Profiles of Borderline Personality Disorder: David O'Garr

After hitting a writer block earlier this week, I spoke to a fellow counselor about my work with DBT and that I specialize and take an interest in Borderline Personality Disorder.  As is often the case, my fellow counselor was stunned that my specialty was the one diagnosis she avoided working with "at all costs."  Being I speak with those with BPD on Twitter daily, I thought a simple way to change the stigma of "Borderlines" would be to do interviews with people with BPD and put a face with the diagnosis.  I was surprised when I put the ABP out and got 6 responses in a few hours.  The interview also took longer than I expected, but I hope to have 2 profiles out a week for the next month or two.

Being Misdiagnosed

Without further ado, I present David O'Garr, male age 29 years old and from Canada.  David is very open and honest in his life, and writes a blog about his struggles with BPD.  David comes from a large blended family, that were invalidating, although he remains close with his mother. Before his BPD diagnosis he felt jerked around by the Mental Health community, "It got to the point that every time I talked to a doctor they just wanted to prescribe me something else, and I kept saying that this isn't working we need to do something else. But instead of referring me to someone, they just kept telling me that the waiting lists for psychiatrists was too long and it wouldn't' help me."  He was diagnosed in March 2011 with BPD, Generalized Anxiety Disorder, Dysthyia and ADHD Inattentive Type. after 17 years of being diagnosed with depression and on a variety of antidepressants, "I was on meds off and on from 11 - 28  none of them worked."  David found out he had Borderline Personality Disorder after knowing something was amiss for years last March, after waiting almost 2 hours to see a Psychiatrist , "he spent 20 minutes with me, told me I had BPD, referred me to a different Psychiatrist and sent me on my merry way.  So I left there, not knowing up from down, not knowing what BPD actually was, basically thought I was being told that I was not a real person pretty much.  That everything I thought was me was a lie...And to top it all off, I felt disrespected, not listened to, and treated like I didn't actually matter."   

The Hardest Part: Romantic Relationships

As David read about the diagnosis he felt unsettled, "Well the first things I were reading was that it was most often diagnosed in women and gay men.  Which made me feel that the diagnosis was actually wrong, that the treatment of it in the medical field was actually sexist and misogynist in nature (I'd say homophobic, but homophobia also has it's roots in misogyny.)  That we were basically being treated for 'hysteria'  I also came across a lot of blog posts by men stigmatizing women with BPD.  Which was a bit heart breaking to read as well."  David is one of only 3 men, I have meet with the Borderline Personality Diagnosis, "I've also been basically written off in discussion and debates, and told well he's a 'borderline' so not worth engaging with.  It's actually those things that have made me really scared of being in a relationship.  That I would be seen as being 'psychotic' 'crazy' and 'clingy' and I have seen how I've been in relationships and it scares me."  David states he struggles with romantic relationships the most, having BPD, "I find love to be the hardest and most difficult emotion to regulate...It's the intimate relationship thing.  I want nothing more then to find a partner, settle down, create a home and a family for myself.  Get a dog, maybe adopt kids.  It's funny I actually wrote a piece about this not too long ago, about dating with BPD after some pretty crappy experiences this summer.  I have actually been really upfront with guys about what I'm like or I try to be before I had my diagnosis I have said like 'I feel things larger then life, it it's difficult for me to dial it back.' After my diagnosis, I explain what my diagnosis is, and what it meant."  "That I have no interest in dating someone, but if you're perusing me you need to know this, because I can't handle someone who is just going to run the first time I get triggered  and fly off the handle about something.  I get a lot of, 'that's okay', 'I'm still interested' 'I like you for you', or we'll work through it.  But then the first time they're confronted with me being angry and pissed off they totally and utterly just cut me off..tell me I'm melodramatic and they don't have time for that."   

"I pretty much hold that Marilyn quote pretty near and dear to my heart after my experiences: “I'm selfish, impatient and a little insecure. I make mistakes, I am out of control and at times hard to handle. But if you can't handle me at my worst, then you sure as hell don't deserve me at my best.”  Actually it's funny because I usually break it to them with that quote. It's like, do you know what this means? Do you know what this actually means? I think a lot of people use that quote because they think it applies to them, but I think that quote applies to people with BPD so much more.  We can totally be out of control and selfish and impatient, but we can also be so completely and utterly selfless and our ability for empathy and compassion I think is amazing too.  That we have bad things and good things, and our good ones really make it worth it.  If you can give us the time to prove that. 

