Category Archives: Bpd Articles

Retraumatization Caused By Psychiatric Care Institutions

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Retraumatization :

If the trauma we experienced as children was severe enough, we may, as adults, at one time or another, require residential psychiatric care (such as inpatient treatment on a psychiatric ward in a hospital, as was necessary in my own case on several occasions).

Obviously, the quality of the care we receive in psychiatric facilities can vary very considerably ; unfortunately, this means that, if we are unlucky, we may find ourselves in an environment that not only fails to be therapeutic, but is actively retraumatizing.

In What Ways Can A Psychiatric Facility Retraumatize Us?

According to Fallot and Harris (2001), the ways in which we can be retraumatized in psychiatric institutions can be divided into two main categories ; these are :

1) BY THE SYSTEM (policies, culture, procedures, rules etc). For example :

2) BY THE RELATIONSHIPS WE HAVE WITH THOSE ENTRUSTED WITH OUR CARE (e.g nurses, psychiatrists etc)

Let’s look at each of these in turn :

1)  RETRAUMATIZATION BY THE SYSTEM. Examples of how this may occur include :

– lack of choice regarding treatment ; for example, being prescribed medication when a form of psychotherapy may be more appropriate and more effective.

– not being given the opportunity to give feedback to the professionals caring for us about how we feel in relation to the treatment we are receiving

– being treated impersonally and not as an individual but, instead, according to how one has been ‘labelled’ by one’s diagnosis (two individuals with the same diagnosis may manifest very different symptom and have very different needs. In the case of those who have been diagnosed with borderline personality disorder, such individuals may experience the additional trauma as being regarded as ‘a trouble maker’ due to misinterpretation of the true causes of their behavior.

– constantly having to retell personal details relating to one’s psychological condition.

2)  RETRAUMATIZATION BY THOSE ENTRUSTED WITH OUR CARE.  Examples of how this may occur include :

– betrayal of trust

– feeling one is not being listened to and/or is being rushed when explaining one’s condition

– feeling one’s views are being dismissed /not taken seriously / invalidated

– being spoken to disrespectfully, insultingly or inappropriately

– being subjected to punitive ‘treatment’ methods (e.g. locked in isolation room without toilet or proper bedding)

– lack of communication / collaboration between patient and staff

My Own Experiences :

SECTIONING :  When my illness was at its worst, I was sectioned (despite my ardent protests) because it was felt I was a high suicide risk (which, in truty, I was) ; however, being sectioned accentuated feelings of powerlessness, humiliation and loss of autonomy

AGGRESSIVE/THREATENING PATIENTS : Unfortunately, some patients one is exposed to in psychiatric wards can be aggressive and intimidating, leading to feelings of being unsafe and constantly under threat

UNPROFESSIONAL STAFF : Sadly, occasionally one comes across staff who are not above behaving unprofessionally ; this can exacerbate feelings of mistrust

ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) : Because I was so ill – utterly unable to function and, indeed, almost catatonic at times, as well as a very high suicide risk, I was ‘strongly encouraged’ to undergo ECT treatment ‘voluntarily’ on several occasions ; in fact, though, there was no genuine choice as I was told that, if I did not undergo it ‘voluntarily,’ I would be sectioned and the act of sectioning me would, in turn, give the hospital the legal right to administer the treatment even without my consent. Due to the controversial nature of ECT treatment, this was an intimidating, degrading and, quite arguably, dehumanizing position in which to be placed. (To read my article about my experience of ECT, click here.)

COMPULSION TO ABSCOND :  Indeed, I often found the conditions to which I was confined so intolerable that, on three occasions, I absconded (each time with the intention of committing suicide – to read about one such incident, see my article On Being Suicidal (Or, Why I Carried A Rope In A Bag Around London For Three Months ).

Obviously, vulnerable patients who find themselves compelled to abscond, as I did, potentially expose themselves to a high level of risk in a multitude of ways.

The Trauma-Informed Environment :

Tailor and Harris (2001) state, based on the main ways in which retraumatization may occur, therapeutic environments that cater for the traumatized (e.g. those suffering from PTSD or complex-PTSD) should be trauma-informed. Trauma-informed environments should :

1) Be calm and comfortable

2) Provide the patient with choice

3) Empower the patient

4) Recognize the strengths and abilities of the patient

5) Involve the patient, as far as possible, in all decision-making processes.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Trauma Triggers : Definition And Examples

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BPD And Hallucinations

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What Are Hallucinations?

