer to others.

If your cup is not full, you are susceptible to being an Energy Vampire (EV).  It's often not intentional.  I got quite judgmental when EVs began coming out of the woodwork - repeatedly asking for help while not showing any signs of working on the issues they were complaining about.   People were also asking me questions that I had no expertise around (such as parenting), and then becoming upset and even hostile that I would not provide answers.

I'm sorry that I did not just send back a simple reply that I wasn't qualified.  Up until now, other than mentioning that I am a peer and not a doctor or therapist, I haven't put out a clear set of guidelines around my boundaries.  I'm working on that.

I've also begun reading this excellent book and would like to start a "BPD Book Club."  This will be the first book in the series.  I'll be blogging about the book and look forward to your thoughts.
You can get a copy here.


Til then, be sure to put on your virtual garlic and fill up your emotional cup.  

Thank you for reading.
More Soon.

Anxiety and Appetite: How I Fell Back In Love With Food

I don't know about you, but when I get very anxious, one of the first things to go is my appetite.  This brings additional distress because we tend to not feel very well when we're not eating enough.  Not feeling well physically leads to more emotional vulnerability. Throw into the mix a long history of disordered eating due to trauma, and anxiety-provoked loss of appetite can become trigger city.
I became very concerned a few days ago when I got so anxious that I completely lost the desire to eat. Nothing sounded good -- not even my favorite foods.
How Might Anxiety Cause a Lack of Appetite?

Let's talk about what likely happened to cause this shift in body and mind, as I am ordinarily someone who loves to eat.
When we are anxious, our bodies go into "fight or flight," states that are intended to serve to protect us.  Back in caveman days, fight or flight would kick in when someone would see a saber-toothed tiger, for example.  The instinct to fight the beast or to get as far away from it as possible would instantly overcome a human being, short-wiring all other instincts, for survival purposes.  
Upon this process beginning, one of the first things that the body does is stop digestion, as this takes up valuable energy from the body that is now needed to run or fight.  
When digestion is abruptly stopped, we may feel sick to our stomachs, and we may experience irritable bowel.  None of this is appetizing to the mind, and I experienced this during this anxious episode. Next comes a loss of appetite.
When we become frightened or anxious today, our bodies still respond in the very same way.  Even if we are nowhere near the kind of danger that our cave people ancestors faced, if our body senses that we are in danger, it responds in like. This is, I believe, what recently happened to affect my appetite.  
It became quite clear to me when I noticed that when I took my prescribed anti-anxiety medication, Ativan, I shortly thereafter felt calm enough to eat.  I knew I needed to work on naturally self-soothing my nervous system in order to get back to having a normal appetite and eating again.
How My Appetite Came Back
Please note that if you're having trouble around eating or appetite, it is essential that you consult with a medical professional for support and guidance through this issue.  I am going to share with you what works for me when an emotional crisis affects my appetite, but please seem medical and psychiatric help from a professional for your own, very individual situation.
My personal plan for when my appetite goes away:
1.)  Even if I don't feel like it one iota, when I'm experiencing lack of appetite, I carry snacks with me and am sure to eat something every few hours.  I carry things like Odwalla Bars, crackers, and fruit. Eating regularly keeps my blood sugar level and keeps me from feeling weak or faint.  If I just can't seem to find anything that sounds good, I'll drink juices, smoothies, and have Ensure, but I really push myself to also have something solid.  White rice works well.  There is some "instant" rice that you can boil for 10 minutes in a pouch and then enjoy with a little bit of salt and pepper. I practically lived on this for a couple of days this past week.
2.) Stay hydrated.  When we eat less, we tend to drink less, so keep up on juices and milk (which also give you energy) and water. I sometimes also have electrolyte infused beverages like reduced-sugar Gatorade (G2).  I was recently told that coconut water is also very good in this way.
I bought two types of decaffeinated, soothing teas as well:
3.) Listen to your inner child.  There are some things that, even when I don't have any appetite at all, I know I can manage to nibble on.  This includes BelVita cookies, which remind me of a cookie biscuit I used to eat when I was little, grilled cheese sandwiches, and certain fast food items.  If you're willing to eat it and it has some nutritional value, let your inner child make some decisions right now.  I often think that it's this part of me that loses her appetite, so it's important to listen to what that part of me is willing to eat.
4.)  Remind myself over and over that "This too shall pass." This week was not the first episode I've had with appetite loss. I've experienced this for pretty much all of my life.  Anxiety is a huge trigger of appetite loss for many people.  I have to remind myself that my appetite will, indeed, eventually come back, even if it literally feels like I can't imagine ever desiring to eat again.  I also remind myself of why my appetite is lacking, which helps me to get motivated to do self-soothing activities to calm my nervous system, for example guided meditations, self-hypnosis as well as hypnosis sessions with my hypnotherapist, and muscle tension and relaxation exercises.  Since learning about autogenics in IOP the other day, I now have another resource to add to my repertoire. 
5.)  Eat with others (or alone).  This varies for me. Sometimes I find it much more comforting to eat meals with others. The conversation and atmosphere help to calm and soothe me, and I am able to eat without making food and appetite the sole focus of the meal.  Other times, I prefer to eat alone, being mindful and not being distracted with other things.  It's important to consider how either choice will help you eat at any given time.
6.) Take medications as prescribed.  My psychiatrist, who is not big on pushing taking additional meds, encouraged me to take additional Ativan tablets during this time for the severe anxiety.  I was resistant  but I must admit, the medication did help me to calm down enough to eat when none of my other tools were working.  I am glad I had it available to me as a resource. 
7.) Let your doctor know how you're doing.  Right now I am in IOP, so I have the opportunity to check in with clinicians and my psychiatrist about how I'm coming along. If I weren't in IOP, I'd likely email or call my doctor to let her know the progress I am making with getting back to eating normally.
And, I'm back!  Today, I finally fell back in love with food again.   I had this delicious Indian meal with my significant other....


