Understanding Borderline Personality Disorder 12 March 2021 Bliss Team No comments Categories: Book Recommendations, Individual Therapy, Therapy, Uncategorised Please note that every person’s experience of borderline personality disorder (BPD) is different. The symptoms and ranges of BPD run both vertically (the number of symptoms experienced) and horizontally (the intensity of how they are experienced). If we also consider other factors that layer and intersect, such as life events (e.g., t/Trauma) and social positions (e.g., financial security, colour of skin, sexual orientation, gender, etc.), our end result is a very unique tapestry of experiences. “People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” Dr. Marsha Linehan What is Borderline Personality Disorder? BPD is the most common personality disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). This manual is used by physicians and psychologists to make mental health diagnoses. Someone with a personality disorder typically faces unique challenges in: Relationships and social situations; Managing emotions and thoughts; Understanding how certain behaviours are creating problems and/or; Recurring difficulties in changing a mindset to suit different contexts. 75% of people with BPD self-injure one or more times. 10% of people with BPD take their own lives. What are the symptoms of BPD? The DSM-IV-TR lists 9 categorical criteria for BPD. A person must present with at least 5 of the symptoms in order to be diagnosed with BPD. The 9 symptoms can be summarized as: Frantic efforts to avoid real or imagined abandonment, significant fears of being alone; Unstable and intense interpersonal relationships; Lack of clear sense of identity; Impulsiveness in potentially self-damaging behaviours, such as substance abuse, sex, shop lifting, reckless driving, binge eating; Recurrent suicidal threats or gestures, or non-suicidal self-injury such as cutting, burning with a cigarette, or overdose that can bring relief from intense emotional pain; Severe mood shifts and extreme reactivity to situational stresses; Chronic feelings of emptiness, loneliness and neediness; Intense, frequent, short-lived and inappropriate displays of anger, depression or anxiety; Transient, stress-related feelings of unreality or paranoia. Inconsistent symptoms are the hallmark of BPD, which makes it difficult to define a single set of criteria for a diagnosis. This is further complicated, as research has shown that about 90% of folks with a BPD diagnosis, share at least 1 other major psychiatric diagnosis. What is it like living with BPD? “Prick the delicate ‘skin’ of a borderline and she will emotionally bleed to death.” Kreisman and Straus BPD has been described as emotional hemophilia. In the case of BPD, the client will have difficulties with moderating their feelings. Mood changes can come and go quickly and can shift from extreme joy to the deepest despair. A person with BPD may be filled with anger or despair one hour and then calm the next, with little understanding as to why. This then leads to feelings of insecurity, lower self-worth and inner criticism, which brings about more self-hate and depression. Symptoms, such as dissociation, can also interfere with concentration making it very difficult for folks with BPD to complete their tasks. Feelings of emptiness makes a person with BPD feel as though they have to do anything to escape, such as impulsive and self-destructive behaviours, so that they may feel something. People with BPD may also feel as though they do not have a core identity and to overcome their mostly negative self-image, they will create characters or codes. People with BPD may also experience splitting. Splitting can happen at any time, if they are under enough pressure, stress, anxiety, or anger. Splitting is when a person only thinks about a situation or person in binaries. It is the rigid separation of positive and negative thoughts and feelings about oneself and others. For instance, a person with BPD may only consider a context to be right or wrong, good or bad, or in black and white terms without any room for grey. A person with BPD may struggle to accept human inconsistencies or ambiguities, and as such favour predictability. When there is a miscommunication or when somebody they idealize eventually disappoints them in some way, or acts in a way that they did not predict, a person with BPD may look at them as though they cannot be trusted. When this occurs, the person with BPD has to make a decision to either restructure their strict and inflexible conceptualization of this person or to isolate themselves in order to preserve the “perfect” image they had created. Research shows that there is no definitive cause for BPD, rather it is a combination of genetic, developmental, neurobiological and social factors that contribute to its development. People with BPD may come from family backgrounds with parents who were indifferent, rejecting or absent. They may have also received little to no affection and/or experienced chronic abuse. A person with BPD will also seek out new relationships (i.e., partners and/or friendships) quite often. Once in a close romantic relationship they will both crave and become terrified of intimacy; fearing abandonment, they will cling to their partner, which will then lead to fears of enmeshment, so they push away. Because of this, they