It's a Shame...

Friends, I am furious.  I try very hard to keep topics mixed up and not to dwell on one for more than one article at a time, but tonight, I need to get this out.  It’s not exactly about pejorative language, but it’s in that same vein: Shaming.  We are watching people being shamed and mocked for their looks, their actions in the past, their race, their gender, and their religion with alarming regularity.  So much so, I fear we are being desensitized to it.  I am trying to follow my own advice, and am not watching news.  It doesn’t matter, because I run IOI solely using social media.  Every time I sit down at the computer, there it is.   So my next step is to do something different with the feelings, so I do what works best for me: I write about it.

I have a real problem with shaming people.  I don’t believe it’s productive in any context.  Shame holds people back and keeps them stuck.  Shame focuses on problems and not solutions.  A person is made to feel shame about something that has already happened, and therefore cannot go back and fix.  It is ultimately a power play.

The person doing the shaming has authority over the person being shamed.  Even if it’s not a direct position, they are invoking an authoritative position and asserting dominance.  It really plays to the lowest common denominator.  Being shamed makes it extremely difficult to fight back.  It puts the person being shamed in the position of having to defend themselves against their own insecurities.  That’s the thing about shame: it’s exploitive.  We know what the skeletons in our own closet are.  We know our weaknesses, our faults, our failings.  By virtue of them being there in the first place, we are already put at a disadvantage.  But then someone flings the closet door wide open, and shines a spotlight on that dark corner.  In a recent article I talked about how important it is to choose your words with care.  Exposing someone to shame intentionally is absolutely cruel.  Let’s look at what’s communicated: First, the words themselves bring to light something the person doing the shaming knows the ashamed person doesn’t want seen.  But I think the second part of what’s getting communicated is even worse.  The underlying message is that the person being shamed has no value.  How inhumane can you get? Shaming involves taking something about someone, something that they feel their absolute worst about, and tells them that they are actually even worse than they had feared.  Why in the world would anyone choose to do this to someone else? To me, it makes the person doing the shaming look worse than they could ever make their intended target look.  

There’s just no reason for it.  I’m not saying we all have to hold hands and sing campfire songs, but there’s a whole lot of increments in between these two extremes.  If there’s really a need to confront someone about past behavior, there are so many ways to do it that aren’t harmful.  If you're really doing it to be helpful, choose helpful words.  

I am deeply concerned.  People I care about (This includes my IOIers) are talking about being harmed by being exposed to shaming tactics which are so prevalent right now.  Past traumas are surfacing that have spent a long time in the dark.  Trauma responses don't just disappear as quickly as they came, and can have lasting, even dangerous, effects. We’ve all got to be careful.  We are all going to have to pick ourselves up and live our lives with one another long after the dust has settled.  But long after the words have been spoken, the effects will remain.  So will the effects of those effects, and so on.  Please, treat human beings with care.  Even the ones you don’t like.  I implore each of you, no matter your politics, religion, race, gender, orientation, ability, or individuality to strive not to harm.  Please.  Help one another to…

Be well.

Transparency

Just a quick thought before I head to bed:

One thing that I strive for in writing IOI is transparency.  It's why I chose to blog through my recent depressing episode.  I tell the truth about my own challenges with physical and mental wellness.  I cannot ask for honesty and vulnerability from anyone in my life, least of all my readers, without extending the same.  So I'm writing a quick bonus entry about this tonight.  Here's something that happened today:

I had a panic attack.  Not feeling nervous.  Not overwhelmed. This was a full-on, head-to-toe, adrenaline pumping, heart pounding, tunnel vision, couldn't breathe, knew I was dying panic attack.  To use one of those clinical terms I am so fond of, it sucked.  As soon as I was able to, I took medication for it to help my body return to its usual state.  But what this meant was that I wasn't able to drive for a few hours afterward.  I was supposed to go to a class tonight where I'm a Teacher's Aide (TA) twice a week (another story).  I went to email the instructor and a couple of my friends who would also be there, and I had a decision to make: What do I tell them?  Something vague like, "can't make it tonight?"  A white lie like a flat tire or a migraine?  Or do I tell the truth, and be prepared to deal with how it might be perceived?  I chose door number three.  I will say the instructor I TA for is really cool, and I had a good idea that it was going to be okay.  She was extremely supportive and kind, as was my friend.  Anxiety is part of my mental health challenge.  It's nothing for me to be ashamed of any more than a broken bone or the flu. 

