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Seven Links to Help Understand Borderline Personality Disorder

Today Jane E. Brody of the New York Times walked bravely into the troubled, misunderstood waters of borderline personality disorder. She quotes a PhD student, Georges Han describing BPD as "a serious psychiatric disorder involving a pervasive sense of emptiness, impulsivity, difficulty with emotions, transient stress-induced psychosis and frequent suicidal thoughts or attempts."  This is all true, however, in my experience this description captures a severe form of the disorder. It is possible to have BPD and not experience suicidality, for example.

The National Institutes of Mental Health define BPD more generally: "Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior."  I like this definition better. My patients with BPD are people in deep pain, subject to emotional tsunamis they have no idea how to control. They will simultaneously push away loved ones, make them miserable and pull them in with declarations of love and devotion. The 'I hate you, don't leave me' syndrome.

People with BPD are found in all social and educational strata. Housewives, college students, CEO's, teachers, factory workers, come to my office for mood or relationship troubles. After a bit of digging a more fully formed diagnostic picture emerges. It is not an easy diagnosis to share. Insight is often blurred by the very defenses that he or she needs to keep from falling completely apart.

In graduate school my professors encouraged us to be careful when considering this diagnosis. Just because we found a patient annoying or difficult didn't mean they had a personality disorder. Many of my colleagues state clearly they will not treat BPD or any personality disorder. Until experience proved me wrong, I was among that camp. Today I find work with people with personality disorders very rewarding thanks to Dr. Marsha Linehan.

Treatment for BPD is most effective if the therapist is knowledgeable in Cognitive Behavioral Therapy and trained in Dialectical Behavioral Therapy. Dr. Linehan developed DBT in response to frustration with CBT's limited ability to help her borderline patients. DBT is like CBT married to eastern philosophies; a kinder, gentler CBT that "helps patients identify thoughts, beliefs and assumptions that make their lives challenging and then learn different ways of thinking and reacting."

Here are seven links to learn more about borderline personality disorder:

An Emotional Hair Trigger, Often Misread

Borderline Personality Disorder, a brief overview

What Is Dialectical Behavioral Therapy?

More On Marsha M. Lenihan, PhD

Ask Dr. Lenihan About BPD

Stop Walking On Eggshells: Taking Your Life Back When Someone You Love Has BPD

I Hate You, Don't Leave Me: Understanding the Borderline Personality

Photo courtesy of cmbellman via Flickr

Positive Self-Talk: Worth 1000 Words

The scale says I lost a pound last week. Once again I forgot to measure my waist. (What's that about?) Oh, well.

Still I didn't feel like celebrating. Why not? Because I saw a photo of myself taken the day before at my daughter's Appreciation Day (That's the politically correct name for graduation from Middle School these days.) As much as I internally feel good about my weight-loss, as soon as I saw that photo the automatic thought in my head was, "Ew! I look like an old woodchuck!" You know, puffy cheek pouches and round middle. I was not nice.

Photos of myself have always been my downfall. I work and work and the dress sizes get smaller and smaller until I see one lousy photo and BOOM, all that work gets blown to bits.

Am I vain? Yes. Totally and unapologetically. Is my self-esteem dependent on how I look? Ouch, that's hard to admit. Maybe, a little. At least enough of the time that my mood can get sucker punched by an unflattering photograph.

Not being abusive to ourselves is so important. It makes me sad to see celebrities like Oprah or Kristie Alley call themselves 'disgusting' or 'pathetic'. Does it help to talk about themselves like that? Experts say talking to yourself in an unhealthy manner makes other healthy habits nearly impossible. On the other hand, I might feel bad too, if I was photographed all the time as part of my job. Just the thought makes me shudder.

Dr. David Kessler, a former commissioner of the FDA, wrote The End of Overeating: Taking Control of the Insatiable American Appetite.

Interviewed for Bingeing On Celebrity Weight Battles, Dr. Kessler said, "No one wants to be fat, but I care most that people stop beating up on themselves."

What's the antidote? Follow my own advise. Right. So I talked back to the negative automatic thought. It took some doing but after reassuring myself that I was not an old woodchuck, that I had valuable attributes not captured by that photo and, by the way, the event was not about me (the get-over-yourself defense), I felt a bit better.

What really did it was saying, "That is just a bad photo," and hitting the delete button. There! Self-esteem restored!

Hey! I lost a whole pound last week!

Top 10 Tips on How to Be Fabulous

Our Lady of Weight Loss, Janice Taylor, tells us how to stop being so unattractive!

"Chances are you've heard about the Laws of Attraction. The basic concept is that you attract into your life whatever you think about. Positive thoughts and beliefs create a positive life; negative thoughts and beliefs attract negativity.

