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Over 850 free, concise articles about childhood trauma and its link to various psychological conditions, including : complex posttraumatic stress disorder (complex PTSD), borderline personality disorder (and other personality disorders), anxiety disorders, depression, physical health conditions, psychosis, difficulties forming and maintaining relationships, addictions, dissociation and emotional dysregulation (such as dramatic mood swings and outbursts of rage). The site also comprises articles on treatments for childhood trauma and related mental health problems as well as articles on posttraumatic growth and other relevant topics. There is a search facility on the site to facilitate exploration of subjects covered.

The Mother Prone to Explosive Rage.

angry mothers

When a mother is prone to uncontrolled, explosive outbursts of rage it casts a shadow over every day for her offspring. The child needs to be on constant ‘red alert’, preoccupied with the possibility of another outburst, always anticipating it, but never being able to predict it. Such a mother will often DISPLACE (take out) her anger about areas of her life with which she is dissatisfied on the offspring, even though the real cause of her anger has nothing to do with them. My own mother, for example, could become almost demented  with anger, hatred and hostility over something as small as an accidently spilt drink.

As I neared my teens and started to answer back, she would rage at me for not demonstrating ‘the respect she deserved.’ In other words, if I protested that I did not deserve to be on the receiving end of this diabolical rage, she would become yet further apoplectic with anger ; she would vigorously justify her own behavior and discount the effect it had on me – it was, according to her, my ‘own fault’ for ‘provoking’ her in the first place.

‘I CARE FOR YOU, I HATE YOU’: THE MENTAL ANGUISH OF BEING PLACED IN A DOUBLE-BIND :

Relationships with such parents often place the child in an impossible position, creating that which experts in family interpersonal relationships term a DOUBLE-BIND. Essentially, this involves the parent giving the child CONTRADICTORY MESSAGES. For example, The parent may profess to deeply care for the child, but in the CONTEXT OF CONSTANTLY NEGATIVE CUES (for example, tone of voice, body language etc).  THE CHILD, IN SUCH CONDITIONS, IS LIKELY TO FEEL FROZEN OUT, even though the parent claims to care about him/her. In such a relationship, the parent will often make use of tactics which put the child under deep psychological pressure to comply with its terms, leading to profound inner confusion which is impossible for him/her to articulate.

angry mothers

Though a child enmeshed in such a relationship may be in deep distress, s/he may find him/herself being dismissed as, ‘silly’, ‘bad’, ‘naughty’, ‘a spoiled brat’ etc ; it is likely, too, that other stratagies will be employed to confuse and oppose the child. These strategies include :

OBFUSCATION : the concerns the child tries to raise are evaded, glossed over, dismissed as ‘not real’ and as being ‘all in his/her mind.’ Sometimes, too, the expression ‘I love you’ , may be employed tactically to put an end to the matter, as it were, without giving the child the chance to express his/her urgent views. The term ‘I love you’, in such circumstances, can be used strategically to imply : ‘ you are therefore ungrateful, in the wrong, and must understand that my saying this completely exonerates me from any possible blame’ or similar.

COUNTERACCUSATION : This is when the child is blamed for creating his own suffering. This may be stated directly by the parent or else implied. I can still hear the phrase my own mother used to use against me ringing in my ears : ‘It’s your own bloody, stupid fault. I’ve absolutely no sympathy for you what-so-ever! None what-so-bloody -ever! None!’ (As you may have gathered, she liked to push her point home!)

MARGINALISATION : This involves dismissing, devaluing, refusing to acknowledge, minimizing the significance of, or otherwise undermining, the child’s protests. This causes the child to question the reality of his/her own feelings and views which can, in turn, lead to deep psychological problems and a sense of self-alienation. When the very validity of a person’s deepest held and most profoundly felt beliefs are attacked in this way (however implicitly) the very inner core of the self can begin to dismantle and disintegrate.

The above are just some of the tactics that may be used by the dysfunctional parent. Often the tactics will be employed in combination, creating enormous emotional turmoil and volatility in the child, as well as deep confusion and internal incoherence. His or her most important feelings about reality are systematically undermined over a period of years or decades.