One of my main goals is to get you, me, our community, and Fluffy the Goldfish talking about mental health and wellness issues.  This isn't going to happen if as soon as there's an issue about mental health, any of us start hiding.  Of course it's always important to be safe.  If disclosing your mental health status is going to put you in harm's way, always make your safety top priority!  Know that IOI is here as a safe community where you don't have to hide.  I want to celebrate accomplishments, share what we learn, and help one another dust off after we fall.  But it means we're all in this together.  I truly hope you learn from what I share here.  I am committed to doing what I can to make IOI really special.  If this means putting myself out there, taking risks, and being vulnerable I'll be first in line for you every time.  

Be well.

What's the Word?

I try very hard not to get political in any particular direction on IOI since I don’t want to alienate anyone.  I am going to do my best to keep from taking a side here and just stick to the issue, but I am sure my personal bias will underly what I write.  I want to talk about language; specifically, pejorative language.  This is language which expresses contempt or disapproval, but there’s more to it than that.  It’s about how the feelings are expressed.  Pejorative language belittles the person.  It’s hostile, disrespectful, and can be abusive.  I am happy that people are paying more attention to language.

I have always had a problem with the word “retarded” used as an insult.  Now it’s not even a clinical term, which is even better.  When I was younger I was told that I was too sensitive for complaining about the word.  But I was called “retard” all through grade school, and it hurt.  I don’t know my IQ, but it’s not low enough to have fit that category even when it was proper to use.  But I was shamed for my reaction instead of the person using the term being reprimanded.   

It’s not just that word either.  People use mental health diagnoses pejoratively in other ways too: “I’m so OCD!”  “That’s retarded.”  “That’s gay.” “Are you bipolar? You’re all over the place!”  “He’s so Schizophrenic!” “What a psychopath!” You get the idea.  We use diagnostic terms and other characteristics of people as insults.  We are making human beings the butt of jokes and insults.  

Mental illness is invisible.  While you may be able to see evidence of symptoms, you can’t see the illness itself.  If you walked past me on the street you would certainly see my walker, but not my Depression.  I know it’s cliche to say that people with mental illness are everywhere, but it’s true.  So at the beginning of a semester if I’m hanging out with a new group of classmates and one of them starts using these terms, they are communicating so much more with their words than just the ones they speak.  They are telling everyone present with a mental health diagnosis that they aren’t safe.  I don’t believe for a moment that this is their intention.  If you asked that person, they’d probably say that they’re extremely loving and compassionate, and would never set out to hurt someone. 

So now let’s get back to the issue of the present political climate.  Now that group of friends I want to hang out with is my church congregation, my coworkers, or my recovery fellowship.  These are all places that have meaning to the members, and it’s important to be part of the group.  In fact, there may be negative consequences to being ostracized.  So someone says something about a particular candidate.  It may not even be that bad.  But then the next person piggybacks on it, and what they have to say is more of a direct insult.  The third person uses an actual pejorative term.  I am going to be expected to join in.  I may feel that what they’re saying is wrong, but I am between a rock and a hard place.  Even if I agree that the candidate is awful, I can’t comment on the language they’re using in a way that feels safe and comfortable.  If I disagree with them, then I’m really in hot water.  It worries me greatly to see people in positions of power use pejorative language.  I believe, even if it’s on an unconscious level, it gives implicit permission to others to do the same.  

I wish I had a nickel for every time I’ve heard, “This is America, I have free speech.  I can say what I want,” or some variation on that.  First, that’s not what the First Amendment actually says.  Here’s the text: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.”  See? It’s not that I can say what I want, when I want, where I want.  It’s that the government can’t put me in jail for saying I disagree with them.  To put it another way, I can’t yell “Fire!” in a crowded theater without there being consequences…unless there really is a fire, but that’s covered in the PTSD blog entry!  I can’t issue a threat to an elected official without people in suits showing up at my door.

You are certainly able to say anything that comes to mind.  It doesn’t mean you won’t be accountable for what you say.  I want to make one more really important point before I sign off: Words mean things.  They can hurt someone.  Something else I was told when I was teased as a child is that “sticks and stones can break my bones, but words can never hurt me!”  Not true.  Words can and do hurt people.  I have written before about how mean my Depression is to me.  If someone were to come at me in a mean way when I am in the midst of a depressive episode, it really could put me in danger.  

