Friday, July 27, 2007

Informal Reflections on BPD

Remember - these are just insights, not gospel:

Never disregard professional advice or delay in seeking it because of something that you have read on ANY internet site or page. Remember - online information resources are not meant to, nor can they, replace the specialized training and professional judgment of a health care or mental health care professional.

If you are feeling like you want to harm yourself or others, please THINK first, contact a mental health or other health care professional, or visit an emergency room or crisis center IMMEDIATELY.

When you were young you knew that you were different and now, your parent/childhood caregiver/significant other makes you feel 'less than' - this is called an ' invalidating environment'. Essentially a situation in which your personal experiences and responses are disqualified or "invalidated" by the significant others in your life. Your personal communications are not accepted as an accurate indication of your true feelings and it is implied that, if they were accurate, then such feelings would not be a valid response to circumstances.

An Invalidating Environment is characterized by a tendency to place a high value on self-control and self-reliance. Possible difficulties in these areas are not acknowledged and it is implied that problem solving should be easy given proper motivation. Any failure on your part to perform to the expected standard is therefore ascribed to lack of motivation or some other negative characteristic of your character.

Kinda like when your parent/childhood caregiver/significant other implies that you could stop drinking if you wanted to, or the implication that your parent/childhood caregiver/significant other somehow does not accept you because YOU are not meeting his or her expectations.
At the same time, if the whole environment is invalidating because the people in it are trying to keep to a pattern that someone/thing else has set (LDS) then everyone suffers.
And - when the same environment blows up (divorce) - then the individuals will revert to the way that they were and will grow from that point rather than grow from the crisis. Hence why your parent/childhood caregiver/significant other seems so unable to relate ...

1. Accepting Reality - and accept that what you are experiencing is real and valid - and 2.Letting BE, or BE WITH Emotional Suffering
Essentially techniques to enable one to become more clearly aware of the contents of experience and to develop the ability to stay with that experience in the present moment
3. Distraction
Distraction is simply doing other things to keep yourself from becoming negatively absorbed. Bring something else in to change the feeling. Using ice, rubber bands, etc, is substituting other intense feelings for the self-injury. Other things g include experiences that change your current feelings, tasks (like counting the colors you can see in your immediate environment) that don't require much effort but do take a great deal of concentration, and volunteer work.