Support

"I have an awesome support system.  My roommate, which I wish I could love romantically because it would make my life simpler.  He's an amazing man, he has his faults too, but when I freak out he just lets me do it and either walks away or goes out, and then when I done I usually apologize to him for having to see that and he just shrugs and we watch TV or a movie, or play video games.  There's also my mother, who's a big PFLAG mom, she's also trying very hard to learn what BPD is all about and doesn't quite get it yet.  And my best friend, who I am able to talk about pretty much anything and everything with.  She's been there for me through a lot of my life, and is really the strongest part of my support network."

Stigma

David would most like to change people's opinion of the diagnosis, "I wish people would understand the part about how difficult it is for us to deal with just every day.  The ups and downs of our emotions are a roller coaster and a lot of times we can't deal and really just want to get off the ride...That being melodramatic isn't us being vindictive or malicious, but a result of us trying to cope and ride the wave of emotions without having the tools to do it in a way that meets the limitations of acceptable behavior or the 'status-quo' of our pretty backwards society.  That being clingy, is me trying to be connected, and all I need is reassurance that you respect that, that you still care and you do want me.  That once I'm reassured, you can do whatever you want, within limits of course."  Exactly, the funniest thing is that it's that first part of the relationship that's the hardest, because that's when I need the most reassurance once the trust is built, and I know you're not going to leave, is when I know I'm more relaxed, but I can never get to that stage."

Getting Better

David has mostly utilized CBT therapy, although he found DBT group more helpful, "Well did a lot of CBT which I found unhelpful because none of my therapists really seem to understand what I was going through.  And I've had a few.  But still the same methods were applied over and over again, and I got really good at talking around my therapists, to the point where I have finished treatment with multiple therapists with them saying I didn't need anymore treatment...I got so good at telling people what they want to hear, that I just said it because I felt frustrated with them.  Then I have taken a six week DBT crash course and I found that REALLY helpful, and I am now just waiting for the year long treatment."

When asked what David has learned about himself since this journey began for him at age 11, "I have learned a lot.  I have learned not to change myself for other people, because once learning about that as a symptom I started catching myself doing that.  I have found that medications can help if you start taking the right ones.  I have found that I don't always need to be right, and my need and want to be just stemmed from my need and want to be accepted."

My Personal DBT Diary Card

I was thinking today while on Twitter that although I do talk about some personal items (mostly my mischievous dog and cooking skills) and I have shared Why I become a Therapist, I have not shared how DBT has helped me.  I currently do not meet any criteria for any DSMIV-r diagnosis, but learning about and teaching DBT has helped me immensely in my life.  Here is a list of the most (and least) common used skills:

Mindfulness: I use this almost daily, so much so during stressful times at work, sometimes while in group that clients have "caught" me suddenly re-positioning myself to do some grounding/square breathing.  This most often happens when someone shares their autobiography or I am dealing with my own personal issue and need to re-focus on the task at hand.  I also use mindfulness when doing paperwork, the dreaded part of counseling.  After 4 hours of Utilization Reviews, "square breathing" and "observe and describe," helps me focus on the task.

HOW Skills: I use these when I come in every Monday to a stack of sheets to file, a slew of notes from clients stating "I need to talk to you ASAP," as well as an occasional bombardment of someone in my office at 7:30am with an urgent issue, that needs to be solved fast.  The HOW skills allow me to non-judgmentally (instead of yelling, freaking out or catastrophizing,) one-mindfully and effectively assess the situation.  In short it helps me to remain calm and prioritize: pick group sheets off floor, quick organize, turn on computer while I read the client notes to me, prioritize highlighting and placing anything urgent on top of pile in front of computer, check e-mails, respond quickly if necessary or it is something short that I don't want on my to-do list, continue working on paperwork to do first (I create a to-do list on Saturdays for Monday.)

Distress Tolerance- Sensations:  All the time in group or one-on-ones I use this skill in very basic ways, sometimes it's as simple as fiddling with a Styrofoam cup I randomly keep in my office, rolling the toilet paper (we don't have the luxury of tissues in prison) into small balls or noticing the heat from the computer on my left leg.

