Borderline Personality Disorder For Dummies

Charles H. Elliott, PhD, is a clinical psychologist and Professor Emeritus, Fielding Graduate University.Laura L. Smith, PhD, is a clinical psychologist and Past-President, New Mexico Psychological Association.Both authors have extensive experience in the treatment of emotional disorders.

• Introduction 1About This Book 1Foolish Assumptions 2Icons Used in This Book 3Beyond the Book 3Where to Go from Here 3Chapter 1: Exploring Borderline Personality Disorder 7Breaking Down Borderline Personality Disorder 8Unpredictable relationships 9Acting without thinking 9Volatile emotions 10Confusing thoughts 10Exploring the Origins of BPD 11Counting the Costs of BPD 12Health costs 12Financial and career-related costs 13The toll on family and friends 14Treating BPD 15Psychotherapy 15Medication 16Relating to People Who Have BPD 16Chapter 2: Defining Personality to Understand BPD 19Characterizing Personality 20Differentiating Healthy from Unhealthy 20Openness: Seeking new experiences 22Flexibility: Rolling with the punches 22Emotional regulation: Controlling what you express 23Ability to delay gratification: Controlling impulses 24Conscientiousness: Responsible and reliable 24Interpersonal effectiveness: Having good relationships 25Emotional resiliency: Bouncing back from tough breaks 25Self-acceptance: Seeing yourself as you really are 26Accurate perception of reality: Seeing the world as it is 26Moderation: Avoiding extremes 27Chapter 3: Describing BPD 29The Nine Symptoms of BPD 301 Sensation seeking (impulsivity) 302 Self-harm 313 Roller coaster emotions 314 Explosiveness 315 Worries about abandonment 326 Unclear and unstable self-concept 327 Emptiness 328 Up-and-down relationships 329 Dissociation: Feeling out of touch with reality 33Diagnosing BPD: Like Ordering from a Chinese Menu 33High or Low Functioning 38BPD Over the Life Span 38Other Personality Disorders 39The odd and eccentric 40The dramatic and erratic 43The anxious and fearful 46Emotional Disorders That Accompany BPD 50Anxiety 51Trauma and stressor-related disorders 52Obsessive-compulsive and related disorders 53Depressive disorders 54Bipolar and related disorders 54Other emotional disorders 56Chapter 4: Exploring the Root Causes of BPD 59Beginning with Biology 60Genetics 60Brain chemistry and functioning 61Psychological Factors 62Problematic parenting 63Abuse and trauma 66Separation and loss 67Disorganized and disrupted families 67Social and Cultural Influences 68The neighborhood 69Friends and peers 70The teen years 70Social media 70Cultural factors 71Mixing and Matching Risk Factors 74Biological and psychological factors 75Biological and social influences 76Psychological and social causes 76A full biopsychosocial mix 77Part 2: The Major BPD Symptoms 79Chapter 5: Sensation Seeking and Self-Harm: The Impulsivity of BPD 81Living Dangerously: Impulsive Behavior 82Hurting for Help 84Types of self-harming acts 84Why hurt yourself? 85Suicide: Seeking the Ultimate Escape 88A cry for help or an attempt at revenge? 89Who’s at risk? 89Chapter 6: Explosive Feelings and Moods 91Emotions 101 91Primitive emotions 93Thoughtful emotions 95Emotions — Borderline Style 95Struggling to recognize and express emotions 97Having emotions about emotions 98Chapter 7: Missing Persons: Identity Problems and BPD 99The Concept of Identity 100What is identity? 100How does identity develop? 102Borderline Identity: Unstable and Fragile 104Waffling identities 105Worries about identity 106Chapter 8: Perceiving, Understanding, and Relating to Others 107Standing in Other People’s Shoes 108Understanding other people 108Seeing yourself through other people’s eyes 110Causing unintended hurt 111Busting through Boundaries 113Disrespecting partners and lovers 114Slighting friends and co-workers 115Straining relationships with helpers 115Riding roughshod over kids 116Chapter 9: BPD and Extreme Thinking 117Understanding How You See the World 117How schemas develop 118Types of schemas 119Why schemas are hard to change 120BPD Schemas: No Middle Ground 121Self-concept schemas 121Relationship schemas 124World schemas 127Chapter 10: Slipping Away from Reality 131Discovering Dissociation 132Feeling Paranoid or Delusional 134Having Hallucinations 135When You Have BPD and Feel Crazy 137Part 3: Making the Choice to Change 139Chapter 11: Researching and Choosing BPD Treatments 141Exploring BPD Treatment