 

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

 

 

How Does PTSD Develop?

WHAT IS THE DEVELOPMENTAL PROCESS OF POST TRAUMATIC STRESS DISORDER (PTSD)?

The psychologists Foa et al. developed the following model to illustrate the psychological process through which PTSD develops.

When a person experiences something which is very traumatic the memory becomes enmeshed into the brain’s circuitry – in essence, a FEAR STRUCTURE becomes incorporated into the brain.

THE FEAR STRUCTURE can be divided into 3 individual units. These are as follows :

a) STIMULI of the trauma. This refers to things which my trigger memories of the trauma. Stimuli my gain access to the brain via any of the 5 senses (i.e. sight, hearing, smell, taste and touch). To use a simple example, someone traumatized by being injured in an explosion in a war may have the trauma response triggered by loud bangs such as fireworks going off (the loud bang being the stimuli).

b) RESPONSES to the traumatic event. This includes both physiological responses (e.g. racing pulse, hyperventilation) and psychological responses (such as a feeling of terror).

c) MEANINGS ATTRIBUTED TO THE STIMULI AND RESPONSES (e.g. this means I must be in great danger).

When somebody suffering from PTSD experiences an event which triggers the original memory of trauma, laid down in the brains circuitry, they feel intense distress. Typically, in response to this distress, they will take evasive action (i.e. try to evade, or get away from, the event which is triggering the traumatic response). It is the meaning aspect of the fear structure ( c, above) which creates the most anguish. The problem lies in the fact that they find it exceptionally difficult to reconcile their old (pre-trauma) beliefs about events and their new (post trauma) beliefs about events (doing this successfully, which therapy can help them, eventually, to do, is known as the PROCESS OF ACCOMMODATION).

An example of pre- and post- traumatic beliefs, which, if the process of accommodation has not taken place, would be in opposition with one another are :

PRE-TRAUMA – the world is a pretty safe place in which I can generally feel relaxed in

POST -TRAUMA – the world is very dangerous and unpredictable and I must always be on my guard against threats which seem to be coming at me from every direction (at worst, leading to clinical paranoia)

COMPULSION TO MAKE SENSE OF THE TRAUMATIC BELIEF

The individual who suffers from PTSD will often try , obsessively, to make sense of the traumatic event which occurred to him/her. This arises because s/he finds it impossible to square what has occurred with pre-trauma beliefs.

THE DEEP PSYCHOLOGICAL PAIN OF TRYING TO MAKE SENSE OF THE TRAUMATIC EVENT

Whilst the individual suffering from PTSD feels driven to make sense of the trauma, constantly thinking about it creates feelings which are both terrifying and overwhelming. THIS CREATES A TERRIBLE PSYCHOLOGICAL TENSION IN THE MIND – there is the PULL TOWARDS ATTEMPTING TO MAKE SENSE OF WHAT HAPPENED ON THE ONE HAND, BUT ALSO THE PULL OF TRYING TO STOP THINKING ABOUT IT ON THE OTHER.

Foa and her colleagues have put forward the theory that it is the tension, created by having one’s thoughts pulled powerfully in two directly opposing directions, which leads to the extreme HYPERAROUSAL (intense anxiety).

The two opposing views of the world the individual tries desperately to fit together (‘safe world’ versus’ unsafe world’) is rather like trying to FIT TWO PIECES OF JIGSAW TOGETHER, ONE OF WHICH HAS BEEN DAMAGED, SO IT NO LONGER FITS.

Therapy can lead to a resolution of this dilemma, leading to a compromise belief, linked to the two opposing beliefs, such as :

THE WORLD IS GENERALLY SAFE FOR ME BUT NOBODY HAS A COMPLETE GUARANTEE, OCCASIONALLY BAD THINGS HAPPEN.

TREATMENTS :

COGNITIVE BEHAVIOURAL THERAPY IS AN EFFECTIVE TREATMENT FOR THE EFFECTS OF TRAUMA – there is a lot of research evidence to support this.