Improve the Moment: Mints, I keep a larger round container in my office and although they are great for some breath refreshing post-lunch I often use it to Improve the Moment.  Simply popping a spearmint piece in my mouth for a few seconds vastly improves whatever I am doing and it also gives me a reason to get out of the chair and look away from the computer for a bit.

Wise Mind: In the prison, we refer to it as "I over E" (intellect over emotion) and use it as a cognitive skill.  I use this all the time, and encourage my clients to do the same.  For example I am now able to notice my ears getting hot, my heart racing before the feelings of anger or panic.  I am able to think very concrete and remind myself almost instantly "this too shall pass."  A close friend/counselor told me she spoke to her anxiety, and for me that seems a little odd, I do talk to my feelings saying things like "This is anger right now, you feel betrayed, upset, sad and disrespected  and this will stop.  Is it valid? What DBT skill can I do to Improve the Moment? What is my best option for being most effective right now. This too shall pass."

Can you tell what days are more stressful and which days I have off?

I am going to stop here, as I could probably list 20 instances in he last 5 days I used DBT skills.  There are some I struggle on still as well:

PLEASE: I try to sleep 8 hours, but stress and the late night anxiety ("I need to remember to pack a lunch tomorrow? Where are my brown shoes? Can I wait until Saturday to wash the dog? Do we have enough OJ for breakfast?") often keeps me up and I find myself staying up to do fun things only to regret it in the morning.

DEAR MAN: I am good with this one up until the end, negotiate is what trips me up.  I do think part of it is due to the power dynamic working in a prison where my word is the final word most of the time.  I am very assertive, but when it comes to moving an inch, I sometimes personalize and I often get stubborn.

So that's my best/worst list.  What skills do you utilize most often? Which ones are you struggling/still working on?

BPD and Relationships

In group I have my clients work on the Power and Control Wheel numerous times in the 6 month program.  I think it is really important for those with mental illness and addiction issues to be able to identify what is abuse.  The most interesting part is when I ask them to identify ways in which they were the abuser and used the P&CW against someone else.  It's harder to come to grips with, but a few are vocal about using abuse against someone else, most of the examples are holding children as pawns, physical abuse, comments about a man's sexual performance to belittle him and cheating as a way to demean him.  I bring this up because as I have been considering writing about Borderline Personality and Romantic Relationship, but everyone I try- I get distracted and a more optimistic blog idea pops up.

Until I read "A Woman With BPD Explains Her Actions in Romantic Relationships"  by the author of Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. In it she has the very honest and personal account of someone with BDP who explains her past relationships and the abusive tactics she has used:

• Purposely broken a gift you gave me 
• Flirted with several other people at a time or having a crush on others while I'm still dating you
• Said some of the most cutthroat things you've ever heard .
• Talked about suicide even though I know it hurts you
• Pulled a "Dr. Jekyll and Mr. Hyde"
• Pushed you away then pulled you right back
• Started an argument out of nowhere

The author of the article goes into depth about why someone with BPD would act this way, most of it boils down to the fear of abandonment as well as mood swings that can cause quick fluctuations of love and hate. Reminds me of I Hate You--Don't Leave Me: Understanding the Borderline Personality.  And yes according to the Power and Control wheel the above 7 bullet points could be broken down like this:

• Purposely broken a gift you gave me Intimidation & emotional abuse
• Flirted with several other people at a time or having a crush on others while I'm still dating you Intimidation & emotional abuse & using coercion and threats
• Said some of the most cutthroat things you've ever heard emotional abuse & isolation & minimizing, denying and blaming
• Talked about suicide even though I know it hurts you emotional abuse & using intimidation & isolation & using coercion and threats & denying, blaming and minimizing
• Pulled a "Dr. Jekyll and Mr. Hyde" emotional abuse 
• Pushed you away then pulled you right back emotional abuse, denying, blaming & minimizing
• Started an argument out of nowhere emotional abuse, minimizing, denying and blaming

So that's the bad news, those with BPD are often the abusers (not saying they are not as often abused) in romantic relationship.  And it may sound like a broken record, but there are ways to get better and once again this is why boundaries are so important. So what steps can be taken to have healthy relationships?  Here is a great article from BPD Central with the 10 Essential Limits for Romantic Relatonships:

The 10 Essential Limits

Keep in mind that a limit is not about rules or telling the other person what to do. You can't control their behavior; you can only control your own. Limits are based on your personal values and about what you will do to take care of yourself. For more information about limits, what they are and what they're not, and how to set and observe them, see my book The Essential Family Guide to Borderline Personality Disorder.