Hallucinations are PERCEPTIONS that people experience but which are NOT caused by external stimuli/ input. However, to the person experiencing hallucinations, these perceptions feel AS IF THEY ARE REAL and that they are being generated by stimuli/ input outside of themselves (in fact, of course, the perceptions are being INTERNALLY GENERATED by the brain of the person who is experiencing the hallucination).

Different Types Of Hallucination :

There are several different types of hallucination and I summarize these below :

  • VISUAL HALLUCINATIONS – these involve ‘seeing’ something that in reality does not exist or ‘seeing’ something that does exist in a DISTORTED / ALTERED form.
  • AUDITORY HALLUCINATIONS – these, most often, involve ‘hearing’ voices that have no external reality (though other ‘sounds’ may be hallucinated, too).
  • TACTILE HALLUCINATIONS – these occur when an individual feels as if s/he is being touched when, in fact, s/he isn’t (for example, feeling the sensation of insects crawling over one’s skin).
  • GUSTATORY HALLUCINATIONS – these occur when a person perceives a ‘taste’ in his/her mouth in the absence of any external to the person causing the taste.
  • OLFACTORY HALLUCINATION – this type of hallucination is sometimes also referred to as phantosmia and involves perceiving a smell which isn’t actually present.

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BPD And Hallucinations :

Mild hallucinations are actually not uncommon even amongst people with no mental illness (e.g. believing one has heard the doorbell ring when it hasn’t).

At the other end of the scale, however, are fully-blown hallucinations that involve the person who is experiencing them being psychotically detached from reality; for example, someone experiencing a psychotic episode might hear, very clearly and distinctly, voices that s/he fully believes are coming from an external source (such as ‘the devil’ or a dead relative). A person suffering from such hallucinations cannot in any way be convinced that the ‘voices’ are being generated within his/her own head/brain.

It is uncommon for people suffering from borderline personality disorder (BPD) to suffer from the most serious types of hallucinations (as described above); however, under acute stress (and those with BPD are, of course, far more likely to experience acute stress than the average person), the BPD sufferer may experience hallucinations that fall somewhere between the mild and severe types.

For example, if s/he (the BPD sufferer) was constantly belittled and humiliated by a parent when growing up, s/he may, when experiencing severe stress, ‘hear’ the ‘parent in their head’ saying such things as ‘you’re useless’ or ‘you’re worthless.’

However, unlike the person suffering unambiguously from psychosis, when this occurs s/he is not completely detached from reality but is aware the ‘voices’ are being generated within his/her own mind and are imaginary as opposed to real.

Severe hallucinations may be indicative of schizophrenia but can also have other causes which include : delirium tremens (linked to alcohol abuse), narcotics (e.g. LSD) and sensory deprivation.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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‘Amygdala Hijack’ And BPD

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One of the main, and most problematic, symptoms that those with borderline personality disorder (BPD) suffer from is the experiencing of disproportionately intense emotional responses when under stress and an inability to control them or efficiently recover and calm down once such tempestuous emotions have been aroused. This very serious symptom of BPD is also often referred to as emotional dysregulation.

The main theory as to why such problems managing emotions occur is that damage has been done to the development of the brain region known as the amygdala in early life due to chronic trauma and, consequently, this area of the brain having been overloaded and overwhelmed by emotions such as fear and anxiety during early development causing a longterm malfunction which can extend well into adulthood or even endure for the BPD sufferer’s entire lifespan (in the absence of effective therapy).

The damage done to the development of the amygdala means that, as adults, when under stress, BPD sufferers are frequently likely to experience what is sometimes referred to as an emotional highjack or, as in the title of this article, an amygdala hijack.

What Is ‘Amygdala Hijack’ And How Does It Prevent Emotional Calm?

When external stimuli are sufficiently stressful, the amygdala ‘shuts down’ the prefrontal cortex (the prefrontal cortex is responsible planning, decision making and intellectual abilities).