Also, hypnotherapy can provide relief from many of the symptoms of trauma (eg anxiety, fear etc).

 

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

Effects of Parental Favoritism

 

 

 

The effects of long-term parental favoritism will clearly affect the way in which the favored and non-favored child perceive themselves. The more extreme the difference in treatment, all else being equal, the more extreme will be the effects on the respective children.

I will use the example of a step-family as I grew up in one. Very sadly, although there are step-families, of course, in which all children are treated equally and the environment is happy and healthy, it can be the case that, again, for example (as it relates to my own experience) the step-mother will favor her own son over her step-son AND MAKE THIS ABUNDANTLY CLEAR.

To elaborate, if you’ll permit the small indulgence, a little more on my own case, my step-mother was,  as far as I could make out, essentially a religious fundamentalist (you know -‘ gay people offend god’, speaking in ‘tongues’, that sort of thing) although, to be honest, her belief structure seemed deeply confused – a veritable pick and mix mishmash, perfectly tailored, in several respects, to her own purposes, which, it has to be said, is not entirely untypical. Her own son she viewed as a kind of mini-messiah – a view, unhelpfully for him, he can’t have failed to have introjected), whilst I was, naturally,  and, no doubt, befittingly, the spawn of the devil. Indeed, I spent much of my childhood worrying I was destined to be eternally tortured in hell.

parental favoritism

In my own case, then, I would have needed to have been in a coma for seven years (although, to my step-mother’s enduring chagrin, this happy event never came to pass) not to have picked up on things, but even if the favouritism is much more subtle, it can be equally bad, especially if  the step-parent is superficially pleasant and in denial about it, which can create a sort of tortured confusion in the child.

Of course, too, the unfavoured child may well (and this was certainly true in my own case)not want to tell anyone about it as often s/he will (ENTIRELY MISTAKENLY) believe that s/he deserves to be treated as the ‘inferior’ and, again, as certainly happened to me, grow up WITH A PROGRAMMED- IN  INFERIORITY COMPLEX . something I myself am still trying to shake off (unsuccessfully, I might add, which the perceptive reader of this blog is overwhelmingly likely to have realized!)

EFFECTS ON FAVORED CHILD :

S/he will tend to grow up with very high self-esteem and high levels of self- belief (irrespective, to a large degree. of actual talents and abilities). Indeed, another very interesting study discovered that every President since Roosevelt had been the favoured child.

EFFECTS ON UNFAVORED CHILD :

S/he has a greater probability of developing depression in later life and can develop ill-will towards the favored sibling/step-sibling.

BUT IT’S NOT NECESSARILY ALL BAD FOR THE UNFAVORED CHILD!!  The reason for this is that whilst the favored child may well go through life unconsciously trying to please the parent who favored him/her, and, if I may be permitted to coin a phrase – PERPETUALLY DANCE TO THE PARENT’S TUNE, the unfavoured child is liberated from such expectations and is free to live an altogether MORE AUTHENTIC LIFE , and plough, as it were, his/her own furrow.

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

Recovery: How the Brain can ‘Rewire’ Itself (Neuroplasticity).

childhood_trauma_effects

Severe childhood trauma can adversely affect the way in which the brain develops, leading to, for example, extremes in anxiety or great difficulty in controlling emotions. However, there has been exciting research conducted showing that the brain is able, under certain conditions, to ‘rewire’ itself, correcting its own faulty circuitry, and, thus, alleviating the behavioral and emotional problems caused by the original damage.

The adult brain is much more changeable and modifiable than had previously been believed. There is now a large amount of evidence to show that damaged neural (brain) circuitry resulting from severe childhood trauma can be corrected, reshaping our brain anatomy and consequent behavior, with the right kind of therapeutic interventions. In other words, it is now clear that brain architecture continues to change throughout adulthood and this can be manipulated in highly beneficial directions.