1. No mindreading. Your job is verbalize your own thoughts, feelings, concerns and preferences. By contrast, assuming you know the other person's thoughts and motivations (e.g., "You think that.." or, "You did this/said this because....") is almost always guaranteed to get you into trouble. Mindreading is one of the biggest obstacles to effective communication; it is invalidating, provocative, and almost always based on misinterpretations.

2. Build routines of taking a time out when things begin to get heated. People who are furious simply can't think straight; their brain is so focused on their feelings that logic gets thrown out the window. This is especially true with BPs and NPs. You can test this yourself. Think about something you said in the moment of anger that you regretted the next day (or week).

Talk about time-outs at a calm before they are needed, letting your partner know how this will work and assuring him or her that you two will come back to finish the discussion when you are both calmer. (Your partner, of course, has the option of initiating a time out too.) Find a safe place that is sacrosanct to you where no one else can enter when you need to be alone.

Early exits when either of you is beginning to feel a temperature rise prevents unsafe, hurtful mistakes--verbal as well as physical. Take the pot off the stove by removing yourself early on from a situation you may not be able to handle calmly.

3. Regularly do things you both enjoy and share positive reactions to your partner. The two of you need positive shared time and interactions to keep the relationship connection solid.

Positivity makes relationships worth having. The more appreciation, agreement, affection, playfulness, attention, etc you offer each other, the sunnier your relationship will be.  And the more you give, the more you'll get.

4. Focus on what you can do to improve situations rather than criticizing each other. And if you do feel it could be helpful to say something to your partner about what she or he has been doing, offer it as feedback, not as a criticism or complaint. People with personality disorders take criticism very badly, so it doesn't work to change their behavior.

Instead, learn ways to bring up your concerns without being critical and triggering the other person's defenses (well, as much as you can for a person with BPD/NPD). To give feedback offer a when-you statement, as in, "When you xyz, I feel abc"). Especially avoid the phrase, "You make me feel."  That's blame.

Remember that it's not your job to tell your partner what he or she should or shouldn't be doing. It is up to you to be honest about how you react as a consequence of your behavior. Your partner's concern for your feelings will tell you a lot about their capacity to show their love.

Just because you stop criticizing them won't stop them from criticizing and blaming you. With your own therapist or one of my books, formulate a strategy for how you will respond. My books go into this in detail.

5. Do not speak with contempt, ever. Studies have shown that couples who communicate contempt for each other are the most likely to break up. This principle is most important with regard to listening. Dismissive or eye-rolling as a form of listening dooms relationships.

6. No hostile touching; no putting hands on each other in anger. No threats or hurting property, either. Have a zero tolerance policy. Men, take any physical aggressiveness by your girlfriend or wife seriously; abuse of men is an underreported epidemic. Document, document, document, and be in communication with the police.

Never put your hands on your partner. Even if it is a mild pat, your partner may exaggerate it and make false abuse claims. You may end up in jail and unable to see your children.

7. Each person needs to have his or her own space, private time, and friendships as well as joint ones. Keep up with your friends and family and never become isolated. Isolation is the kiss of death to your confidence level, well-being, and sense of reality. Find at least one friend or counselor you can be honest with about what's going on. You need outside perspective, even if that threatens your partner.

8. Take responsibility for having and managing your own feelings, verbalizing your concerns and preferences, and being responsive to your partner's concerns and preferences.

9. Come to a mutual agreement about monogamy (or lack of) so you are honest and on the same page. Do not put up with infidelity (however you define it) that goes against your values. With infidelity, your sense of self-esteem will take a huge nosedive and your marriage will eventually be in name only. Again, formulate strategies with a therapist.

10. Work on problem-solving, not blame, and find win-win solutions so "Your-way" and "Their–way" differences lead to an "Our-way" solution that you both feel good about.