end up pushing away those they want to connect with the most. Of all the major mental health diagnoses, BPD is the most stigmatized. Stereotypes include viewing folks with BPD as dramatic, manipulative, unfeeling or lacking emotion, attention-seeking and/or narcissistic. They are consistently suspected of wrongdoing, carelessness, anger, and difficulties with building a regular routine. This leads folks with BPD to hide this part of themselves from others. For a person with BPD there are significant fears of abandonment and they will attach to a favourite person and rely on this person for emotional validation and security. Their favourite person becomes the source of their comfort and devotion. A BPD person’s favourite person can be anybody: a relative, parent, best friend, lover, or somebody they just met. The difference between a best friend and a favourite person, is related to the intensity of the thoughts that surround this person. A person with BPD requires compassion, understanding, acceptance, honesty, patience and love. They may not have grown up with either receiving or learning how to share these characteristics with their formative relationships, so accountability for behaviours that are challenging a relationship and empathy, are key. Of course a person with BPD will need to learn how to give themselves the love and compassion that they crave from others, as well. What can you do if you or a loved one is experiencing BPD related symptoms? It is important to recognize that there is no “cure” for BPD, rather somebody who experiences these traits and is receiving treatment may just have more time between self-harm episodes and/or coping strategies to support emotional regulation. Kreisman and Straus have described a structured method of communication, known as SET that can be used when communicating with a person who is in a BPD related crisis, or emotionally spiralling. Support – Use a personal “I” statement of concern to demonstrate a personal pledge to try to support the person in emotional crisis. For example, “I am really worried about how you are feeling.” Empathy – Acknowledge their chaotic feelings with a “You” statement. For example: “You must be feeling awful/scared/hurt/etc.” Truth – Emphasize that this person is accountable to their own life and that others’ attempts to help, cannot avert this primary responsibility. In this statement, you must acknowledge that there is a problem that exists and offer a solution for what can be done to solve it. This must be done in a matter of fact tone. For example, “Here’s what happened…These are the consequences…. This is what I can do… What are you going to do?” It is possible to have a healthy relationship with a person with BPD, especially if you are the favourite person. You can do this in 5 easy steps. Step 1 : Communicate The first step is to have a discussion, to acknowledge that you are their favourite person, and to determine if the relationship is mutual. Questions to reflect on and consider during this discussion are: What are each person’s needs? Are they currently being met? Has there been an instance where either person’s needs weren’t met, why might that be and how might you both be able to overcome this in future interactions? What are both of your feelings regarding space and emotional boundaries? Step 2: Avoid Assumptions BPD folks generally think in black and white (e.g., “they don’t love me anymore”). In order to avoid this assumption and the potential for an emotional crisis, or “testing” the favourite person to make sure they still do love them or won’t leave them, the BPD person should feel comfortable with being direct and asking for reassurance from their favourite person (e.g., “Is everything alright? I’m just worried because I haven’t heard from you in a while”). Step 3: Develop More Friendships It is comfortable and easy for a BPD person to give all of the love and everything they have to their favourite person, but it’s a lot of pressure to receive and also reciprocate as a single human being. This is why it is important for both the favourite and BPD person to have friends of their own that they enjoy spending time with. This will help the BPD person with the intensity of putting all of their emotional needs on one person, and will also help the favourite person to have other outlets and their own support. It’s important that the BPD person avoids scheduling their plans around their favourite person. Step 4: Limit Expectations This is one of the most difficult ideas for a BPD person to incorporate into their worldview, but it is to cultivate a mindset in which their favourite person may leave, by choice or not, and this is okay. This requires a mindful appreciation for enjoying the day for what it is. No matter what happens. It is not possible to control a person or to demand that they be committed to your relationship or friendship forever. Thinking of the future and the possibility that they could leave, may generate anxious thoughts and feelings of being abandoned. Instead, the BPD person can try practicing gratitude for the current state of their relationships. Step 5: Therapy & Medications Treatment for both the BPD and favourite person usually begins with education; discussing what is known about BPD and its causes, as well as how the BPD person can self-manage and prevent relapses. Therapy and counselling may also be offered