Please choose your words carefully.  Everything out of your mouth doesn’t have to be sunshine and roses, but think about what you’re saying and how you’re saying it.  There are very few things in life that are more important that our relationships with other people.  Disagree, but do so in a way that’s not going to cause harm.  State facts, and then describe how YOU feel.  After the election, a lot of people are going to be very happy, and a lot of people are not.  But no matter what, we still have to go on with our day to day life together.  So let’s not make messes we’re going to be cleaning up long after November 8th.  So now I have two words for you:

Be well.



U.S. Const. amend. I.

Antisocial Personality Disorder: From Surgeons to Serial Killers

Now that we’ve discussed Narcissistic Personality Disorder and Borderline Personality Disorder, we’re ready to see what’s behind Personality Disorder Door Number Three…It’s Antisocial Personality Disorder (ASPD)!

While people with ASPD have the propensity for extreme violence, and some of the most violent people in our society have or have had it, I am not going to spend a lot of time on the crimes they have committed.  This article does contain one mention of a violent act, but not a detailed description.

This is a really interesting one.  The word “antisocial” leads a lot of people to misunderstand what the disorder really is.  It’s not about not socializing.  Some people with ASPD are some of the most charming, smooth, sociable characters you’ll ever meet.  Think of the “social” part of the word as “society.”  Anti-society.  These folks are not playing by the same rules as the rest of us.  

A person with ASPD has no regard for right and wrong.  They will ignore the rights and feelings of other people.  They may be harsh, callous, and indifferent toward someone.  They will do so without guilt or remorse.  

Here’s an example from when I was working inpatient forensic mental health: 

In order to restrain someone or force medication, the patient had to be currently violent and threatening.  Keep that in mind.  On this particular day, a patient with BPSD walked into another patient’s room who owed him money.  He beat the man so badly, the victim’s jaw was broken.  Afterward, the assailant walked back to his own room, and laid calmly on his bed until staff came running.  Our hands were tied.  He had just violently assaulted someone, but no longer posed a threat.  He was talking to us as calmly as if he were asking about the weather.  We were able to place him in secluded observation for 30 minutes.  But the whole time he was in the locked room, he sat on the bed and was completely quiet.  I don’t think he was even breathing hard.  When the 30 minutes were up, we had no choice but to release him back onto the ward.  

Creeped out?  So was I.  

So let’s talk about the diagnostic criteria.  The DSM 5 states that a person with ASPD will have:

 A.  A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1 Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.

2 deceitfulness, as indicated by repeated  lying, use of aliases, or conning others for personal profit or pleasure.

3 Impulsivity or failure to plan ahead. 

4 Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

5 Reckless disregard for safety of self and others.

6 Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

7 Lack of remorse, as indicated by being in different to or rationalizing having hurt, mistreated, or stolen from another.

B.  The individual is at least age 18 years.

C. There is evidence of conduct disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

(American Psychiatric Association, 2013).”

I am not going to get into Conduct Disorder in this article.  It’s a whole other topic which deserves its own article, and I figure ASPD is a lot to digest on its own.  What I would like you to take from this is that it’s a lifelong pattern.  Other personality disorders don’t really start showing until early adulthood, late teens at the earliest.  ASPD, on the other hand, starts showing up earlier.  

What I find really interesting about ASPD is that it can also make a person highly effective in certain situations.  I like to think of it as using their powers for good instead of evil.  Think of careers where a person would need to make decisions without letting emotions interfere in judgement:  I am absolutely serious when I tell you that people with ASPD make great attorneys.  A surgeon, to give another example, has to make split-second decisions based on what’s right in front of them, as opposed to feelings they may have about what may happen.  It’s also not hard to find examples of this disorder whenever you look at people in management level positions.  I’m not trying to be insulting.  It’s just that the characteristics of ASPD make for someone who makes shrewd business decisions without letting feelings get in the way.  A person has to have at least some of the traits in order to succeed in politics.  