Many people who suffer extreme childhood trauma go on to develop personality disorders as adults; one hallmark of these disorders is rigid, destructive behavioural patterns. Research is now showing, however, that certain therapeutic interventions, due to neuroplasticity (the brain’s ability to change itself), can change those behaviours to become more flexible and adaptive (helpful in creating a more successful life).

Another problem those who have suffered extreme childhood trauma  develop later on is extreme and obsessive worry which can be so severe it is pathologically categorized as obsessive-compulsive disorder (OCD). For the purposes of explaining how neuroplasticity works, let’s take that (ie OCD) as our example of a problem which needs to be alleviated.

With OCD, obsessive worries can become so extreme that the person experiencing them becomes actively suicidal. Such a tortured state of mind can persist for months or even (as in my own case) years. Indeed, one suicide attempt nearly killed me and I even underwent electroconvulsive therapy (ECT) — to no avail, most regretably .When anxiety is this pathological, medications may dampen the symptoms somewhat, but, this, of course, fails to address the root psychological cause of the problem.

With this kind of anxiety, terrible and terrifying events are unremittingly anticipated – whether these are largely imagined or not is not the point : the problem is that the threats FEEL real. When something truly appalling is even remotely possible, in the mind of the individual experiencing obsessional anxiety, it FEELS INEVITABLE.

Neuroplasticity-Based Treatment :

In order to address such life-threatening (due to risk of suicide) conditions, the psychologist Jeffrey Schwartz has developed a NEUROPLASTICITY-BASED TREATMENT; it has already yielded excitingly successful results.

To understand his form of treatment, let’s first examine the theory of why those suffering from OCD become mentally fixated on their intense anxieties.

Schwartz, first of all, compared the brains of those who suffered from OCD with the brains of those who did not (by taking scans). After he delivered his form of psychotherapy, he took the scans again which revealed the brains of the patients had normalized.

In ‘normal’ people, when something goes wrong, there is a period of anxiety which gradually wears off. However, with OCD sufferers, the period of anxiety is not only much more intense but also maintains an iron mental grip on the sufferer – the individual becomes ‘stuck’ in this intense anxiety phase. So what is going on in neurological terms?

Schwartz generously enlightened us in the following manner :

1) When something anxiety inducing occurs, a region of the brain, known as the ORBITAL FRONTAL CORTEX, is alerted. Activity in this region of the brain is far greater in those who suffer OCD – it becomes HYPERACTIVE.

2) A chemical message is then sent from that brain region to another brain region – the CINGULATE GYRUS, triggering the anxiety response. IN PEOPLE WITH OCD, the activity here is, again, far more than normally intense. Crucially, too, in people with OCD, the intense activity in this brain region STAYS ‘LOCKED ON’ (as if the ‘ON SWITCH’ which has activated it CANNOT BE ‘SWITCHED OFF’). Indeed, Schwartz referred to this phenomenon as ‘BRAIN LOCK’. (In ‘normal’ individuals the activity in the stimulated brain regions gently fades away, as the brain designed it to do).

The treatment Schwartz developed is designed to ‘UNLOCK’, and normalize, the manner in which the brain’s circuitry works.

THE FIRST STEP in the therapy is for the OCD sufferer to RELABEL what s/he is experiencing AS A SYMPTOM OF HIS/HER OCD. S/he should remind him/herself that it is ‘just’ the neurological malfunctioning (the ‘brainlock’) which is the true cause of his/her discomfort, NOT the content of the anxiety itself. This relabeling provides some mental distance from the content of the obsessive concern. The more the person can concentrate on the physiological reasons for the feeling of distress, and the more s/he can distance her/himself from its actual content, the more effective the therapy tends to be.

Once this has been acknowledged, THE SECOND STEP is to REFOCUS THE ATTENTION ON SOMETHING POSITIVE and, ideally, pleasure-inducing.

As the person gets better at implementing these steps, new brain circuits start to develop : the obsessive circuits begin to be bypassed. Of course, changes do not materialize instantaneously – the brain takes time to ‘rewire’ itself.