at the individual or group level for both the BPD and favourite person. The BPD person may also wish to take prescription medications that align with their specific symptoms (e.g., mood swings or anxiety). There are a number of therapeutic tools that can be used in the treatment of BPD symptoms. The 2 major tools are cognitive behavioural therapy (CBT), which focuses on the present and on changing negative thoughts and behaviours, and dialectical behaviour therapy (DBT) which uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and the client’s emotional state. DBT helps clients to regulate intense emotions, to reduce self-destructive behaviours and to improve relationships. It’s important to remember that like any relationship, the connection you build will be at it’s healthiest if it is constructed on a foundation of trust, friendship, mutual respect and care, honesty and accountability. At Bliss, we want to help our clients navigate the complexities of BPD and help them live balanced, happy, fulfilling lives. If you need additional guidance, please book an appointment with one of our therapists who specialized in this area and will guide you through the therapy process in a safe, non judgemental atmosphere: Sheila Mcdonough Sergius Semuyeh Valentina Messier Josh Rinz Marni Moss You do not have to go through this alone. Bliss is here to support you. Written By: Jess Jess is our amazing office strategist at Bliss Counselling. Jess is a Master’s graduate from the University of Guelph. During this degree, they focused on aging and end-of-life, communication, human sexuality, LGBTQI2S+ health, inclusive practice and policies, knowledge mobilization strategies, research methods, and program evaluation. I would like to learn more about BPD, what other resources exist? For more information and support, please consider the following resources. Books Beyond Borderline: True Stories of Recovery from Borderline Personality Disorder by John G. Gunderson (edited by Perry D Hoffman) Building a Life Worth Living: A Memoir by Marsha M. Linehan Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder by Blaise Aguirre I Hate You – Don’t leave me: Understanding the Borderline Personality by Jerold J. Kreisman and Hal Straus Loving Someone with Borderline Personality Disorder by Shari Y. Manning Mastering Adulthood: Go Beyond Adulting to Become an Emotional Grown-Up by Lara E. Fielding The Dialectical Behaviour Therapy Wellness Planner: 365 Days of Healthy Living for Your Body, Mind, and Spirit (The Borderline Personality Disorder Wellness Series) by Amanda L. Smith The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT by Cedar R. Koons This is Not the End: Conversation on Borderline Personality Disorder by Tabetha Martin The Dialectical Behaviour Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance by Matthew McKay, Jeffrey Wood, and Jeffrey Brantley Online Documents Borderline Personality Disorder: An Information Guide for Families by CAMH https://www.camh.ca/-/media/files/guides-and-publications/borderline-guide-en.pdf?la=en&hash=69DE097DD9DC16A66440FCD4573E73358AEEECEC Borderline Personality Disorder by the National Institute of Mental Health https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml DBT Skills Training Handouts and Worksheets by Marsha M. Linehan https://projecticee.files.wordpress.com/2018/12/lin-c-dbt-handouts.pdf The Overlap Between Autistic Spectrum Conditions and Borderline Personality Disorder by Dudas et al., (2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590952/
Conquering Self-Doubt 3 June 2019 Bliss Team No comments Categories: Individual Therapy, Inspiration, Self Care, Therapy Self-doubt is that awful voice in our head that tells us we can’t do something, that we won’t be successful, or that we will fail. Self-doubt is something that builds over time, maybe it developed from a chaotic childhood, a parent we couldn’t please, a time we failed at something, a relationship that didn’t work out, a rejection from a job, or even a person or loved one. Most of us deal with a form of self-doubt at some point in our lives. It is amazing to me how quickly our brains can automatically turn to doubt. These automatic thoughts often leave us stuck and holding ourselves back from achieving goals, when we should be taking risks in either our jobs or relationships and enjoying a fulfilling life. So what do we do to conquer self-doubt? The process itself isn’t an easy one, but can be very rewarding if you are able to consciously make an effort to combat it. Here are some tips to help you conquer your own self doubt 1. Recognize it exists – recognition is the impetus for any change. We can’t change what we don’t acknowledge. When self-doubt rears its ugly head, pay attention to it. Acknowledge that it’s there, but work toward identifying that these negative thoughts aren’t facts. 2. Challenge the thought – if you went on a date with someone and they didn’t call you back, is your first assumption that the rejection was because of you? What if the person’s mother fell ill? Or their ex-partner contacted them and wanted to reconcile and give the relationship another chance. What if you got rejected for a job? Not because you weren’t qualified but because the company decided to take a different route due to budget cuts. There are many explanations that have absolutely no connection to you or your worth. 