This is the last article in the series on Personality Disorders.  I am looking forward to your thoughts, questions, and comments.  I wanted to end with this one because it tends to be interesting information that not many people know.  Antisocial Personality Disorder is something we see around us at a greater frequency than we really think about.  This article isn’t so much about techniques for dealing with someone with ASPD, but is intended to be more informative.  Just know that as with any personality disorder, you’re not going to change the person.  This is who they are.  But also remember that you are not the cause either.  

Be well.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/home/ovc-20198975

Voting in the United States

Friends, it is my personal opinion that voting is one of the most important things we can do.  It is a right afforded to each of us who are United States citizens.  The method to register varies by state.  If you'd like to add information for your particular state in the comments section, it is certainly welcomed.

Even if you choose not to vote for a presidential candidate, there are usually state and local elections and issues also on the ballot.

Here's a website that will connect you with voter registration for your particular state: https://vote.usa.gov/

Here are the voter registration deadlines for the November General Election for each state.  I used the soonest date for each state if postmarked/received/in-person dates were different.  Please double check your state's requirements and, if need be, let me know of any errors!

Alabama	Monday, October 24, 2016	Montana	Tuesday, October 11, 2016
Alaska	Sunday, October 9, 2016	Nebraska	Friday, October 21, 2016
Arizona	Monday, October 10, 2016	Nevada	Tuesday, October 18, 2016
Arkansas	Sunday, October 9, 2016	New Hampshire	Saturday, October 8, 2016
California	Monday, October 24, 2016	New Jersey	Tuesday, October 18, 2016
Colorado	Monday, October 31, 2016	New Mexico	Tuesday, October 11, 2016
Connecticut	Tuesday, November 1, 2016	New York	Friday, October 14, 2016
Deleware	Saturday, October 15, 2016	North Carolina	Friday, October 14, 2016
Florida	Tuesday, October 11, 2016	North Dakota	Not Required
Georgia	Tuesday, October 11, 2016	Ohio	Tuesday, October 11, 2016
Hawaii	Monday, October 10, 2016	Oklahoma	Friday, October 14, 2016
Idaho	Friday, October 14, 2016	Oregon	Tuesday, October 18, 2016
Illinois	Tuesday, October 11, 2016	Pennsylvania	Tuesday, October 11, 2016
Indiana	Tuesday, October 11, 2016	Rhode Island	Sunday, October 9, 2016
Iowa	Monday, October 24, 2016	South Carolina	Saturday, October 8, 2016
Kansas	Tuesday, October 18, 2016	South Dakota	Monday, October 24, 2016
Kentucky	Tuesday, October 11, 2016	Tennessee	Tuesday, October 11, 2016
Louisiana	Tuesday, October 11, 2016	Texas	Tuesday, October 11, 2016
Maine	Tuesday, October 18, 2016	Utah	Sunday, October 9, 2016
Maryland	Tuesday, October 18, 2016	Vermont	Wednesday, November 2, 2016
Massachusetts	Wednesday, October 19, 2016	Virginia	Monday, October 17, 2016
Michigan	Tuesday, October 11, 2016	Washington	Monday, October 10, 2016
Minnesota	Tuesday, October 18, 2016	Washington D.C.	Tuesday, October 11, 2016
Mississippi	Saturday, October 8, 2016	West Virginia	Tuesday, October 18, 2016
Missouri	Wednesday, October 12, 2016	Wisconsin	Wednesday, October 19, 2016
		Wyoming	Monday, October 24, 2016

Borderline Personality Disorder Part 2: Help Me, Help You

Now you are well versed in the symptoms of Borderline Personality Disorder (BPD) and one of the theories of its origin in a person.  So now let’s discuss treatment, and how people can support a loved one, while at the same time, keeping safe.  

There are a number of treatment modalities being used with BPD.  I’m not going to try to put together an exhaustive list.  These will be the most common ones, and ones with which I am the most familiar.  I am not comfortable writing about treatment methods with which I have no experience.  I don’t think it’s fair to my readers.  As with anything on IOI, I encourage you to use this as a starting point.  Do your own research too.  Ask questions.  Think critically about what you find out, and know that IOI is here.  I can learn from you too!

Cognitive Behavioral Therapy (CBT) - While CBT is not directly targeted at Borderline Personality Disorder, the next type of treatment is a derivative of CBT, so I want you to have a frame of reference.  Cognitive Behavioral Therapy basically does what it says on the box: it teaches the person to change how they think, which then changes how they behave.  The effect is then a change in how the person feels; lather, rinse, repeat. 