If the person finds implementing the above two steps difficult to do, s/he should remind him/herself that even distancing him/herself from the content of the anxiety and doing something pleasurable instead for just one minute will help develop the beneficial new brain circuitry.

Two rather pithy sayings, often quoted by psychologists, help us to remember the theory behind the therapy :

– ‘neurons that fire together, wire together’

– ‘neurons that fire apart, wire apart’

To end this post with an encouraging statistic, it is worth recording that 80% of Schwartz’s patients got better when this therapy was combined with medication.

 

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

Narcissistic Personality Disorder : Its Link To Childhood Trauma

obsessive love disorder

Can Childhood Trauma Cause Narcissism?

This article examines the link between narcissistic disorder and childhood trauma. Several of my articles have already looked in some detail at the link between childhood trauma and the subsequent risk of developing a personality disorder (or disorders) if appropriate psychotherapeutic intervention is not sought.

narcissistic personaliy

Narcissus from Greek Mythology

Whilst precise mechanisms underlying the link between childhood trauma and subsequent development of a personality disorder are still being researched, it is a statistical fact that the experience of childhood trauma and personality disorder are very frequently indeed seen to be ‘co-morbid’ (this is a psychological term used to mean existing in the same patient – i.e. if the patient has a personality disorder, he/she very probably also experienced severe childhood trauma).

Suffering from a personality disorder has a profoundly damaging impact on a person’s life if it is left untreated. People who suffer from personality disorders tend to have very rigid, inflexible and damaging (both to themselves and others) ways of managing vital areas of their lives such as work, relationships and even leisure time which, naturally, causes a whole host problems.

NARCISSISTIC PERSONALITY DISORDER :

A good place to start is to look at how the DSM-IV (a diagnostic manual used by psychologists and psychiatrists) defines narcissistic personality disorder. Here’s the definition :

‘a pervasive pattern of grandiosity, need for admiration, and lack of empathy’

Other features of narcissistic personality disorder are :

– a grandiose sense of self-importance
– expectations of being treated as special
– extremely fragile sense of underlying self-esteem

The psychologist Masterson (1981) expanded upon the definition to include two particular types of narcissist:

1) the manifest narcissist
2) the ‘closet’ narcissist

Let’s look at both of these :

1) the manifest narcissist : similar to the description provided in DSM-IV (above)

2) the ‘closet’ narcissist : the person suffering from this disorder tends to present him/herself as timid, shy, inhibited and ineffective but reveals in therapy elaborate fantasies of a grandiose self

Narcissistic personality disorder is thought to be due to ARRESTED DEVELOPMENT. In therapy s/he will tend to seek the admiration s/he craves from the therapist, and, if the therapist is skilled and experienced, s/he will often uncover an array of psychological defense mechanisms which the patient uses to protect him/herself from unbearable emotional pain. These can include :

1) IDEALIZATION : this is often the primary defense whereby the individual IDEALIZES HIS/HER RELATIONSHIPS at first, elevating both self and other, in terms of status and specialness, to (illusionary) high levels

) DEVALUATION : this refers to the individual discounting and regarding as worthless anyone who undermines his/her grandiose vision of him/herself

3) DETACHMENT : this is linked to DEVALUATION (above) and refers to the individual’s propensity to sever links with anyone who threatens to undermine his/her exalted view of him/herself

4) ACTING OUT : this refers to performing extreme behaviours to express thoughts, feelings and emotions the person feels incapable of otherwise expressing

5) SPLITTING : this refers to the cutting off from consciousness the part of themselves that holds the emotional pain to prevent it from becoming integrated into consciousness, as, for this to occur, would be psychologically overwhelming

6) PROJECTIVE IDENTIFICATION : this is when the person (unconsciously) projects onto another (imagines the other to possess) parts of their own ego and then expects the other to become identified with whatever has been projected

7) DENIAL : in its simple form this just means not accepting certain unpleasant parts of reality to protect the ego

8) AVOIDANCE : also sometimes referred to as ‘escape coping’ – making efforts to evade dealing with particular stressors

