My wife, Dr. Smith, and I are big fans of mindfulness approaches to therapy and we’ve included discussions of mindfulness in most of our self help books within the For Dummies series (including Borderline Personality Disorder For Dummies). In brief, Mindfulness is typically described as involving focused attention on experiences in the present moment as well as acceptance and openness to whatever the present entails. Experiences are observed and noticed rather than evaluated and judged.

A real advantage of taking a Mindful approach to experience is that relatively few present moment experiences are truly “awful” or intolerable. In fact, the vast majority of things that gravely upset people have to do with imagined, future catastrophes or guilt, shame, and self loathing over past actions.

One of our favorite discussions was about me learning the value of mindfulness in our earlier book, Depression For Dummies and it goes as follows:

Charles never feels as grounded and at peace as when he takes our dogs on a long jog three or four times each week. He heads out the door and in just a few minutes makes it to the West Mesa overlooking Albuquerque. You can see the entire city laid out at the footstep of a majestic mountain range. The view is stunning and you can see many miles out to the horizon.

The mesa is laced with dirt roads and gullies created by occasional downpours that blow through the otherwise parched land. Rabbits routinely dart across the running path. And once in a while, you can spot a coyote in the distance. Charles connects with the experience by noticing the rhythm of his running, the obvious joy the dogs exhibit, the quiet, and the (usually) gentle breezes.

Because he runs a long way, sometimes predicting a sudden downpour is impossible. The first few times rain started to drizzle, Charles cursed his fate and picked up the pace to return home as quickly as possible. But frequently Charles got soaked before he arrived home, and he felt distressed at his soaked condition. After all, …

OCD also involves thoughts. For some people with OCD their obsessions and compulsions are more in their heads than in their guts. Consider a woman who feels a compulsive urge to arrange her canned goods in a “certain, perfect” order. She doesn’t report feeling particularly anxious at all. It’s just that she feels things aren’t “right” if she doesn’t have everything in a just so order.

OCD can also show up primarily in behaviors. For example, a man might feel a driven need to go through doorways in a particular manner. Until he gets it “right,” he can’t let himself continue on his way. He can’t come up with any particular thoughts about why he needs to go through doors in this way; he just feels he must.

As these examples illustrate, OCD manifests itself in many widely differing forms. The prominent feature(s) may involve anxiety, thoughts, behaviors, urges, or distress. Although OCD is currently considered a type of Anxiety Disorder, many professionals believe it deserves its own separate diagnostic category.

The take home message is that this is a fascinating, yet quite complex disorder. If you “think” you may have it, consider seeking professional consultation. This is one problem that you don’t want to self diagnose. The good news is that usually treatments work …

People sometimes ask us if they should stay with a partner who has Borderline Personality Disorder. They tell us that their loved one can flip from wonderful to horrible in a split second. They wonder whether they should keep working on the relationship or abandon ship.

We tell those asking this question that people with Borderline Personality Disorder (BPD) indeed engage in a wide variety of behaviors and states of mind. Not surprisingly, people who care about those who have BPD often ask which of these various states represent the “real” person–the difficult states or the endearing ones? In order to answer that question, let’s first take a look at some of the disagreeable states as well as what may cause them. Then we’ll review the positive behaviors and the causes for those. We’ll conclude by filling you in on which ones reflect the “true” person at the core. And most importantly, we’ll give you a few issues that may help guide you in making this difficult relationship decision.

Negative Behaviors and States of Mind
People with BPD often inflict harm on those they love (sometimes quite intentionally; other times without conscious intent at all). They can say and do things that are perceived as astonishingly hurtful. Furthermore, people with BPD often fail to understand appropriate limits and boundaries of those they care about. Thus, a man with BPD might attempt to control his partner by demanding that she cut herself off from her family because they don’t “like him.”

In addition, those with BPD often criticize their partners for not “doing enough or earning enough” for them or their family. They may burst into rage, anger, or impulsive actions with seemingly little provocation. Often their partners who don’t have BPD find that their self-esteem suffers and they begin to question their own sanity, thinking that their partner is right–they really aren’t doing enough or they’re doing things the wrong way.

What causes such distressing, yet inappropriate behaviors in those with BPD? All too often, people with BPD completely fail to understand the nature of their behavior and …

Last week, I attended a well orchestrated day long conference on treating people with Post Traumatic Stress Disorder (PTSD). Organized by Dr. Rex Swanda from the New Mexico VA, the content of the conference primarily focused on therapeutic practices that have been studied and found to be effective in treating those who suffer from this disorder. Treatments that are considered evidence based have been subjected to at least several independent research studies, compared to other types of treatment, or to no treatment. Here is an abbreviated description of PTSD.

