Archive for September, 2009

How and Why Do Those With Borderline Personality Disorder Hurt Themselves?

Saturday, September 26th, 2009

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 attention away from the overwhelming emotions for a little while.
  • To …

Are You Getting SAD?

Friday, September 18th, 2009

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.

More on getting your zzzzzzzzs

Sunday, September 13th, 2009
Last night the phone rang at 2:18 am. I was sound asleep-it was great sleeping weather last night, the cool air streamed through open windows. By the time I woke up enough to understand that the ringing was real and not part of a dream, the noise had stopped. Unlike the phones in other rooms of the house, the bedroom phone doesn’t have caller ID and the volume of the ring is turned down. I didn’t know who was calling. Could it be a wrong number, a crank call, or somebody in trouble?  I looked at the time. Then I turned over. But, sleep did not come. I was wide awake wondering who called. Darn.     
I got out of bed and padded into the kitchen to look at the caller ID. The call had come from my daughter Sara who was working the night shift at the hospital. Should I call her back? Did something happen to one of the grandkids? Is she alright? Now my mind generated non-stop worries. Forget sleep. The story ended. She had accidently hit her speed dial and hung up after two rings. But my middle of the night awakening persisted.

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 doesn’t work.
  • Have a very small snack. It doesn’t have to …

Increasing Hope for the Treatment of Borderline Personality Disorder

Sunday, September 6th, 2009

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…

Anxiety and Sleep

Thursday, September 3rd, 2009

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 sleep schedules due to travel or work may have difficult …

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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Overcoming Anxiety for Dummies and Child Psychology & Development for Dummies.

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