One sure way to get those positive vibes swirling out there is to be attracted to yourself, in a healthy and self-affirming way (not in a narcissistic, oh my goodness, I'm the greatest ever, where's the mirror - I need to look at myself again - kind of way). Truthfully, if you aren't attracted to you, if you don't fully recognize your qualities and embrace yourself, how attractive could you possibly be to the universe."

I could not have said it better myself

For all ten Laws of Un-Attraction click here.

Becoming All We Can Be

Last week I lost another half a pound and have no idea what my waist measured because in my enthusiasm I forgot to measure it. All I know is I got into my 'skinny jeans' and did a booty dance to celebrate.

Around the edges of my weight-loss happiness I feel an unsettling anxiety that I could gain again at any time. What is that about?

Do I not trust myself? Am I gearing up for self-sabotage? Can I not stand the feeling of becoming self-actualized? All of the above?

What is self-actualization anyway? Developmental theorist Abraham Maslow (1908-1970) described it as, "The full realization of one's potential." [Digging into this for this post I found a website maintained by a Dr. C. George Boeree, what he call's an electronic textbook of personality theories.  This is stuff I studied in depth in graduate school and frankly could use a bit of refreshing.] Whether you swallow Maslow's theory hook, line and sinker or not, he has some good points that are still relevant today.

For instance, he suggests that before you can reach self-actualization you've got to have good self-esteem. OK, I buy that. Dr. Boeree says:

"Maslow noted two versions of esteem needs, a lower one and a higher one.  The lower one is the need for the respect of others, the need for status, fame, glory, recognition, attention, reputation, appreciation, dignity, even dominance.  The higher form involves the need for self-respect, including such feelings as confidence, competence, achievement, mastery, independence, and freedom...   The negative version of these needs is low self-esteem and inferiority complexes."

So according to Maslow, for me to really embrace my weight loss acheivement (self-actualization) I need to be confident that I've mastered good health habits (high form of self-esteem). Yeah, I could work on that.    

Photo courtesy of marcelgermain via Flickr

Tips to Find A Good-Enough Doctor

When you have chronic illness your relationship with your doctor is second only to your spouse or your parents. Being honest (and you must be honest!) with that person means being able to trust them to hear you.

In my CI career I fired three highly recommended specialists because they were rude assholes. Thankfully I’ve also had wonderful physicians who literally saved my life and my mind. Not uncommonly for people with chronic illness, the path to find a good-enough doctor is an odyssey.

Laura Hillenbrand, author of the fabulous book Seabiscuit: An American Legend, was diagnosed with Chronic Fatigue Syndrome but not before she was put through all kinds of humiliation by physicians who out of ignorance did not listen to her.

"The doctor I found waved me into a chair and began asking questions and making notes, pausing to rake his fingers through a hedge of dark hair that drifted onto his brow. He ran some tests and found nothing amiss. He told me to take antacids. A few weeks later, when I returned and told him that I was getting worse, he sat me down. My problem, he said gravely, was not in my body but in my mind; the test results proved it. He told me to see a psychiatrist."

Ms. Hillenbrand was 20 years old. At 5' 5" her weight had dropped to 100 pounds. She suffered from chills, fevers, exhaustion, swollen lymph nodes and dizziness. Being young and alone, she went to the recommended psychiatrist. After a thorough assessment:

"He wrote my internist a letter stating that he would stake his reputation on his conclusion that I was mentally healthy but suffering from a serious physical illness."

Her doctor's reaction?

"'Find another psychiatrist,' my internist said over the phone, a smile in his voice."

Ms. Hillenbrand went through two more doctors before she found the good-enough one at Johns Hopkins. He listened to her, read all her documentation and correctly diagnosed her condition.

Recently a client of mine asked how to tell if she had a good doctor. "If I were you," I said, "I would look for these three basic qualities":

• Expertise, knowledge, intellectual curiosity and all the right credentials.
• Warm, receptive, a good listener and communicator. The bedside manner thing.
• A well run office, with smart, efficient support & medical staff.

You know you’ve hit the jack pot when your doctor rates high on all three. I’ve had two doctors like that in my life, both gifts from heaven. Several were really awful. Picture this....

Five Links to Cheer Your Recession Blues

The headlines are full of more dour economic news. A friend of mine is trying to keep calm. She has a good job but will she be next when the lay off Russian Roulette wheel turns? Another wants desperately to leave an unhappy job situation but doesn't dare because he'd lose the benefits. At a seminar I gave recently, an elderly woman said she had money to invest but who could she trust to advise her? There are resources out there to help guide us. Here are a few:

Living Within Your Means – A Geeky Concept?

10 Great Jobs for the Recession and Beyond

Find A Good Trustworthy Financial Adviser

Anger and the Economy

The Good side of the Recession

A Bonus Link: Recession Haiku

Exercising the Excuses

The Chronic Illness Wrangler

To prepare for writing this book, "How To Have A Chronic Illness So It Doesn't Have You!" I wanted to find a way to describe the person with chronic illness without having to say ‘person with chronic illness’ all the time.