9) PROJECTION : this defense mechanism involves attributing to others one’s own unwanted or socially/culturally unacceptable emotions, attributes or thoughts

In essence, the individual with narcissistic personality disorder lives in a world where everything is viewed in extremes of ‘good’ or ‘bad’. Underneath the defense mechanisms, there invariably lies an extremely FRAGILE SENSE OF SELF-ESTEEM. Therefore, the individual really feels EXTREMELY VULNERABLE and tends to have an overwhelming need to PROTECT HIM/HERSELF FROM ANY THREAT TO HIS/HER EXTREMELY PRECARIOUS SELF-IMAGE. The person with the disorder has a disturbance of the basic structure of the self.

THE THERAPEUTIC APPROACH TO TREATING NARCISSISTIC PERSONALITY DISORDER :

Research suggests that one of the main keys to psychotherapeutic intervention is an acknowledgement of the person’s pain, their overwhelming sense of their own vulnerability and their consequent desperate need to protect themselves from further psychological suffering. The therapist needs to reassure them that their defenses have been identified as self-protective, and, as such, are understandable


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

Reducing Damaging Behaviors Caused by Trauma – 1) Smoking

 

The experience of childhood trauma can lead us to develop maladaptive (self-damaging) coping strategies to attempt to gain some relief from symptoms caused by the trauma such as depression and anxiety. Such self-damaging behaviors, to give just a few examples, may include : smoking, drinking too much, drug use and gambling – these are all what are known as ways of dissociating from uncomfortable emotions.

These can be regarded, in part, as indirect symptoms of our painful life experiences. In this post, I want to discuss how such harmful behaviors may be addressed by employing the use of hypnotherapy

Self-damaging behaviours frequently give rise to what are known as PREVENTABLE DISEASES. Lung cancers caused by smoking (about 80% of all lung cancer cases) would clearly be one example of a preventable disease.

Hypnosis can be used to not only reduce the incidence of health damaging behaviors, but, it may, too, be used to ENHANCE BEHAVIORS WHICH BENEFIT HEALTH such as keeping to a healthy diet or increasing the amount of exercise a person takes, to give just two examples.

Extremely often, however, when people attempt to alter their health behaviors for the better on their own, they find it extremely difficult. Because of this, about a quarter of people in the U.S. are at increased risk of illnesses such as heart disease and cancer.

smoking_hypnotherapy

It is particularly important to focus on the self-damaging health behaviors of people who have suffered childhood trauma because, frequently, they will have developed psychological problems as a result of their painful experiences such as depression and anxiety., both they and their doctors may well have been focusing so much upon their emotional difficulties that their physical health issues have taken a back seat.

HYPNOTHERAPY AS AN AID TO HELP PEOPLE STOP SMOKING :

Out of 65 million people in the U.S. who smoke, up to 80% of them want to quit the habit at any one time. However, research shows that only about 5% of those individuals will be able to achieve this on their own.

Because of the very poor success rate of individuals stopping smoking without any help, many turn to hypnotherapy. Research studies into the effectiveness of hypnotherapy in helping people to quit their habit has yielded varying results, but one study, by Elkins et al (2003), showed that its success rate can be as high as 80%.

Further research, by Glover and Glover (2001) demonstrated that hypnotherapy can be even more successful in helping individuals stop smoking when it is combined with nicotine replacement therapy such as nicotine patches, nicotine lozenges.

 

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

 

How Borderline Personality Symptoms Reinforce Each Other.

 

One of the greatest difficulties of managing borderline personality disorder (BPD) is that the symptoms it creates tend to feed off, and intensify, each other; often this will end in a crisis point at which the affected individual will become suicidal and/or require hospitalization. Until the disorder is properly treated with the relevant therapy, the individual is likely to keep experiencing such crisis points throughout his/her life.