BPD and Medication

A counselor friend this week asked me the following question:  If there is no medication for Borderline Personality Disorder why are so many on medications?  Pretty valid question.

No medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective. source

I have meet many people with BPD who have another diagnosis (or 5); Anxiety disorders, depression, PTSD, etc.  So for some people they are receiving medication for a separate disorder, which sometimes has overlapping symptoms.  For those of you who follow me on Twitter you know my issue with being people misdiagnosed with a plethora of other diagnosis, that gets added to each year when BPD is the only one.  Putting that aside I also think some people with BPD (especially those whom are newly diagnosed) are given Benzodiazaphines (I will save my opinion on that for another rant) to cope with the anxiety caused my BPD.

I work full-time in a prison, the female inmates are in a 6-month program, I find that month 1 everyone is knocking on my door about medications, someones their mental illness is valid often it is not (mostly due to drug use.)  Month 2-3 some mental health issues come to surface, as the program is intensive 20-hour a week therapy and people are now dealing with things they have stuffed for so long and they have a decent amount of clean time.  Right now my group is in month 3, what started as 11 on medication (out of 21) is now 5.  I asked the group why it has dwindled down significantly in 90 days.  The answers not surprising; 'we now have cog skills, I started journaling, grounding techniques, coping skills, I take to my bunkie about it.'  Many of these women are using skills over medication.*

So maybe medication is not available to you (Big Pharma will be another rant as well,) or maybe you are on medication and looking to gain more coping skills- here is a list of modes to get well for BPD:

• Dialetcical Behavioral Therapy Self-study material
• EMDR mostly used to handle trauma
• EFT (tapping)
• MBT used more in UK (Thanks to anon comment for the info)
• Social Support. Talk to others who may understand what you are going through. 
• Behavioral Activation. Engage in an activity that might take your mind off the stressful situation for a little while. 
• Relaxation Exercises. Practice a relaxation exercise, such as deep breathing or progressive muscle relaxation.
• Grounding. Practice grounding exercises that are designed to keep you "grounded" in the present moment, rather than caught up in replaying events in your head, worrying about the future or zoning out. 
• Mindfulness Meditation. Practice mindfulness meditation, which helps you to observe and describe your experiences without judging or rejecting them. 
• Active Problem-Solving. Consider the problem at hand: Is there a way to solve the problem directly? (source for 5-10)

*I am not saying medication may not be necessary for some

BPD Community Pinterest

I love Pinterest and I find myself spending more and more time sharing inspirational quotes I find on there.  So, I decided to create a Pinterest Community page.  E-mail, comment here or DM on Twitter with your e-mail address and you can view, share and add your own pins.  

As an FYI I had to set it up as a business account, otherwise it would sync with my personal account (and only so many people can look at Corgi boards!) 

I won't be doing any kind of "screening" before someone posts on there, so if you see anything triggering or inappropriate let me know and I will be quick to delete and if necessary un-invite someone.

BPD Community

November Book Giveaway

Update: After seeing all the lovely comment's about Debbie Corso's work I have decided to give away 10 copies of her book instead of 5

It was a great success last month, with 5 people winning Debbie Corso's last book (1 person even paid it forward giving away another 5 copies!)  On November 30th her new book Stop Sabotaging a 30 Day DBT Challenge to Change Your Life will be available for purchase on Smashwords.

And I am happy to announce I am the introduction writer!

Starting on Friday November 23rd at 11:59pm until Friday November 30th at 11:59pm I will be giving away 10 copies of Debbie's new book as well as 1 copy of Brene Brown's The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are and the 1 copy of Buddha and The Borderline

There are 2 ways to win one of *10* of Debbie Corso's book:

1) Leave a comment here with an e-mail address stating which book your prefer

2) Become a fan of my twitter then tweet: "Just entered to win 1 of 10 copies of Stop Sabotaging by Debbie Corso.  Follow @APazMA and RT to enter #BPD #DBT"

There are 2 ways to win the other 2 books:

1) Leave a comment here with an e-mail address stating which book you prefer. 
2) Become a fan of my twitter then tweet: "Just entered to win 1 of 5 copies of (book title).  Follow @APazMA and RT to enter #BPD #DBT"