In this way, when a certain threshold of stress is passed (and this threshold in far lower in BPD sufferers than the average person’s) the amygdala (responsible for generating emotions, particularly negative emotions such as anxiety, fear and aggression) essentially ‘takes over’ and ‘overrides’ the prefrontal cortex.

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Above : under sufficient stress the prefrontal cortex (the seat of rational thought) is shut down, leaving the amygdala (the seat of intense, negative emotions like anxiety, fear and aggression) to ‘run riot.’

As such, the prefrontal cortex ‘goes offline’ leaving the BPD sufferer flooded with negative emotional responses and unable to reason, by logic or rational thought processes, his/her way out of them.

When the amygdala is ‘highjacked’ in this way, there are three main signs. These are :

1) An intense emotional reaction to the event (or external stimuli)

2) The onset of this intense emotional reaction is sudden

3) It is not until the BPD sufferer has calmed down and the prefrontal cortex comes ‘back online’  (which takes far longer for him/her than it would for the average person) that s/he realizes his/her response (whilst under ‘amygdala highjacking’) was inappropriate, often giving rise to feelings of embarrassment, humiliation, guilt, remorse and regret.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

 

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Borderline Personality Disorder Is Not A Choice

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Nobody chooses to suffer from borderline personality disorder ; this is obvious.

Borderline personality disorder (BPD) is probably the most tormenting and agonizing psychiatric condition known to man. One in ten sufferers end up killing themselves after years, or even decades, of appalling mental suffering. Due to the disturbed behavior that accompanies BPD,  sufferers may become social pariahs and/or be rejected by their families – in the latter case, often by the very family member/s who have played a major role in causing the disorder ; I have said elsewhere that this is rather like somebody cutting off all your limbs and then blaming you for bleeding for over them. Or injecting you with a cancer causing agent and then blaming you for wasting away and dying.

One of the great torments of BPD sufferers is a belief that they are bad and that their behavior is due to some fundamental character flaw rather than due to a desperately serious psychiatric condition. It is this false belief (frequently caused by internalizing parental negative views of them whilst growing up) that contributes to many of the suicides and, as such, is a belief which is in urgent need of correcting.

On what grounds do I make this assertion? I summarize them below :

  • DAMAGE DONE TO THE PHYSICAL DEVELOPMENT OF THE BRAIN:

The physical development of the following three brain regions is affected by our upbringing in early life and this physical development may be adversely affected if that upbringing is significantly dysfunctional.

  • AMYGDALA
  • HIPPOCAMPUS
  • ORBITOFRONTAK CORTEX

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Let’s look at each in turn:

AMYGDALA : This part of the brain controls emotions and, especially, negative emotions like fear, anxiety and aggression. It follows that because the amygdala has developed abnormally in BPD sufferers, they will be prone to experiencing abnormal levels of fear, anxiety and aggression.

HIPPOCAMPUS : This part of the brain plays a significant role in our ability to exert self-control. Again, it follows that because the hippocampus has developed abnormally in BPD sufferers, they will have difficulties with self-control, leading to impulsive and self-destructive behaviors.

ORBITOFRONTAL CORTEX : This part of the brain is involved with planning and decision making. Yet again, it follows that because the orbitofrontal cortex has developed abnormally in BPD sufferers, they will have problems planning ahead (including poor ability to consider future implications of behaviors or to act in a premeditated or carefully deliberated manner) and be prone to irrational and illogical decision-making.

Furthermore, these three brain areas play a very significant role in mood regulation / our ability to control how we feel. As these three areas have developed abnormally in BPD sufferers, this helps to explain why their moods can fluctuate so dramatically, in turn leading to extensive problems both forming and maintaining healthy relationships with others.

Now, consider this : If a person was hit on the head with a hammer, causing brain damage which, in turn, affected how s/he felt and behaved, should s/he (the person hit) be blamed for this change in behavior? No, of course not. So, why should a different view be taken in the case of BPD sufferers? Indeed, to take a different view would seem suspiciously like discrimination against mental illness and a failure of imagination in regard to how devastating the infliction of emotional suffering can be.
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Types Of Dysfunctional Upbringing That May Damage These Brain Regions :

These include :

  • suffering abuse from parent/primary carer
  • being neglected by parent/primary carer
  • being brought up by a parent with a significant mental health problem
  • being brought up by a parent/primary carer who is an alcoholic
  • being brought up by a parent/primary carer who is a drug addict

What About The Role Of Genes?