3. If your doubt is related to past mistakes, then acknowledge them, but remind yourself that the past is in the past. If we attempted something in the past and weren’t successful, it doesn’t mean that we won’t be successful now. We have grown since then, we have looked back on what didn’t work, and we have experienced some new learning since then. Instead of looming in your doubt, remind yourself of the things you did to overcome the failure from the past. 4. Think of some positive thoughts. Instead of looking at only what could go wrong, ask yourself what could go right. Give yourself some positive messages. Why are the negative ones the only ones you are allowing in? 5. DO NOT COMPARE. In the age of social media this is an important one. You have no idea what is happening in someone else’s life, they may have a great partner but hate their job, or may be dealing with a sick child or ailing parents. 6. Remember that we aren’t only our failures, we are also our successes. If you weren’t successful at something reflect on what you would do differently the next time. For example, if you don’t feel you did well at a job interview, how might you go about it differently next time. Could you practice with someone? Do more research about the position? Self doubt exists in all of us, maybe at different times and for different reasons, but all of us have it. The key is to work towards combating the things that are holding us back or keeping us stuck and causing us to beat ourselves up. If you continue to struggle, it may be best to speak with a therapist. They can provide you with additional tools to help you overcome self-doubt. Written by Bliss therapist Tammy Benwell. Learn more about Tammy and get her secret “Tips From the Couch” here. If you liked this article on self-doubt, you might enjoy these too: What Does it Mean to be Authentic? Others Will Treat You the Way You Let Them – 3 Keys to Boundary Setting Why we Need to Stop “Agreeing to Disagree” Are you ready to speak with a therapist about some of the self-doubt you’ve been experiencing? We’re happy to help! Get in touch with us here. If you’re interested in booking your first appointment at Bliss, you can do that here.
8 Simple Ways to Love Yourself More This Year 11 February 2019 Bliss Team No comments Categories: Guest Post, Inspiration, Self Care It may be a new year, but self-love is always in vogue. If one of your goals is to appreciate yourself more, then you’ve come to the right place. These 8 simple ways to love yourself will get you feeling more comfortable in your own skin than ever before. Fit in some self-care everyday Self-care isn’t a once-a-month gig. To properly cultivate a sense of equilibrium and inner wellbeing, you need to dedicate at least 30 minutes per day to taking care of number one. You weren’t born to serve others, and the least you deserve is half an hour of uninterrupted me-time to get you ready for the next day. What you do to relax is entirely up to you. some people adore a long bath, while others prefer a good book or TV series. Take yourself on a solo break For many people, even the act of sitting in a café and having lunch alone is a big step. It can take some serious willpower to forget about what other people think of you, and to just luxuriate in being alone. Once you do, though, it’s the most freeing thing in the world. When you’ve graduated from the solo café trip, you might consider taking yourself further afield. When’s the last time you travelled by yourself? Maybe it’s time to do that European walking tour you’ve always dreamed about. Believe that you can, and you will People who grab opportunities, take chances, and doggedly pursue their ambitions truly succeed in life. They don’t always win, but they never shy away from fighting for what they want. This kind of determination nurtures the soul just as much as any pampering night. Take inspiration from the women you know who thrive in typically male-dominated sectors or industries. Determined women have risen to the top ranks of trucking companies, and have become CEO of a law firm. These ladies needed self-belief to get where they are, and set a fantastic example for the rest of us. Stop putting yourself down Humility is a virtue. When you’re modest to the point of actually denying your talents and achievements, however, self-destruction can ensue. Enjoy celebrating your wins! That new promotion or personal triumph needs recognition – most of all, by you. Figure out the kind of exercise you actually enjoy Think back to the types of activities you enjoyed as a kid, and determine the type of exercise which will make youhappy. There are so many inside-out benefits to getting active! Don’t compare yourself to others There’s no better testament to the phrase “comparison is the thief of joy” than social media. Although these platforms were created to better connect us with others, they’ve actually turned out to be detrimental to our self-esteem and wellbeing. Consider whether it may be time to take a break from comparing yourself to thousands of curated social media platforms. Treat others as you would treat yourself This doesn’t mean whitewashing your own flaws, but accepting them as a part of you,along with the good. Be objective in your relationship with yourself so that you don’t get lost in the mire of self-loathing. Forgive your past mistakes, and cultivate a sense of positivity about the future. Perhaps most of all, become your own best friend. Make your life a story Committing the daily events of your life to pen and paper is a way to value your personal narrative. Writing in a journal can be a fantastic way to step back and reflect. What’s making you happy? Alternatively, are there parts of your life you need to change? About the Author: Harper is an adventurer, freelance creative writer and Japanese Anime geek. She loves nothing more than long bubble baths, unplanned getaways with her partner, Max, or kisses from their furry babies! You can visit her personal blog here– be sure to come say hi!