Rules: After I receive 200 entries or by 11/30/2012 at 11:59pm EST, whichever comes first I will contact the 7 winners and ask for an e-mail address for those on twitter so I can "gift" the Stop Sabotaging e-book to you.  I will not use your e-mail address for anything else besides sending the book and an e-mail confirming the book was sent if there are any issues.  If I can not get in touch with any winner within a week (and I will try my hardest to do so) I will give the remaining book(s) to another contestant.  The winners of the other 3 books will need to send me their physical address to have the book shipped from Amazon via DM on twitter or e-mail.  The winners will be selected at random from my blog and twitter.  2 entries per person per day allowed (1 on here and 1 on twitter, so 14 total max.) Failure to comply with rules, such as tweeting your entry more than once a day will make you disqualified.  If you have questions tweet me!

Please play fair as I plan on doing this once a month with different books I purchase.  Next month I might give away Linehan's DBT workbook & 3 months of DBT coaching for the holidays....will update!

Dealing with trauma issues with BPD

Although the DSM IV-r criteria for Borderline Personality Disorder does not include trauma, it is often a common thread in those with the disorder.  Often on Twitter I see a tweet started with "TW" (trigger warning) before something that may be triggering, it's a safety boundary for many in the BPD community.  In DBT we strictly enforce the rules about saying things that can be triggers, sometimes those who don't have BPD don't realize how harmful what they say can be, sometimes people try to stir up some drama and some are so disconnected from their trauma they don't understand how someone could be hurt by what they are saying.

Adults with borderline personality disorder (BPD) showed excessive emotional reactions when looking at words with unpleasant meanings compared to healthy people during an emotionally stimulating task, according to NIMH-funded researchers. They also found that people with more severe BPD showed a greater difference in emotional responding compared to people with less severe BPD. The study was published in the August 1, 2007, issue ofBiological Psychiatry. [source]

This week myself and a client came to the conclusion that talking about her trauma only continues to hurt her more than help her.  Creating a boundary became necessary since other clients continue to push her to speak about the horrific trauma thinking that like them she needs to "get it out and give it away." In group she announced this decision and the overall look was puzzled, so we decided to allow questions as this appeared to go against everything they have been taught since being in therapy.  The questions were in 3 categories; 1) doesn't keeping it in, keep us sick? 2) How does talking about it make it worse? 3) So what are you going to talk about then?  The group decided to respect her boundary, although they were skeptical.  I decided to not go into the details of Borderline Personality Disorder since the client had told me she was not comfortable with that.

The end question was then "Ms. Paz, how is she going to work on her trauma issues without talking about it?"  I spoke about working on how the trauma affects you now; relationship issues, boundaries, PTSD symptoms and focusing on coping skills and grounding techniques instead of living in the past.  The group was still unsure about this plan as it goes against what they have (thought) they have known for most their life.  HEre are some ways to work on your trauma without talking about the trauma [source]

1. Tell yourself that you are having a flashback  

2. Remind yourself that the worst is over.  The feelings and sensations you are experiencing are memories of the past.  The actual event has already occurred and you survived. Now it is the time to let out the terror, rage, hurt, and/or panic.  Now is the time to honor your experience.  

3. Get grounded.  This means stamping your feet on the ground to remind yourself that you have feet and can get away now if you need to.  (There may have been times before when you could not get away, now you can.)  Being aware of all five senses can also help you ground yourself.  

4. Breathe.  When we get scared we stop normal breathing.  As a result our body begins to panic from the lack of oxygen.  Lack of oxygen in itself causes a great deal of panic feelings; pounding in the head, tightness, sweating, feeling faint, shakiness, and dizziness.  When we breathe deeply enough, a lot of the panic feeling can decrease.  Breathing deeply means putting your hand on your diaphragm, pushing against your hand, and then exhaling so the diaphragm goes in.  

5. Reorient to the present.  Begin to use your five senses in the present.  Look around and see the colors in the room, the shapes of things, the people near, etc.  Listen to the sounds in the room:  your breathing, traffic, birds, people, cars, etc.  Feel your body and what is touching it: your clothes, your own arms and hands, the chair, or the floor supporting you.  