There is NOT a gene for BPD.

However, some may be born with a greater vulnerability to being adversely affected by stressful environments due to high levels of sensitivity.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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BPD Sufferers Over-React To Facial Expressions

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A study conducted by Donegan et al, 2003, found that sufferers of borderline personality disorder (BPD) were prone to interpreting neutral facial expressions as threatening facial expressions.

The study involved 30 participants split into two groups as follows :

Group 1 : This group consisted of 15 individuals who had been diagnosed with borderline personality disorder (BPD).

Group 2 : This was the control group, consisting of 15 individuals who did not have borderline personality disorder (BPD).

 

How Was The Study Conducted?

All 30 participants in the study were shown pictures of people with four types of facial expressions, these expressions were as follows :

  • neutral
  • happy
  • sad
  • fearful

Sometimes, too, the participants had to focus on single fixation point (rather than a picture of a face).

Functional Magnetic Resonance Imaging :

Whilst each of the participants was looking at each of the four different facial expressions, or at the single fixation point, they underwent a brain scanning process known as functional magnetic resonance imaging (fMRI).

The purpose of undergoing the fMRI whilst looking at the pictures of facial expressions or at the single fixation point was to measure the level of activation in a region of the brain known as the amygdala. The amygdala, among other functions,  is involved in generating negative emotions.

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What Were The Findings Of The Study?

When participants from GROUP 1 were shown pictures of faces displaying emotions (versus the single fixation point), their amygdalae were found to be more highly activated than were the amydalae of those from GROUP 2 whilst undergoing the same activities.

Furthermore, interviews after the participants were shown the pictures revealed that some in GROUP 1 had interpreted the neutral faces as being threatening.

What Can We Infer From This Study?

This study suggests that individuals suffering from borderline personality disorder (BPD) can be prone to interpreting the facial expressions of others more negatively (e.g. as being threatening when this is not objectively the case) than those individuals who are relatively psychologically healthy.

According to this study, this would, at least in part, appear to be due to an abnormal physiological response in the brain, namely over activation of the amygdala in response to the emotional facial expressions of others.

This finding goes towards explaining why those with borderline personality disorder (BPD) tend to have severe problems in connection with their interpersonal relationships and often perceive others as threatening and as wanting to hurt them which, in turn, frequently gives rise to overly defensive behavior.

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David Hosier BSc Hons; MSc; PGDE(FAHE).
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Thin-Skinned? Its Link To BPD.

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Do people ever accuse you of being thin-skinned?

If we have developed borderline personality disorder (BPD) as a result of our traumatic childhood, then one of the main symptoms we are likely to have developed is difficulties with interpersonal relationships. Most often, too, part of this difficulty resides in the fact that we are likely to be extremely thin-skinned. 

Our being thin-skinned can, most frequently, be explained by our having experienced severe negative attitudes expressed towards us as children (most commonly by a parent or primary carer), rejection, abandonment, emotional abuse or some combination of these.

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Thus, in an unconscious, desperate attempt to protect ourselves from further psychological pain, we become hypervigilant in connection with being on the look out for further signs that someone may be a threat to our psychological welfare by emotionally hurting us.

Rather like a dog who has been regularly beaten, we ‘snarl’ at  (or ‘run away’ from) anyone who remotely seems to represent such a threat lest they harm us like we were harmed before.

Do Those With BPD Imagine Others Are Behaving Negatively Towards Them When, In Reality, This Is Not The Case?

Do people with BPD constantly imagine slights against their character when, in reality, such slights have not occurred?  In fact, this doesn’t seem to be the problem (or, if it is a problem, not the main problem). Rather, people with BPD, due to their hypervigilant state when interacting with others, perceive real negative attitudes towards them which others may not be perceptive or sensitive enough to pick up on or let pass over their heads.

The problem from here is often how those with BPD react once they have picked up on such negative attitudes.

How Do Those With BPD Tend To React In Such Situations ?