Dialectical Behavioral Therapy (DBT) - This is a therapeutic method created in the late 1980s by psychologist Dr. Marsha Linehan.  What I like about it is that it takes a person’s strengths and builds on them.  This is something I was taught to do early on in my professional training.  It has components of CBT which help a person to shift from the all or nothing, black and white thinking that is characteristic of Borderline Personality disorder.  DBT teaches people to deal with the surges of emotion they feel. It is a multi-faceted treatment approach which uses individual therapy, group therapy, consultation for the therapist, and phone coaching.  DBT consists of four modules, each of which teach different skills.  These are mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.  The goal of DBT is for a person to learn to manage emotions by recognizing, accepting, and experiencing them.  

Medication - While medication will not cure Borderline Personality Disorder, it can help with conditions which often accompany it.  These include Depression, and Post-Traumatic Stress Disorder (PTSD). Treating symptoms of these may make it easier for the person to get more out of other types of treatment such as DBT.  Medication will not take these disorders away.  But if the person is not feeling distressed by the symptoms, they will be better able to focus on skills learned in DBT, and therefore, be better equipped to use them. 

Hospitalization - Hospitalization is sometimes necessary for a person with Borderline Personality Disorder.  It is common for a person with BPD to also have Depression. The person may require inpatient treatment for suicidality.  

So now let’s talk about when someone close to you has Borderline Personality Disorder.  First and foremost: YOU ARE NOT OBLIGATED TO CARE FOR SOMEONE AT THE EXPENSE OF YOUR OWN WELLBEING.  You MUST take care of yourself first.  If your relationship with someone, not just someone with BPD is causing you distress, you need to attend to that.  It is really important to know that you are not the cause of what’s happening.  Like we’ve talked about before, if you feel you have some responsibility, own up to it.  But you are not obligated to take on more than your share to appease someone else.  

You can honor someone’s feelings without taking their side.  Even if I disagree with someone one hundred percent, I can still acknowledge their experience and their pain.  Remember Maslow?  Right above our physical needs sits our need for love and belonging.  Now imagine still having that need without ever really being able to trust that you are loved?  We can start helping someone just by letting them know they are being heard.  If you’re not sure, ask!  “I want to make sure I’m hearing you right.  It sounds like you’re really sad about how your boss talked to you yesterday.”  You’re not taking the person’s side, you’re not taking the boss’s side.  If they agree, you can say that you understand how they could feel that way.  It can be really tempting to take sides to make the person feel better in the moment, but this is tricky.  This opens you up to be the bad guy when the boss apologizes tomorrow.  

Try not to directly argue.  The all-or-nothing thinking is hard.  It’s hard to see someone we love feel worthless.  When something bad happens in the person’s life, they may make absolute statements like, “everybody hates me!” I know my first reaction would be to say, “I don’t hate you!  I love you!” This can actually make things worse.  The person may feel the need to defend their awfulness to you, which reinforces it in their own mind.  Instead try, “I understand how you could feel that way, given what happened.  I’m so sorry you’re hurting like this.” 

Something else that can happen is that someone may give the person with BPD attention while they are in crisis, and then drop off when everything is okay.  This is understandable.  It also reinforces to the person with BPD that they need to be in crisis to get attention.  It can feel like you need a break when things are going well for them.  Understandable!  But if it feels healthy and safe for you, grab coffee together.  Give a phone call or a text.  Whatever feels right for your relationship and your well-being.

You may need to access your own mental health support, especially if the person is immediate family.  In fact, if this is the case, I really suggest you do.  You are going to need your own support system.  This is a hard thing to watch someone else go through, and a person with BPD is likely to be a hardcore practitioner of “misery loves company!”  Remember, always put your own oxygen mask on first.

This is by no means an exhaustive description of methods of treatment for Borderline Personality Disorder, nor for how to relate to someone who has it.  There are great resources online, as well as books and community groups.  You’re always welcome to ask questions here on IOI as well.  No matter your interest in this topic, thank you for being here.

Be well.

http://www.borderlinepersonalitydisorder.com/what-is-bpd/treating-bpd/

http://www.dbtselfhelp.com/html/dbt_skills_list.html

http://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/

http://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/

Borderline Personality Disorder Part 1: What Good are Buttons if no one's Pushing?