PTSD can occur when people suffer or witness a traumatic event in which they are threatened with death, injury, or physical violation. During the time of the trauma these people respond with horror, fear, or helplessness. The symptoms of PTSD include some of the following:

• Re-experiencing the trauma: through dreams, flashbacks, unwanted thoughts, or distress when reminded of the trauma.
• Numbing or avoiding: attempts to avoid situations, triggers, or thoughts about the trauma, feelings of detachment from others, loss of interest in activities, beliefs that their lives will be short, and restricted emotions.
• Hyperarousal: problems with sleep, easily irritated or angry, problems concentrating, and jumpiness.

If you have concerns that you or someone you care about has PTSD, please consult with a mental health professional for a diagnosis and treatment plan.

Now, back to the conference. There were multiple sessions that mostly reviewed the effective treatments for PTSD. Not surprisingly the therapies that work are based on mixtures of cognitive and behavioral therapies. These approaches have stood the test of time and science. Cognitive Behavioral Therapy (CBT) has been used to successfully treat …

We just returned from a trip to New York City. While there, we managed to do a little work and visit some family. Our family, like many families, stretches from the west coast to the east coast. We don’t see each other as often as we’d like. So, when we get together there are always changes. Change is the only predictable, dependable essence of our family (like most families).

For us, one significant change has been our assignment to the older generation. For many baby boomers, this new status is largely unanticipated and surprising. Where did all that time go? Our transfer to elder status comes with the gain of grandchildren, the joy and pain of watching our children love, learn, and leave. It also comes with the dissipation of dreams, the creation of new dreams, the loss of our own parents, new aches and pains, technological challenges, and the wonderful perspective of experience. Of course, that wonderful perspective derived from experience isn’t always sought out or appreciated. Sigh.

Family members change. Children are born, or adopted. Adults join families through new ties or partnerships. People leave families. Some die, others move on, some lose connections by choice, some by circumstance.

Getting together with family evokes lots of feelings. Okay family-Chuck and I are both clinical psychologists and it’s true, we really are analyzing everything you say or don’t say. And we know exactly what you’re really thinking (well, that’s not true-we still can’t read minds, but we’re working on that).

On the long (delayed) flight back to New Mexico, we had time to reflect on our family. And we both concluded that the people in our family–like those in most families–do the best they can do given the time and context of their births, childhoods, biology, learning, luck, and fate. We’re good people, for the most part, and we plod ahead, not always really sure of where we’re going.

So, does this hopelessly egocentric rambling have a point? Yes, one way to improve mental health and happiness is acceptance. So family, we have analyzed you completely by now and want you …

People with Borderline Personality Disorder sometimes engage in acts of self harm. These acts of self harm are wide ranging; they’re also dramatic and startling in many cases. These behaviors include:

• Blunt force trauma: This type of self harm includes banging one’s head on a hard surface, punching oneself, and using a hammer or other tool to inflict damage and pain to the body.
• Cutting: This is one of the most common and widely known types of self harm that those with BPD engage in. Cutters use a variety of tools such as scissors, razor blades, knives, needles, and broken glass. Scars often result and many people who cut try to cover up their injuries while some people actually try to put them on display.
• Burning: People resorting to this tactic use cigarettes, matches, lighters, and hot objects to burn themselves. They usually only burn a small area each time, but the resulting scars can often occur over a large part of the body.
• Intentional accidents: Folks who set themselves up for accidents may not look like they’re trying to hurt themselves, but their failure to take even the most basic, reasonable precautions tips you off to their true motives. These people often end up in far more than their share of mishaps and investigation often reveals that they set ladders on obviously unstable ground or fail to use essential safety equipment.
• Miscellaneous self injurious behaviors: These include swallowing harmful objects, inserting objects into body cavities, hair pulling, consuming harmful chemicals, pushing one’s eyeballs, or biting one’s body.

You’re probably wondering what the motivation is for these various acts of self harm that seemingly would result in no gains for the person who does them. The answer to your question is that there is no single motivation for self harm. Both mental health professionals and those with BPD have suggested a variety of possible motivations including:

• To distract from emotional pain: You can’t underestimate the unbearable nature of inner pain experienced by those with BPD. Although the pain from self injurious acts rarely matches the internal, emotional pain, it does pull one’s …
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We’ve had clouds and rain for the last few days in New Mexico; an unusual occurrence in the land of sunshine (more than 300 days a year). But with the rain came lower temperatures and the quick change to fall. Here in Corrales, we look forward to the harvest festival, roasting green chili, and in early October the Balloon Fiesta. At this time of year temperatures can go from the 80’s in the day to the 40’s at night. It’s a great time of year.
For those with Seasonal Affective Disorder, a form of depression that comes during the darker days of winter, now is the time to make plans. Like the animals that begin to prepare for a season with less food, people with SAD can benefit by making preparations for the winter season. Activities that help people with SAD include more light (especially natural light), social support, and exercise.

• First, think about some activities that you might enjoy outside this winter. If it is a sport, consider taking a class or joining a group so that you can combine going outside with socializing.
• People with SAD tend to hibernate in the winter. Try to arrange some activities to do during the winter months in the early evenings.
• Find an exercise routine that you enjoy. Again try to make this a social time as well.
• Weight gain is also common in the winter for people with SAD. If you struggle with weight consider a support group to get you through the dark times.