In such situations, those with BPD tend to feel intensely hurt and misunderstood ; this can then lead to becoming highly emotional or, as a form of self-protection, detached. Unfortunately, neither of these reactions tend to be useful in terms of resolving the situation; indeed, such reactions most often serve only to compound the BPD sufferer’s interpersonal difficulties.

 

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David Hosier BSc Hons; MSc; PGDE(FAHE)

 

 

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Linehan’s Biological Vulnerability Model Of BPD

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Linehan (1993) proposes that various biological aberrations contribute to borderline personality disorder (BPD) which causes sufferers great difficulty controlling (regulating) their emotions. Linehan described this impaired ability to regulate emotions as consisting of three key factors :

Three Key Factors Contributing To Impaired Self-Regulation Of Emotions :

1) Heightened emotional sensitivity (particularly in relation to experiences that give rise to negative emotions, according to research by Jacob et al., 2008)

2) Inability to regulate intense emotional responses (again, particularly in relation to negative emotions)

3) Slow return to emotional baseline (ie. once emotionally upset, the BPD sufferer finds it very hard to calm down again)

Is Being Highly Sensitive A Bad Thing?

Linehan points out that, in fact, being highly sensitive, per se, should be seen as neither a good thing nor a bad thing, but, rather, it should be viewed in neutral terms ; whilst those with BPD frequently find their high level of sensitivity causes them immense mental turmoil and suffering, such individuals can learn to make their sensitivity work for them rather than against them with help from a skilled and experienced therapist.

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Biology Of Borderline Personality Disorder (BPD) – The Limbic System:

As stated above, Linehan proposed that individuals who develop BPD may have a biological predisposition to do so (such as abnormalities in the brain’s limbic system) and, whether these individuals develop BPD or not, will depend upon the environment in which they grow up. Childhood environments that are especially likely to lead to the development of BPD, according to Linehan, are those which are INVALIDATING (invalidating environments are ones in which the parents significantly inhibit the child’s healthy expression of emotions).

Other Biological Factors Thought To Be Associated With BPD :

Since Linehan first proposed her theory of how biological vulnerability and BPD may be interlinked, far more research has been conducted on the topic. From this research, it has been found that sufferers of BPD tend to have :

amydalae (see notes below) that are of smaller than average volume

hippocampi (see notes below) that are of smaller than average volume

– underactive prefrontal cortices (see notes below)

– lower than average levels of serotonin (see notes below)

It has also been hypothesized that the activity of the neurotransmitter, dopamine (see notes below), and the hormone, vasopressin (see notes below) , may be disrupted in individuals suffering from borderline personality disorder (BPD).

NOTES :

Amygdala – a region of the brain involved in various emotional processes

Hippocampus – a region of the brain involved in the consolidation of new memories

Prefrontal Cortex – functions of this brain region include discerning right from wrong, repressing unacceptable social behaviour, planning and other complex processes. It is also crucially involved with the development of the personality.

 – Serotonin – is a neurotransmitter that has been described as ‘a natural mood stabilizer’ and is involved in sleep and the regulation of anxiety (amongst other processes). Many experts subscribe to the theory that low levels of serotonin in the blood (and it is supposed, therefore, but not proven, in the brain) are associated with depression.

Dopamine – this neurotransmitter is involved in motivation, reinforcement of behaviour through reward, arousal, sexual gratification, control of the body and executive function (including problem solving, planning, reasoning and inhibitory control).

 – Vasopressin – this is a hormone that can be released directly into the brain and there exists a growing body of research that suggests it may be involved in sexual motivation, pair bonding and social behaviour.

 

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Emotional Intensity Disorder

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Many who have been diagnosed with borderline personality disorder (a condition strongly associated with a history of significant and long-lasting childhood trauma) resent the label, preferring instead to consider themselves as having complex post traumatic stress disorder (although this diagnosis has still to be formally acknowledged and is not yet included in the DSMDiagnostic And Statistical Manual Of Mental Illness) or, more recently, emotional intensity disorder.

This is largely due to the fact that many patients and clinicians consider the label borderline personality disorder to be stigmatizing, demeaning and even insulting as it seems to imply the person’s whole personality (and, perhaps, by extension, character), is fundamentally flawed, giving him/her the status of social outcast and pariah – this, of course, can only exacerbate their isolation, and illness, further. NOT HELPFUL! (Especially as it is the experience of profound rejection, often by parents and other family members, which has contributed to the illness in the first place.