Friends, this is the second entry in a series about personality disorders.  I want to give it the attention it needs in order to really cover the topic.  I am splitting this into two entries.  This one will talk about the symptoms of Borderline Personality Disorder (BPD).  My next entry will discuss treatment, and advice for loved ones.

There are several theories about the origins of BPD.  I am going to share one with you, but I need to make something clear: It is extremely important not to assign blame for a diagnosis.  It's a really easy trap to fall into, but it's also not productive.  My purpose for sharing this theory is to help my readers understand where some of the symptoms of BPD may come from, and how a person with the disorder may feel.  So, having said that, I want to share with you one that makes sense to me:  Remember when we were discussing Erik Erikson, and his developmental stages?  The very first one, from birth to about 9 months, is Trust versus Mistrust.  When we are in this stage, we are completely dependent on our caregiver.  However, the only method we have to communicate is to cry.  We typically only cry when we are experiencing some kind of distress: hungry, wet, tired, hurt, you get the idea.  What usually happens once we start crying is that somebody comes and figures out what we need, and meets that need. What we learn from this is that we are safe, and when we express a need, it's going to be met.  Even when we face challenges and difficult feelings, we develop a sense of security that things are basically going to be okay.  It therefore makes sense that the virtue we develop is hope.

So what happens when we cry and nobody comes? The world is apparently not safe. We can't rely on anyone to meet our needs.  People are not trustworthy.  But not being able to trust anyone doesn't make the need go away.  We still want to be picked up and cuddled and fed.  If the baby doesn't develop trust at this stage, what they are left with is fear.  When we start at the diagnostic criteria, try to think about how fear drives the emotions and reactions of a person with BPD.  Let's also remember that a person has to successfully resolve one stage in order to move on to the next.  If someone gets stuck at the very first one, life is going to be very challenging.  While they may develop coping strategies for various situations, the underlying personality is still there.  They're not set up to develop autonomy, which makes it difficult to maintain a separate identity in relationships.  Initiative, competency, identity, and intimacy are the values we should be learning as we go through childhood, adolescence, and young adulthood.

So keeping this in mind, let’s take a look at the symptoms:

According to the DSM 5, the diagnostic criteria for Borderline Personality Disorder states that a person must have “A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. “Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)”  A person with BPD is constantly in fear of losing significant relationships.  They may feel extremely vulnerable in these relationships, since trust is never fully developed.  We’ll discuss more about the intensity of a person with BPD’s feelings when we get to criterion 6.

2. “A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.”  One of the leading books written about BPD is called, “I Hate You, Don’t Leave Me.”  This characterizes relationships in a person with this disorder’s life extremely well.  Relationships are all good, or all bad.  A person with this disorder will feel the need to have proof of the other person’s commitment to them.  They will obtain it by pushing someone away, which reinforces their internal lack of self worth.  Soon after, however, they will need the other person to prove that they would never really leave for good. The person will then idealize the one they recently pushed away in order to win them back and keep them close.  

3. “Identity disturbance: markedly and persistently unstable self image or sense of self.”  A person with BPD may love themselves one day, and hate themselves the next.  Facts aren’t important in making judgements; emotions are.  The black and white thinking about relationships with others also applies to the person’s feelings about themselves.  When you add to this the fact that the person’s feelings are all or nothing, it becomes a really difficult way to live in their own skin 24/7.

4. “Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.”  Let’s define impulsivity as acting or speaking based on feelings, without applying logic and reason.  It’s easy to see how not thinking through a decision based solely on emotion could be problematic.  Again, a person with BPD experiences strong emotions.  When we look at a person with strong emotions combined with impulsivity, it becomes easier to see how they would be prone to these behaviors.    

5. “Recurrent suicidal behavior, gestures, or threats, or self-mutilating

behavior.”  Borderline Personality Disorder is a very difficult disorder to have and to manage.  Feelings are intense.  Relationships are both wonderful and horrible, even relationships the person desires and values.  There are incidences of self-harm which are not meant to be suicidal.  However, it is not unheard of for an incident that was only meant to be one of self-harm to be fatal.  Someone with BPD may engage in self-harm because they want to feel physical pain to distract themselves from emotional pain.  Another person, also having BPD, may do it because they feel numb, and want to feel “something.” It may be to feel a sense of control over one’s body.  It can also be a form of self-punishment.  