If you have had severe problems with SAD, we suggest that you discuss this with your medical provider or a mental health professional experienced with this particular problem. Some people take a certain antidepressant as prevention for SAD. If you want more information about SAD, we have a great book (you can buy it new or used on Amazon) Seasonal Affective Disorder For Dummies.

My first inclination, like many people, is to fluff up the pillows, reposition myself, and will sleep to overtake me. Sometimes that works, but usually sleep remains evasive. So, instead of counting sheep for hours, here are a few tips to manage sleepless nights:

• Get up. Yup, put on your robe and slippers and get out of bed. If you can’t sleep, you don’t want to stay in bed. That’s because you want your brain to associate your bed with sleep, not with insomnia. So, go check your email, read a book, or watch TV in another room for a while. When you start to really get tired, go back to bed.
• Don’t catastrophize. Realize that you will likely sleep better tomorrow and that you can get through the day without your regular sleep. The more you get upset about not falling asleep, the more your brain will keep you awake. Worrying just …
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For decades, a considerable body of research has demonstrated that a number of psychotherapies are highly effective in the treatment of depression and anxiety disorders. Cognitive behavioral treatments have received the most attention from researchers, but other treatments such as interpersonal psychotherapy have also shown significant promise. The treatment of Borderline Personality Disorder has been another matter. Marsha Linehan developed a treatment known as Dialectical Behavior Therapy (DBT) which utilizes cognitive behavioral principles in conjunction with acceptance, emotional regulation skills, and principles of validation to the treatment of Borderline Personality Disorder (DBT). Significant research supporting its efficacy did not start showing up until the 1990’s or so. And, for a while, DBT virtually stood alone as an empirically validated treatment for BPD. This treatment is fairly intensive and requires at least a full year of treatment, but a growing number of studies have supported its value.

Nonetheless, we have needed more ideas for treating BPD. Dialectical Behavior Therapy, as effective as it is, sometimes fails to improve life satisfaction and quality of life as much as one would hope. And in the past few years, new treatment ideas have begun to emerge. These include:

• Mentalization-Based Therapy (MBT)
• Transference-Focused Psychotherapy (TFP)
• Schema Therapy (ST)
• Cognitive Behavioral Therapy (CBT) tailored specifically to BPD

Research has just started to support these new approaches to BPD treatment. Schema Therapy and Mentalization-Based Therapy look especially promising, but we need more studies before anything definitive can be concluded. Interestingly, having reviewed these approaches, we have failed to discover much that seems especially incompatible among them. Therefore, we suspect that ultimately, an integrated approach to treating BPD may ultimately emerge as the best strategy. Whether or not our hunch is right, the next ten years promise to be quite exciting in the treatment of BPD.

In a future blog, we’ll discuss the role of medications in the treatment of BPD. Although most prescribers of medications recommend multiple medications for the majority of people with BPD, research has demonstrated surprisingly little value from medications for this problem. As we said, more to come…

I’t’s 4 am, I’m awake. I hope that I can go back to sleep. . . . Did I remember to get the coffee ready?  I hope the traffic won’t be so bad tomorrow night, last night it took me an hour to get home. I’ve got to decide about whether or not I’ll keep the consulting job. Geez, one of us has to write a blog tomorrow, we’ve been putting that off.  I wonder whether I can fit in the gym tonight. I have to remember to take out the trash before I leave. I have to stop thinking . . . I need sleep. Okay, I’ll try to concentrate on my breathing. Breathe in to the count of eight and then let it out slowly and then in. . . I have way too much to do tommorow….breathe in 1,2,3,3,4,5,6,7,8…….

Sound familiar? More and more people complain about poor sleep. The sale of prescriptions for sleep aids and over-the-counter solutions continue to skyrocket. One reason behind this pandemic is likely the modern lifestyle. We don’t fall into bed exhausted after spending the day doing physical labor on the farm or at the factory.

People generally need about eight hours of sleep per night. The real gauge as to whether you’re getting enough sleep is how you feel during the daytime, not the exact number of hours you get. In any case, anxiety frequently disrupts sleep, and a lack of sleep can increase your anxiety. The following list describes the most common sleep disturbances.

• Insomnia, by far the most common sleep problem, may be the result of anxiety, depression, stress, poor sleep habits, discomfort, or an inadequate sleeping environment such as living in a noisy apartment building or sleeping on a lumpy mattress. Insomniacs have difficulty falling asleep and/or staying asleep.
• Hormonal fluctuations that occur during pregnancy and menopause can cause physical discomfort and changes in bodily temperature that interrupt sleep.
• Jet lag or shift work can disrupt normal sleep patterns. People have a biological clock or rhythm that likes to stay on a regular schedule. Those who have to switch …
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