4. Improve the Moment
'Emotional modulation' : ways of changing distressing emotional states and 'distress tolerance skills' include techniques for putting up with these emotional states if they can not be changed for the time being. These include recognize the feeling and go into a VERY cognitive mode that can be practised over a couple of days - or until the stress period has passed -
Relax by using something as simple as looking up and putting your arms up and make a basket of your hands behind your head -
Each day stop and breath several times. In breath to the count of five (tensing your whole body gradually - finishing with tensing your shoulders ) and then as you exhale to the count of five let your body relax down and outwards towards the tips of her fingers.
If you think you have a task -- work out the steps beforehand.
If you feel like you are going to stress out .... stop, shut everything down, breath and stretch, put your hands behind your head .... then think about what you want to do and go back to it. If you want to phone someone then do that AFTER you have calmed yourself down.
Stress/Panic is normally more physiological than emotional. Remember that and don't blame yourself! Have one thing a day that you will really enjoy -
Defer & Recollect: Everyday at night or during the day take a pad of paper and doodle for ten minutes at the same time as you write down words that describe thoughts/actions that have happened during the day. You can even write down thoughts for the next day as well. Try and do this while something else is going on to distract you - radio, music ...
Look at your body clock : notice when you get jittery. I suggest some kind of soup, As humans we are supposed to eat at the 'stress' times of the day : 8:00am - 11:30am, between 2:00pm - 4:30pm, 6:00pm - 9:00pm .... and then a small carbohydrate snack before bedtime ( or a low fat yoghurt ). No milk after 6:00pm. Small meals - and plenty of them, good for weight, good for alcohol
Crave foods ? Do it -
5. Tolerating Distress
Try and seperate from the stress and look at it from the outside in. See if you can place the pain/stress beside you where it can be "bracketed" - sometimes it helps to imagine that you put it into a scrapbook that you can come back to later on.
6. Self-Soothing
Just like with food, match the activity to the feeling. A few examples:
~ angry, frustrated, restless:
Try something physical and violent, something not directed at a living thing:
Slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock.
Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.
Flatten aluminum cans for recycling, seeing how fast you can go.
Hit a punching bag.
Use a pillow to hit a wall, pillow-fight style.
Rip up an old newspaper or phone book.
On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture.
Make Play-Doh or other clay models and cut or smash them.
Throw ice into the bathtub or against a brick wall hard enough to shatter it.
Break sticks.
I've found that these things work even better if I rant at the thing I am cutting/tearing/hitting. I start out slowly, explaining why I am hurt and angry, but sometimes end up swearing and crying and yelling. It helps a lot to vent like that.
Crank up the music and dance.
Clean your room (or your whole house).
Go for a walk/jog/run.
Stomp around in heavy shoes.
Play handball or tennis.
~ sad, soft, melancholy, depressed, unhappy:
Do something slow and soothing, like taking a hot bath with bath oil or bubbles, curling up under a comforter with hot cocoa and a good book, babying yourself somehow. Do whatever makes you feel taken care of and comforted. Light sweet-smelling incense. Listen to soothing music. Smooth nice body lotion into the parts or yourself you want to hurt. Call a friend and just talk about things that you like. Make a tray of special treats and tuck yourself into bed with it and watch TV or read. Visit a friend.
~ craving sensation, feeling depersonalized, dissociating, feeling unreal:
Do something that creates a sharp physical sensation:
Squeeze ice hard (this really hurts). (Note: putting ice on a spot you want to burn gives you a strong painful sensation and leaves a red mark afterward, kind of like burning would.)
Put a finger into a frozen food (like ice cream) for a minute.
Bite into a hot pepper or chew a piece of ginger root.
Rub liniment under your nose.
Slap a tabletop hard.
Snap your wrist with a rubber band.
Take a cold bath.
Stomp your feet on the ground.
Focus on how it feels to breathe. Notice the way your chest and stomach move with each breath.
[NOTE: Some people report that being online while dissociating increases their sense of unreality; be cautious about logging on in a dissociative state until you know how it affects you.]
~ wanting focus:
Do a task that is exacting and requires focus and concentration.
Eat a raisin mindfully. Pick it up, noticing how it feels in your hand. Look at it carefully; see the asymmetries and think about the changes the grape went through. Roll the raisin in your fingers and notice the texture; try to describe it. Bring the raisin up to your mouth, paying attention to how it feels to move your hand that way. Smell the raisin; what does it remind you of? How does a raisin smell? Notice that you're beginning to salivate, and see how that feels. Open your mouth and put the raisin in, taking time to think about how the raisin feels to your tongue. Chew slowly, noticing how the texture and even the taste of the raisin change as you chew it. Are there little seeds or stems? How is the inside different from the outside? Finally, swallow.
Choose an object in the room. Examine it carefully and then write as detailed a description of it as you can. Include everything: size, weight, texture, shape, color, possible uses, feel, etc.
Choose a random object, like a paper clip, and try to list 30 different uses for it.
Pick a subject and research it on the web.
~ wanting to see blood:
Draw on yourself with a red felt-tip pen.
Take a small bottle of liquid red food coloring and warm it slightly by dropping it into a cup of hot water for a few minutes. Uncap the bottle and press its tip against the place you want to cut. Draw the bottle in a cutting motion while squeezing it slightly to let the food color trickle out.
Draw on the areas you want to cut using ice that you've made by dropping six or seven drops of red food color into each of the ice-cube tray wells.
Paint yourself with red tempera paint.

~ wanting to see scars or pick scabs:
Get a henna tattoo kit. You put the henna on as a paste and leave it overnight; the next day you can pick it off as you would a scab and it leaves an orange-red mark behind.
Another thing that helps sometimes is the fifteen-minute game. Tell yourself that if you still want to harm yourself in 15 minutes, you can. When the time is up, see if you can go another 15. I've been able to get through a whole night that way before.
~ "I tried all of that. I still want to hurt myself ":
Sometimes you will make a good-faith effort to keep from harming yourself but nothing seems to work. You've slashed a bottle, your hand is numb from the ice, and the urge is still twisting you into knots. You feel that if you don't harm yourself, you'll explode. What now?
If, in all honesty, you see no other answer, then give yourself permission, but set definite limits. Do not allow the urge to control you; if you choose to give in to it, then choose it. Decide beforehand exactly what you will allow yourself to do and how much is enough, and stick to those limits. Keep yourself as safe as you can while injuring yourself, and take responsibility for the injury.
Try to answer the following questions to reconstruct a moment by moment analysis of the interactions ans sensations that cause the cutting.
FEELING REAL:
Why do I feel I need to hurt myself? What has brought me to this point? Have I been here before? What did I do to deal with it? How did I feel then? What I have done to ease this discomfort so far? What else can I do that won't hurt me? How do I feel right now? How will I feel when I am hurting myself? How will I feel after hurting myself? How will I feel tomorrow morning? Can I avoid this stressor, or deal with it better in the future? Do I need to hurt myself?

Staying safe while "hurting yourself": A few things to keep in mind should you decide that you do need to hurt yourself: Don't share cutting implements with anyone; you can get the same diseases (hepatitis, AIDS, etc) addicts get from sharing needles. Try to keep cuts shallow. Keep first aid supplies on hand and know what to do in the case of emergencies. Do only the minimum required to ease your distress. Set limits. Decide how much you are going to allow yourself to do (how many cuts/burns/bruises, how deep/severe, how long you will allow yourself to engage in SI), keep within those boundaries, and clean up and bandage yourself later. If you can manage that much, then at least you will be exerting some control over your SI.

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