6. “Affective instability due to a marked reactivity of mood (e.g.,

intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).”  Something to understand is that many people with BPD describe their experience of their emotions as quite strong.  It may seem like the person is blowing things out of proportion.  But remember, everyone’s experience of any given situation is going to differ.  Think of people without BPD as having emotions on a dimmer switch.  Someone with this disorder is wired differently, with only an on/off switch. 

7. “Chronic feelings of emptiness.”  These empty feelings contribute to the intensity of relationships a person with BPD has with other people.  They are unable to meet their own emotional needs, and rely on others fulfill them.  The person may feel worthless outside of their relationships with others.  These feelings of emptiness are intense, just like the person’s other feelings.  Therefore they contribute to the other criteria like relationships, risk taking, and self-harming behaviors.

8. “Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).”  Anger is like any other emotion the person experiences: intense!  It’s important to remember that there is no gray area in a person with BPD’s thinking.  Statements using “always” and “never” are common in arguments.  This is how the person experiences the world: always in absolutes.  The person may also bait others into arguing with them.  This is a way the person combats the chronic feelings of emptiness.  Arguments with a person with BPD often result in a no-win situation, and can be very hurtful.  Remember criterion 2 when the person with BPD was pushing you away to see if you’d still come back?  Lashing out in anger is a prime example of how they may accomplish this. 

9. “Transient, stress-related paranoid ideation or severe dissociative symptoms.”  This is another symptom that comes from making decisions and judgments based only on emotion without considering facts.  What it may look like is that the person with BPD will remember an event that never happened, or not be able to remember another event that did happen.  Most people are able to alter their thinking to take in new information.  A person with BPD alters the information to fit with their thoughts.  In this way, they are able to alter events in their mind, contradict their own story, and ignore facts, even when confronted with them.  This type of thinking is also how the complete idealization and devaluation takes place.  The person will change the information they have to fit how they feel about someone or something. 

(American Psychiatric Association, 2013)

People with personality disorders rarely seek treatment.  This is because they view the world and the people around them as needing to change, but not themselves.  There are, however, treatment models which are effective in helping someone with BPD manage.  I’m going to split this entry up into two, and write about treatment, and also how friends and family of someone with Borderline Personality Disorder can engage with the person, and keep themselves safe.

Be well.

Narcissistic Personality Disorder: Mirror, Mirror on the Wall...

 have been meaning for a while to start writing about personality disorders, but I felt I needed to get some background information written first.  Now that you, my fine followers, my righteous readers, my savvy subscribers, are so well-versed in several developmental theories, we are ready!

The three I’m going to write about on IOI are Narcissistic Personality Disorder, Borderline Personality Disorder, and Antisocial Personality Disorder.  Please remember that I write this blog to give my readers more information.  If there’s a personality disorder you would like me to write about, PLEASE let me know either in the comments, or you are always welcome to email me at insightoutsidein@gmail.com, or on the Facebook page: www.facebook.com/insightoutsidein.

Personality disorders are a class of mental disorders which are characterized by long-lasting, inflexible patterns of thought and behavior.  It’s important to remember that many people will display one or more of these traits.  It has to be a certain number to even begin to qualify as being that particular disorder.  Also, to qualify as a personality disorder, the traits must cause significant impairment or distress in personal, social, and/or occupational settings.  Personality disorders also do not usually manifest until a person is in their 20s, or even 30s.  A person with a personality disorder will rarely seek treatment.  Personality disorders are extremely difficult to treat because they are so ingrained in who the person is.   Someone with a personality disorder usually does not see themselves as “disordered,” and will see other people as the problem.  I had a wonderful professor in graduate school who used to say that as clinicians, most disorders, we will know from the neck up.  Personality disorders, we will feel from the neck down.  What he meant was that another disorder like Schizophrenia for example, a clinician will use their knowledge to diagnose the patient.  They will either have delusions, or they won’t.  They will either hallucinate, or they won’t.  Patients with personality disorders present very differently.  The clinician will potentially be emotionally affected by the patient.  The clinician may doubt himself or herself, or feel personally attacked by the patient.  A psychotic patient may cause a clinician to feel mentally tired, but a patient with a personality disorder will cause the clinician to feel emotionally tired!

So let’s jump right in and start with Narcissistic Personality Disorder (NPD).