and then this beautiful bowl of vegetable soup with whole grain bread later in the day:
If you're struggling with your appetite, please reach out for the help you need. Consider ways to self-soothe your nervous system so that your body can find calm and begin to make resources available for digestion again.
Think of some of your inner child's favorite foods. What are they? Maybe some warm soup?  A grilled cheese sandwich?  Macaroni and cheese? Pizza?  I'd love to know.
Thank you for reading.
More Soon.
 
 
The author wrote this blog post several years ago. She is now in RECOVERY from BPD and thriving as an emotionally sensitive person. She teaches all she learned in her live, weekly, global ONLINE classes. Learn more  and sign up for a class at DBT Path.

Autogenics for Ultimate Self-Soothing and Relaxation


I was very curious yesterday during our Education Group in IOP when the doctor said we'd be practicing "autogenics."  I hadn't heard of it before and was pleased to be in a position of beginner's mind on the topic.

She pulled out this book and CD, which, after experiencing it, I highly recommend and will be purchasing for myself:

Total Relaxation: Healing Practices for Body,
Mind & Spirit
1 CD (Book +CD)
 
by John Harvey


During the particular guided exercise that we did, we used our imaginations to experience our arms and legs as becoming heavy. We also focused on the breath and temperature sensations in different parts of the body. It was incredibly relaxing! (It reminded me a lot of hypnosis, another self-help tool that I've found to be very effective. Here is some information on autogenics.)

Because I am very invested in being and feeling well, I was excited to throw myself into the exercise, wholeheartedly and enthusiastically, because I wanted to feel the results. It worked!  At the end of the meditation, I felt so relaxed, soothed, and at ease.  The muscles in my neck and shoulders, which were incredibly tense (and even painful) before the exercise, were relaxed, had softened, and had let go to the point where it was noticeable. I was impressed.

As a person with Borderline Personality Disorder, I often experience my emotions very intensely, so it takes a bit more time, attention, and care to cope with this intensity.  I think that one of the frustrating things about being uncomfortable emotionally is that this comes with feeling discontent. Along with this can come physical manifestations of discomfort  such as muscle tension, stomach upset, and headaches. It can be easy to forget (or easy not to know if you've never even experienced them in the first place) that there are effective ways to cope with and even bring some relief to the suffering that we experience at these times.

I found this sample video on YouTube for you. The woman's voice is very relaxing, and it will only take ten minutes for your to soothe. 

I encourage you, whether you're feeling stressed or not, to take some time today to try autogenics. I think you will be surprised and maybe even feel renewed just like I did.  I'd love to hear about your experiences.


Thank you for reading.
More Soon.

IOP Day 1: Intensive Outpatient / Partial Hospitalization



Today was day one of IOP (Intensive Outpatient/ Partial Psychiatric Hospitalization.)  Programs like this are offered in many communities. Those of you who have been following my blog are aware that I have recently become overwhelmed with my emotions due to multiple, intense triggers, and collectively, they became too much for me to handle on my own. So, I reached out for the help I knew I needed in order to get through this difficulty without making the matter worse by self harming or self sabotaging in some way.

IOP is intended to help you become stable when you are suffering an emotional crisis. This particular program that I have been accepted into is three days a week for 3 hours each day.

There is a set schedule of groups that include a processing group where you talk about what issues brought you into the program and what goals you are working on for your recovery, a mindfulness group where you talk about the principles of mindfulness and do meditations, and a recreational group where you do art and play games that help get your mind off of your troubles for a little while (today we colored detailed images while answering Trivial Pursuit questions.) There are other groups, but these are the ones that they offer on Wednesdays and that I experienced today.

The length of your stay in the program is very individualized and decided between you and your treatment team. In years past, I have been in the program for up to three weeks. It was during a previous

IOP experience that I was officially diagnosed with Borderline Personality Disorder and began my path wither Dialectical Behavior Therapy.

Fortunately, this particular IOP program is based largely on DBT and mindfulness principles. I am truly in a good place.

After just one day, I am beginning to feel hopeful, and I have even noticed a slight improvement in my appetite. It's still amazing to me how healing it can be to be willing to reach out and then receive support and help when we need it. It felt so validating today to be allowed to cry and express my distress about the myriad of issues I am coping with. It was also very helpful to engage in the various activities as well as listen to others who are also suffering and hearing what they are doing to cope and heal.

My day started out rough. I was highly anxious and was dissociating and depersonalizing. I stuck with it and ended up getting a lot out of each of the sessions.

In addition, it just so happened that a member of my DBT group is also in IOP right now. We have a lot in common in terms of our mental health issues and beyond, and although we were both anxious about eating, we made the commitment to sit down together at a local restaurant and eat something, anxious or not. And, we followed through! We ended up enjoying each others company for 2 hours before realizing the time had passed. I felt so at ease and accepted in her presence, and I truly hope she felt likewise.

I'm now at a different part of the hospital campus and getting ready to head home soon. I don't have IOP tomorrow but another DBT class (Distress Tolerance). I'll keep you posted. Thank you for the outpouring of support and kindness. It means so much!


Thanks for reading.
More soon.





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