Single this Valentine’s Day? We’ve got you Covered! 5 February 2019 Bliss Team No comments Categories: Individual Therapy, Inspiration, Relationship Therapy, Relationships, Self Care, Therapy As Valentine’s Day is fast approaching, it’s hard not to notice stores filling up their shelves with chocolates, stuffies, cards and everything pink and red. For those that soak up all the fun, loving, mushy sentiments, Valentine’s Day can be great! But what about those of you who are riding solo this year? Here are 5 ways to help navigate this Hallmark holiday: Check in with yourself.What emotions is this day bringing up for you? Once you have identified if there are any lingering feelings that you haven’t dealt with, you can begin to make space to process them. Whether it’s sadness, loneliness, relief or happiness, what are you feeling? Are you holding on to a past relationship, lover, experience, etc.? What do you need to heal and move forward? Valentine’s Day can stir this pot, so make sure you are being honest with where you are at, and what you need. Check in with your friends.Who else is in the same boat as you? Sometimes it can be helpful to know that there are others feeling the same way. Do you have other single friends that you could connect with? Or maybe even friends that are in relationships that don’t celebrate Valentine’s Day? Think about getting together and going out for a movie, dinner, paint night, dancing, a spa day, a yoga session or a killer spin class. If going out isn’t your thing, maybe you could have a low key night at home, or invite friends over for dinner or to hang out on the couch catching up. All my friends are coupled up, so now what do I do? Do something for yourself!Buy yourself those special chocolates you were eyeing earlier at the grocery store, take yourself out for dinner or order in your favourite dish. Do something that will make you feel good and empowered. We are our own worst enemies, and we can get wrapped up or lost in our own thoughts and self-judgments. Be kind to yourself and give yourself a break. Remember that you are worthy of love and healthy relationships, but being single can be celebrated just as much as being coupled up; and Valentine’s Day gives you the opportunity for self-reflection and well-deserved me time! Check in with your family.Maybe you could use this day to have dinner with your parents, or to spend time with a grandparent. Do you have any nieces or nephews? Maybe you could babysit them while their parents go out. It could be fun to do cheesy crafts again, or decorate some heart shaped goodies! Limit social media.We all have those friends on our Facebook or Instagram feeds who create over the top posts on how great their partner is, and how loved they are. While that may be something they feel is important for them to share on their platform, it can feed challenging or unhelpful thoughts that you may be experiencing. Social media has the tendency to contribute to our need to compare where our friends are at in their lives and relationships with where we are. So, if you think you may feel triggered by seeing what your friends are sharing on Valentines Day, don’t spend as much time scrolling! There isn’t a clear path to avoiding Valentine’s Day altogether, but there are definitely ways to help you navigate the day and get out on the other side. If you really do find yourself struggling with where you’re at right now and need someone to talk to, you can always connect with one of us here at Bliss Counselling. Do you need some ideas of solo activities, or things to do with friends this Valentine’s Day? Check out these websites for things to do around KW! https://www.ammayoga.ca (Restorative yoga? Yes please!) https://www.hustlandflow.com/home (Kick boxing, spin classes, yoga and juice bar) https://www.socialart.ca (Get your paint on) https://www.dejavusalonandspa.ca (Pamper yourself) https://www.thewatersspa.com (Making me time) https://www.ginaspa.com (Focusing on yourself) http://adventurerooms.ca(Grab a team and try to escape these rooms) https://batlgrounds.com/axe-throwing-kitchener/ (Let it go!) https://www.ctrlv.ca/ctrl-v-waterloo-flagship/ (Whoa!) https://www.cineplex.com/Theatre/cineplex-cinemas-kitchener-and-vip?utm_source=google&utm_medium=organic&utm_campaign=local&utm_content=CPXKitchenerVIP (Drinks, food, movies, sounds like a plan) https://apollocinema.ca (A gem kind of spot) http://www.princesscinemas.com (And they have a café too!) https://www.facebook.com/PatentSocial/ (Super Mario!) https://www.acepingponglounge.com (Ping Pong) http://www.crossroadscafe.ca (Board games) http://www.gamesontap.ca (More board games) Written by Bliss sexologist Lindsay Kenna. Learn more about Lindsay and get her secret “Tips From the Couch” here.