6. Get in touch with your need for boundaries.  Sometimes when we are having a flashback we lose the sense of where we leave off and the world begins; as if we do not have skin.  Wrap yourself in a blanket, hold a pillow or stuffed animal, go to bed, sit in a closet, any way that you can feel yourself truly protected from the outside.  

7. Get support.  Depending on your situation you may need to be alone or may want someone near you.  In either case it is important that your close ones know about flashbacks so they can help with the process, whether that means letting you be by yourself or being there.  

8. Take the time to recover.  Sometimes flashbacks are very powerful. Give yourself time to make the transition form this powerful experience. Don't expect yourself to jump into adult activities right away.  Take a nap, a warm bath, or some quiet time.  Be kind and gentle with yourself.  Do not beat yourself up for having a flashback.  

9. Honor your experience.  Appreciate yourself for having survived that horrible time.  Respect your body's need to experience a full range of feelings.  

10. Be patient.  It takes time to heal the past.  It takes time to learn appropriate ways of taking care of yourself, of being an adult who has feelings, and developing effective ways of coping in the here and now.

 Stay safe.
AP

Grieving The Death of Your Counselor

This week I received an e-mail from my boss stating my co-worker (of a team of 4) passed this week.  I was at first dumbfounded and was unable to continue the conversation I was at the time having with one of the inmates.  Two hours later we held a "Family Meeting" to announce it to the 95 total clients, and her group of 17 clients.  The moment it was announced the room feel apart; women were sobbing and the staff was still in disbelief and shocked.

I worked as a grief counselor at a hospice about 6 years back in which my primary job duty was to call the next of kin listed and "check in;" how are you eating? sleeping? coping?  It was a difficult job at times and at age 20, I often went to the bathroom to cry between calls.  In my life I have not experienced loss to the extend that many of my client's have, and I have the coping skills to handle some things the clients/inmates do not.  The e-mails began at 4pm on Friday about what to do to provide the client's closure and a place to express their feelings about the grief.  They have had 2 process groups since, and have had been talking about it among each other, each client is in their own place with the grief cycle.  The ideas have been back and forth including having a memorial ceremony, creating a paper quilt/banner to display at graduation and having them 'bury' goodbye letters to her.  I am open to ideas about what we can do in a prison to help these women with the process, as a ex-grief counselor I feel like I "should" know what to do/say to these women and yet with 17 different views, mental illnesses, and past trauma related to loss it is a difficult task to begin unraveling as each person handles grief differently.

If you are dealing with grief here are some ideas of how to work through it [source]

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

• Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need – whether it’s a shoulder to cry on or help with funeral arrangements.
• Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you – such as praying, meditating, or going to church – can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
• Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.
• Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
  
  
  
  

Coping with grief and loss tip 2: Take care of yourself

Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

• Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.
• Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
• Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
• Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms of complicated grief include:

Intense longing and yearning for the deceased Intrusive thoughts or images of your loved one Denial of the death or sense of disbelief Imagining that your loved one is alive

Searching for the person in familiar places Avoiding things that remind you of your loved one Extreme anger or bitterness over the loss Feeling that life is empty or meaningless

The difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness.

Slow speech and body movements Inability to function at work, home, and/or school. Seeing or hearing things that aren’t there.

Can antidepressants help grief?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

When to seek professional help for grief

If you recognize any of the above symptoms of complicated grief or clinical depression, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.

Contact a grief counselor or professional therapist if you:

• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities

Hopelessness and Suicide

At the women's prison I work at they have a new job, essentially life sentenced inmates who have had specialized training are now "observing" other inmates who are in segregation due to suicide (talk of it, paraphernalia or an attempt.)  This is a controversial plan; inmates watching other inmates and when necessary calling for an Officer.  The inmates who have just started this say more than anything it is boring; lots of downtime, odd shift hours- but they get paid for it and these are "mentors," in our program.  I spent part of this week talking to one of these inmates about her shift last night which began at 2am and she told me about the training and what she had learned about suicidal risk factors.  She did not mention the #1 risk factor for suicide, which is hard to assess as an observer- hopelessness.

From this amazing documentary interviewing people who jumped

Hopelessness is the despair you feel when you have abandoned hope of comfort or success.  I often refer to hopelessness of being in a black box and being able to see a way out.  Hopelessness is the #1 indicator of suicide; more than age, gender or even past attempts.  When someone does not see a way out, or things improving they are more likely to hurt themselves.

