Monday, October 29, 2012

Is Mental Illness a Lack of Healthy Coping Skills?

I few months back I was at a 4-day training to learn about  a new group to work with the women in prison whom have violent pasts.  One of the members of the training introduced herself on day 1 to our table, she owned a residential drug and alcohol treatment center and had been using the new program at her site.  On the 4th day we had to do an exercise where we talked about something important to us to another member of our group.   She told me she did not believe in mental illness, thought the DSM IV-r should be "thrown out" and that all disorders were from a lack of coping skills.  I was dumbfounded, but she continued to explain using this analogy; someone whom is neglected as a child is going to need to find a different way to get their needs meet.  At age 2 that means having tantrums, crying excessively and being loud to get mom or dad's attention.  Age 6 may be ongoing conflict with other students to get teachers attention, age 10 bullying other students, being suspended in order to get attention and power, age 15 acting promiscuously to gain male/female attention and at 19 they will continue aggressive behaviors, possibly use substances and have abusive relationships.  At the time I thought this woman was way off base, how can mental illness be from a lack of coping skills?

It has been 2 months and although I believe in mental illness, chemical imbalances and medication, I can see how especially with those with personality disorders how this algorithm works:

Invalidating Environment+Trauma+Lack of Coping Skills= Personality Disorder

I often talk on here and on Twitter about how many women are misdiagnosed have trauma and/or anger issues, instead of BPD.  Someone on Twitter told me last week she was diagnosed with Bipolar, Schizoaffective disorder and attended anger management classes for years and was medicated for such and just found out her "only" diagnosis was Borderline Personality Disorder.

As someone without a mental illness, it is difficult for me to fully comprehend what the experience of having one is like.  I grew up in a mostly validating environment, the trauma I did experience was immediately remedied (due to the validating environment) and I was taught coping skills.  I can remember having anxiety and trouble sleeping as a adolescent and my mom teaching me mindfulness techniques, validating my feelings, normalizing the stress of that age and giving me tapes she has bought to help, while my dad made me chamomile tea and listened to my woes.

More than any other post I would really like feedback from the Borderline Personality Disorder Community about how accurate this "formula" sounds to your life experiences.


  1. Hello Alicia,

    I don't think there is a straightforward answer to this particular question. I believe an aspect of BPD is a lack of coping skills, I myself have been on a quest for some years to learn the 'life skills' I didn't develop in childhood. I've done this by extensive reading, self-analysis and observing and talking to other (more stable) people in my life. I have made a lot of progress with this and now make better choices and have healthier relationships, I am a lot more self-aware and that is a major strength. However. The thing that sets me apart from my more stable friends is that I experience my emotions as overwhelming and have done for as long as I remember. I am reluctant to describe this as an illness, it is more of a 'personality type' (reading The Highly Sensitive Person by Elaine N. Aron helped me to understand and come to terms with this aspect of myself to some degree). To me, my BPD is a combination of my personality type, the invalidating environment I grew up in, along with significant long-term emotional abuse in addition to having poor role-models for learning essential 'life skills' from. So I may well be able to make better decisions now but I still collapse emotionally at the slightest trigger, such as my boyfriend snapping at me, when something like that happens I feel exactly like the helpless, scared child I was thirty years ago and I just have to let myself sob until the feeling passes. I think this will always be an issue for me and I have to accept that and deal with it as best I can, whilst remembering that there are many positives to having BPD. One area I really struggle with is depression, which I have also experienced for as long as I can remember, it is difficult to know whether the dpression is an integral part of my BPD or a separate issue altogether. I think there is more of an argument in favour of depression being an illness, although of course, it all depends on how you define an illness! I have plenty more to say on the subject but I think I've rambled on for long enough. I hope some of what I have said has been helpful.

    Best wishes,


  2. I concur with Clare, that there is probably no one size fits all answer to this. It is acknowledged that upbringing/family/early childhood experiences can have a contributing factor. I would certainly say that would be true for myself. I would consider myself to be not as skilled as others in managing emotions. That being said, it might imply that once the appropriate skills have be learnt (through DBT for example) that the person would then be cured of there BPD, and that is obviously not the case.
    Another aspect of the BPD disorder is that of poor emotional regulation, I don't consider that to be wrapped up in my early years experience, whilst I can see that if you have little "training/teaching/modelling" of good emotional reactions it can lead to problems. My mood "cycle" is a lot quicker than most and I tend to experience more extreme highs and extreme lows.
    Another factor to consider is that of other siblings within the same family. I grew up with a brother in the same household experiencing the same parenting and he has no psychiatric problems at all.
    So it comes to the classic "nature/nurture" debate. If this person is correct then one might expect for my brother to have similar difficulties, which he doesn't.
    Growing up within a validating environment is obviously going to model appropriate response's and skills, but I really don't think the absence of that is the sole reason for my BPD.
    Hope that made sense and was helpful.


  3. Thank you both for your in depth responses. I completely agree with both regarding the lack of coping skills/healthy relationships being a piece of the BPD diagnosis. I think often some professionals in the field are hoping for a one size fits all approach, it would make diagnosing easier. I also think having an invalidating environment cold be the "pre-requisite" for addiction issues as well as a slew of other diagnosis-able conditions.

  4. Hi - my mother has BPD and both my brother and I suffer from it too. I tried so many different coping strategies, and few of them work. I finally realised that some of it is biological - and I have no doubt about this. Coping skills can definitely help and play a part in getting better - but it's not the full picture.