Fishing around in my mind I came up with some petty lame efforts. It was hard to conjure up anything that didn't smack of victim-ness, the opposite of what this book is about.  Then 'the Chronic Illness Wrangler' popped up. Hmmmm...

I’m a cowgirl from Kansas who grew up with horses, so the idea of a wrangler has happy connotations for me. Nellie, (our little quarter horse mix mare when I was a kid), was full of energy and fun to ride. Or she was unless she got spooked and bolted. Kind of like the way my disease took over my body. Therefore... the Chronic Illness Wrangler: the illness is the horse that needs to be lassoed and trained to behave. The wrangler does the training. Get it?

When I was first diagnosed with scleroderma and for a couple of years after that, my doctors described the illness as ‘galloping.’ They said it was a nice way of saying the disease was running away with me and no one could tell me where it was headed. Did they say nice?

Then again, maybe it helped that I actually knew what it was like to be on a run away horse. The panic, both mine and Nellie’s, the noise, the wind, the desperate prayers to stay on, or if I fell off, the plea that I’d land on something that didn’t kill me. Galloping? Hell. Try riding a rocket!

Did it help that I knew that to stop a run away horse you needed to keep your head and think, know that the run couldn’t last forever and that what the frantic horse needed was guidance? As long as I could keep my head, I didn’t yank back on the reins, causing her more panic. As long as I could think, I kept my center of balance with my mare’s and stayed on. As long as I could think, I chose not to think of every possible woodchuck hole she could fall into.

Best of all, as long as I could think I could remember that to stop a run away horse you reached down on the rein and turned her head firmly to one side. Whoa!

Without knowing it my doctors gave me a metaphor I could live with.

My twice monthly appointment during that time didn’t amount to much more than the nurses and physicians tut-tutting about how the disease had progressed. Pain management was reduced to a game of ‘What non-steroidal shall we try this week?” I would go home despondent, feeling empty and powerless.

Until I remembered the run away horse.

All at once I was the cowgirl wrangler ready to outrace any stupid galloping illness. It wasn't much but it was what I had. No matter how long it took, I was ready to ride this baby out. Just keep a cool head and stay on. As long as I could think, I could reach down, turn this crazy mount's head and gain control again. Whoa!

Photo courtesy Kristian M via Flickr

Just For Fun - A Crazy Funny Spoof

Saturday's Weigh-In: A Bullet Dodged

Last week was not a good one for discipline. The exercise got done but the workouts weren't as intense as the weeks before. And eating? Fugedaboudit! After all, the traditional Memorial Day cook-out meant potato chips, s'mores and strawberry shortcake.

Days before I got on the scale I was composing a confessional type post in my head about why I gained weight instead of losing. Saturday morning, full of trepidation, I forced myself to get on. When the scale said I had lost a pound, a whole pound and nothing but a pound, I jumped off before it had time to change its mind. I grabbed the tape measure, now ready to face the truth. Down half an inch!

What a mess of mixed thoughts in my head. This was great! I ate what I wanted, didn't exercise that hard and I still lost! But wait, how can that be? And wasn't it just a week ago that I was feeling the opposite? Wasn't I a super good girl back then and my weight didn't budge?

This is dangerous territory. What if I allow myself to think I can abandon the ideals of good eating and exercise and still lose weight? No good can come of that. It just doesn't make sense. How could I defy the laws of weight-loss physics? There has to be another explanation.

In the first book Bob Greene wrote with Oprah, Make The Connection, he said Oprah had trouble with this. If I remember correctly, he said she'd get all snarly because for weeks she worked like a dog and the scale didn't show it. Oprah can be scary when she's snarly, just ask James Frey. Greene (with infinite patience, I imagine) explained to her that our bodies don't work on the Roman calendar like our minds do. There is so much going on physiologically in the day to day workings of our body we can't say why or when it will decide to reflect on the scale the amount of real fat burned. One big reason daily weigh-ins are verboten in Greene-land. Sure enough after three or four weeks the scale gave up three plus pounds and a happy Oprah could see Bob's point.

My theory is that my six weeks of attention to the hunger scale, reducing portions and rarely having seconds, not eating after 7:30PM and stepping up the good ol' exercise routine is finally reflected in pounds shed. Maybe if I had passed on the chips, chocolate and toasted marshmallows I would have lost even more. Who knows?

One thing I know for sure, if I'm serious about losing a healthy 10% of my weight (from a high 156; don't forget I'm a puny 5'3") I can't allow myself to think now's the time to relax my resolve. I still like my self-imposed rules. They really aren't that hard. I can see living with them for the rest of my life. As long as the scale is going in the right direction, a little at a time, that's reward enough.

Photo courtesy Jamelah via Flickr