The Beck Hopelessness Scale is a 20-item self-report inventory developed by Dr. Aaron Beck. It is designed to measure three major aspects of hopelessness: feelings about the future, loss of motivation, and expectations. The test is designed for adults aged 17 – 80.Individuals completing the scale are asked to answer the questionnaire based on their attitudes during the preceding week. It may be administered in written or oral form, and each item is scored with a true/false. Total scores range from 0-20 with higher scores indicating a greater degree of hopelessness. 

Beck’s cognitive model of depression focuses on a “cognitive triad” which includes negative thoughts about self, the world/environment, and the future. Hopelessness is the experience of despair or extreme pessimism about the future. As such, hopelessness is part of the “cognitive triad” of depression, but it also plays an important role in predicting suicide. [source]

Although I typically advise against taking any online quizzes to determine any mental health diagnosis, there is a copy of the "test" here if you are interested to see where you might be at this moment on the scale.  I would advise that if you feel you are at risk for hurting yourself you immediately call your local crisis line or go to the hospital to keep yourself safe.

I always tell client's who are suicidal, that by taking their own life they won't ever know if it gets better; their mood improves naturally, situation at home/relationship change or if new medications will hit the market.  They will never know what their life is going to be like in 2 or 20 years, if they end it right now.

Borderline Personality Disorder and Hallucinations

I often (maybe too often) talk about the misdiagnosis of those with BPD and along with many other diagnosis I find those with BPD have been diagnosed with Schizoaffective Disorder due to the hallucinations.  Part of this I believe is also the disassociation those with Borderline Personality Disorder deal with from past trauma. The term Borderline came from the original belief that those with BPD were  on the border between psychosis and neurosis.  Although this is no longer the belief, some still suffer with the psychosis elements.  

[source] A study of 171 Borderline personality disorder (BPD) patients revealed that 29.2% reported hallucinations. Most patients expressed that the hallucinations were distressing, occurred with great frequency over prolonged periods, took control of actions or behavior (especially, self-harming behavior) and had a critical quality. Although the majority of hallucinations were auditory, visual and olfactory hallucinations were also reported.

Hallucinations: Coping Strategies [source]

When voices are distressing, some patients may self-adjust their prescription medications or use drugs or alcohol to minimize the hallucinations. But there are better ways to deal with this issue.

• Fighting back. This technique involves yelling or talking back to the hallucinations. While resisting the voices may seem like a good idea, studies show that the "fight or flight" response can lead to depression, since the voices typically don't go away on their own.

• Passive acceptance. Although accepting that the voices are part of life for a person with schizophrenia seems to have more positive emotional effects, some argue that the danger of acceptance is that the hallucinations may start to consume your life.

• Mindfulness techniques. In a trial of a therapy called Acceptance and Commitment, participants significantly reduced the effects of their symptoms, and had slightly fewer re-hospitalizations, than a control group using traditional therapy. With this philosophy, the patient agrees to acknowledge the voices but does not agree to accept guidance from them.

For coping with delusions, not all strategies work for every person, and many people report using more than one strategy.

• Distraction. Focusing on a task, reciting numbers, taking a nap, or watching television can help distract the person from delusional, often paranoid, thoughts. A recent study showed that the choice of distraction is important. Researchers found that choosing favorite music or a news program was a more effective distraction tool than white noise. The study also reported that a personal music player with headphones might be the best way to listen to music when trying to ignore delusions. Headphones minimize other distractions, and people who used them tended to stick with this technique even after the study was completed.

• Asking for help. Some people with schizophrenia seek out the company of friends and family when they are experiencing delusions. Friends and family can help by providing a distracting activity, or even just a listening ear.

• Religion and meditative activities. People who are religious believers report using prayer or meditation to help deal with their active schizophrenia symptoms. Yoga, exercise, or walking can also shift the focus from the delusions and provide a sense of calm.

• Be selective. Some voices are positive and some voices are negative. An organization called Hearing Voices takes an interesting approach: The voices may not be physical beings, but they should still treat you with the respect that you expect from other people. This group recommends engaging with the voices, but politely. The patient should ask the voices to make an appointment, or tell the negative voices that they are not welcome until they have useful information.