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Other terms have also been considered to replace the borderline personality disorder label; I list these below :

– emotionally unstable personality disorder (not much of an improvement, it has to be said!)

– emotional regulation disorder

– emotional dysregulation disorder

– impulsive personality disorder

– impulsive emotional dysregulation disorder

Emotional Problems Of Those With BPD :

So, what emotional problems do people with BPD suffer? Below, I attempt to summarize them:

– rapid and dramatic mood swings

explosive rage and anger, even in response to (objectively speaking) minor provocations

– emotions so intense the individual experiencing them feels ‘out of control’

– incongruous emotional displays (such as crying at times that the majority of people would find ‘inappropriate’).

– experiencing of strong emotions which seem to ‘come out of nowhere.’

– suicidal impulses

depression

– feelings of ’emptiness’

intense psychological pain (often this leads to ‘self-medicating’ behaviour (i.e. excessive use of drugs and/or alcohol)

– extreme fear of abandonment

paranoia

– impulsivity

(The above list is not exhaustive; to read my article on borderline personality disorder, click here).

 

What Causes These Emotional Problems?

– imbalances in the brain of certain chemicals ; in particular, dopamine and serotonin

– childhood trauma (such as neglect, abuse, rejection, loss, grief and abandonment)

– further research needs to be conducted on the contribution of genes

How Common Are These Problems?

About one in every fifty people suffer from these severe emotional problems I refer to above. Also, women are about three times more likely to suffer from them than men. For most sufferers, the condition improves once the individual approaches middle-age.

Currently, one of the most effective treatments for borderline personality disorder is dialectical behaviour therapy (DBT). Many sufferers also find mindfulness training and cognitive behavioural therapy (CBT) helpful.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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BPD, Algopsychalia And Examples Of Specific, Amplified Emotions

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In my last article I wrote about how borderline personality disorder (BPD) sufferers are especially likely to suffer from intense, tormenting, psychological pain, a condition known as algopsychalia. Why is this?

What Are The Possible Causes Of This Pain?

The causes of this pain are highly complex; however, one interesting theory put forward by Schneidman is that algopsychalia comes about as a result of unfulfilled and frustrated psychological needs.

 

What Are These Unfulfilled And Frustrated Psychological Needs?

According to Schneidman, these include :

– affiliation / meaningful connection with others

– love

– personal autonomy / a sense of control over one’s own life

– achievement

– the need to avoid shame

Also, associated with such unfulfilled and frustrated needs, sufferers of BPD experience particularly intense, negative emotions. Indeed, all negative emotions felt by BPD sufferers are, in general, more amplified, and, therefore, generate more psychological pain, than is the case for the ‘average’ person.

Examples Of Amplified Negative Emotions In BPD Sufferers Contributing To Psychological And Emotional Pain :

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  • instead of becoming annoyed or irritated the BPD sufferer may well, instead, fly into an uncontrollable rage and fury from which s/he is not easily able to calm down.
  • instead of mild or moderate embarrassment, the BPD sufferer may experience on overwhelming and profound sense of shame
  • instead of feeling mildly apprehension, the BPD sufferer may experience a severe, full-blown panic attack, complete with hyperventilation and fear of imminent and impending death
  • instead of feeling sadness, the BPD sufferer may suffer a sense of deep and intense grief.

To make the adverse effects of these terribly painful emotions worse still, those suffering from BPD find it very difficult indeed to self-comfort or self-sooth when experiencing such feelings due to early life disruption to the development of certain critical brain regions. (To read my article entitled : ‘Three Critical Brain Regions Harmed By Childhood Trauma’, click here).

RESOURCES :
1) Article about DISTRESS INTOLERANCE – click here

2) Article about DIALECTICAL BEHAVIOUR THERAPY (a therapy specifically developed to help those suffering from BPD and difficulty controlling their emotions) – click here

3) HYPNOSIS DOWNLOADABLE MP3/CD – CONTROL YOUR EMOTIONS -click here.

 

David Hosier BSc Hons; MSc; PGDE(FAHE)

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