In this post, I want to look at how the symptoms of BPD can keep reinforcing and worsening each other, leading to a downward spiral from which the majority will find it impossible to break free without professional intervention. In order to do this, it is worth revisiting the main symptoms of BPD:

– almost always full of painful and distressing emotions
– becomes intensely attached to others very quickly, leading to feelings for, and expectations of, others that are not warranted given the context and/or history of the relationship
– expects to be rejected by those s/he forms an emotional attachment to
– is simultaneously deeply needy of, and rejecting towards, others ; feels deep need of emotional intimacy with, and caring from, others but then will tend to reject it when it is offered
– interpersonal relationships become unstable and chaotic
– experiences great difficulty in controlling (regulating) emotions which quickly become powerful and overwhelming ; these frequent powerful, intense, uncontrollable emotions frequently spiral out of control and then have a very adverse effect upon normal functioning
– inability to self-soothe (it is theorized that this is due to damage to the area of the brain known as the AMYGDALLA,thought to be caused by severe trauma and high levels of stress during childhood)
– suffers from impulsivity and recklessness
– frequently, or continuously, prone to severe depression and anxiety
– feels, and almost always is (by non-experts), misunderstood
– tends to constantly expect utter and devastating calamity (a mind-set referred to by psychologists as CATASTROPHIZING, a state of mind cognitive behavioural therapy, and other types of therapy for BPD, seek to correct).

HOW SUCH SYMPTOMS INTERACT AND INTENSIFY ONE ANOTHER:

Because the symptoms of BPD trap the sufferer in a downward spiral, as I shall illustrate below, it is just about impossible for individuals to cope with, let alone manage, the condition on their own. Professional intervention is therefore imperative. Because BPD is frequently misdiagnosed, it is worth noting down relevant symptoms and presenting them to the relevant professional in advance of an appointment. Also, there is nothing to prevent one seeking a second (or even third!) opinion. It is important to seek out a therapist who is expert in the condition and one is, of course, free to ask any potential therapist what experience s/he has of the disorder, together with their views about treatments (eg medication, talk therapy, a combination?) What is your own instinct on this? Let the therapist know.

Let’s now look at how the symptoms of BPD may become so mutually, destructively intertwined:

Because the person who suffers from BPD can be in such continuous, painful emotional distress it is very common for him/her to turn to alcohol or drugs in an attempt to numb these intolerable feelings.
The individual may well then castigate him/herself about this alcohol/drug use, seeing him/herself as an alcoholic or drug addict which lowers even further his/her already greatly damaged self-esteem. S/he may then seek psychological support from a friend, but, as a consequence of his/her distress, become clingy and demanding. In response to this, the friend may set down boundaries which the BPD sufferer interprets as rejection, thus further lowering his/her self-esteem and causing further painful emotions leading to yet more excessive drinking or drug taking…

Of course, this is just one example of how symptoms of BPD may unhelpfully feed off each other, though an almost infinite variety of harmful interactions between other symptoms can be easily imagined. Essentially, the BPD sufferer LACKS INTERNAL RESOURCES TO COPE WITH MENTAL PAIN AND STRESS, so will turn, with depressing regularity, to DESTRUCTIVE EXTERNAL RESOURCES such as one-sided relationships or activities which allow temporary, psychological DISSOCIATION from the emotional distress being experienced, such as ALCOHOL, DRUGS, PROMISCUOUS SEX or GAMBLING – in other words, maladaptive (unhelpful) coping mechanisms.

As these maladaptive coping strategies continue to aggravate and worsen one another, the BPD sufferer is likely to become increasingly desperate and to undertake increasingly self-destructive behaviours. How can s/he break free from this vicious cycle? Sometimes, as I said in the opening paragraph of this post, hospitalization may be required to interrupt the cycle; however, this has its negative side: being placed in a psychiatric hospital can significantly worsen, yet further, damaged self-esteem, making the sufferer feel like a pariah – stigmatized, demeaned, humiliated, and on the bottom rung of society’s ladder. S/he will also be burdened with the often acute worry of how s/he will now be perceived by others for having being placed in a psychiatric ward, making him/her less capable still of finding the confidence to interact successfully with acquaintances, friends and society in general. In extreme cases (eg when the sufferer is actively suicidal), however, there may, sadly, be little alternative.

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Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).