First, the DSM 5 criteria:

Five or more of the following:

“1.  Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

2.  Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3.  Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

4.  Requires excessive admiration.

5.  Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).

6.  Is interpersonally exploitive (i.e., takes advantage of others to achieve his or her own ends).

7.  Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8.  Is often envious of others or believes that others are envious of him or her. 

9.  Shows arrogant, haughty behaviors or attitudes.” (American Psychiatric Association, 2013)

I have heard NPD being discussed frequently in the past year or so.  I’m sure this has some to do with the fact that I hang out on psychology forums, blogs, and websites.  Yes, I am a nerd.  Proud of it!  But I digress.  It's also being discussed more in mainstream media and wider social circles.  One of my primary goals for IOI is for my readers to have accurate information about different diagnoses.  This may be useful for you in your personal life, but also in your life as a member of society.  

I am, of course, not in a position to diagnose anyone from a distance, so I am not going to attempt to assign the criteria to any particular person.  But as different topics about mental health are discussed in the media, I use this forum to address them. 

So there you have it.  I want to hear from you!  What questions do you have about personality disorders?  Do you have experience with anyone with this diagnosis, or anyone you believe has it?

Be well

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

http://psychcentral.com/personality/

Checking in for Friday, September 16, 2016...Getting Good!

I can honestly say I feel good today.  I am pleasantly surprised.  In the past, depressive episodes tend to last about two weeks.  Tomorrow will be a week since the first symptoms started.

I am not completely back to my baseline.  Baseline means how a person was doing before the symptoms started.  I still don't have all my energy back, and I still have trouble staying asleep all night.  But the important thing is that my mood is improving.  I am no longer having negative thoughts about myself.  I am usually an optimistic person, and enjoy making people laugh.  When I am depressed, neither of these apply.  Someone told me once, "I can always tell when you're depressed.  You don't make jokes."  True.  

Depression is not just feeling sad.  It feels like a void.  It feels like there's a black hole inside me that sucks in all the joy, all the personality, all the drive, everything that makes me who I am.  All that's left is lethargy.  I don't feel like a whole person.

This is what makes it so important to get help as soon as possible when the symptoms start.  Depression doesn't suck everything away all at once, but it happens fairly quickly.  But if I can activate my care plan, it can't get it all.  I can still hold onto enough that I can work back into feeling better.  The meds are a huge part of this.  I know that I will need medication for my Depression for the rest of my life, and that's just fine with me.  If it means keeping from being consumed by the black hole, sign me up!

I had originally thought I would delete some, if not all, of the updates once the Depression was under control, but I am not going to.  My hope is that this can help someone else who goes through a depressive cycle.  One thing about Depression is how isolating it can be.  I could barely drag myself to the computer, and getting out and socializing felt impossible.  So if you can relate to how I have been feeling this past week, there is help.  It's going to get better.  I know it doesn't feel like it, but you're going to have to trust me.  I have complete faith in your ability to get through this.  

Be well 

Checking in for Thursday, September 15, 2016

Well friends, today was better!  I got up and out, and had lunch with someone.  It really helps to have to get up, clean up, and get dressed.  One of my meds starts working right away, so I can already tell the difference with the increased dose.  I go up another step today.  

I am finding that my mental state is improving, but I am still physically tired.  I am still having trouble falling asleep at night, and then staying asleep all night.  I am communicating with my psychiatrist about this though, instead of just trying to power through it.  If I tried to manage it on my own, I might ignore or rationalize warning signs, and end up in more trouble than when this depressive episode started.  Symptoms are how we know something's not right.  They're how our bodies and minds let us know something is wrong, and needs attention.  Ignoring mental health symptoms has never made mine go away.  It has only ever made them worse.  

I have a new book, and am actually looking forward to getting outside and reading more later.  It's about psychopathy, so you have THAT to look forward to reading about, my friends!  

Making the decision to blog every day during this depressive episode was a really good decision for me.  It's making me think about my symptoms instead of just feeling them.  This helps me keep from letting them take over.  It's also a goal for myself that I know I am able to meet.  Meeting a goal, even a small one like writing a blog post, makes me feel better about myself.  This proves all the horrible things my Depression is trying to tell me wrong.  It's losing its power more and more every time I do something for myself.  In other words, I am driving the bus once again.  Who's driving in your world these days? 

Be well.