Settings 142Working individually with a therapist 142Giving groups a chance 142Spending more time in treatment: Partial hospitalization 143Needing more care: Inpatient psychiatric wards 143Combining and changing treatments 144Researching the Treatment Strategies That Work for BPD 144Dialectical behavior therapy (DBT) 145Mentalization-based therapy (MBT) 145Transference-focused psychotherapy (TFP) 146Cognitive therapy 146Schema therapy 147Transdiagnostic treatment 148Metacognitive therapy (MCT) 148Systems training for emotional predictability and problem solving (STEPPS) 148Acceptance and commitment therapy (ACT) 149Compassion focused therapy (CFT) 149Medication 149Common factors in therapies 149Choosing a Mental Health Professional 150Primary healthcare providers 152Psychologists 153Psychiatrists 153Counselors 154Marriage and family therapists 154Psychiatric nurses 155Social workers 155Starting Treatment 156Evaluating your therapy 156Giving therapy some time 157Chapter 12: Breaking Through Barriers to Change 159Overcoming the Fear of Change 160Losing who you are: It’s not going to happen 161Opening up: No need for cold feet 161Dreading even more loss: Try not to test the ones who want to help 162Fearing treatment: Don’t let therapy myths hold you back 162Looking at fears of change in action 164Taking Charge and Giving Up the Victim Role 165Ending the blame game 165Thinking like a victim: It doesn’t help 166Finding forgiveness and coping 167Stop Procrastinating 167Dismantling excuses 167Debating the decision 169Getting Comfortable with the Process of Change 171Chapter 13: Explaining BPD to Others 173Deciding Whether and Whom to Tell 174The benefits and costs of telling 174Figuring out whom to tell 176Deciding What to Tell 180Educating yourself 180Deciding how much to say 181Telling Your Story Effectively 184Chapter 14: Taking Care of Yourself 187Dealing with Stress 187Reviewing how stress affects health 188Managing and reducing stress 189Taking Better Care of Your Body 190Revising your diet 191Energizing with exercise 192Getting enough sleep 192Taking healthy actions 195Finding More Time for Yourself 196Part 4: Treatments for BPD 197Chapter 15: Inhibiting Impulsivity 199Increasing Your Awareness of Impulsive Behavior 200Write down your impulsive acts 200A case study of working on impulsiveness 202Putting the Brakes on Impulsivity 206Putting time on your side 206Putting off your impulses 208Doing something different 209Fire drilling 209Seeking Healthier Alternatives 211Chapter 16: Calming the Storms Within 213Putting a Name Tag on Feelings 214Understanding the thought-feeling connection 214Practicing emotional regulation 215Forbidding Feelings from Ruling Over Thoughts 216Doing the opposite of what you feel 217Calming down with coping self-statements 218Relaxing and Practicing 219Making muscles relax 219Soothing through the senses 223Visualizing calm 224Discovering Meditation 225Benefits of meditation 225How to meditate 226Types of meditation 227Meditation myths 229Acquiring Acceptance 230Discovering your observant mind 231Playing with your judgmental mind 233Chapter 17: Creating an Identity 235Clarifying What’s Important in Your Life 236Finding your personal priorities 236Creating a personal life mission statement 239Finding Forgiveness and Self-Compassion 242Forgiving yourself first 242Going from self-forgiveness to self-compassion 243Fumbling to forgive others 244Chapter 18: Putting Yourself in Other People’s Shoes 247Understanding Others’ Points of View 248Projecting: Thinking others feel what you feel 248Practicing perspective taking 250Noticing Your Impact on Others 255Decreasing Defensiveness 255Taking the “I” out of interactions 256Putting a friend on your side 257Musing over defusing 257Getting Along Better 258Listening 259Giving compliments 259Pillowing rather than pummeling 260Chapter 19: Finding Shades of Gray: Changing Problematic Core Beliefs 261Schema Busting Strategies 262Recognizing the effects of schemas on your feelings 263Exorcising problematic childhood schemas 266Tabulating a cost-benefit analysis 268Adopting Adaptive Schemas 271Taking the direct approach 272Staying on track with flash cards 273Chapter 20: Considering Medication for BPD 277Putting Medications on Trial 277Getting Help from Medications 279Considerations for taking medication 280Precautions to consider 280Surveying the Medicine Cabinet 282Antidepressants 282Neuroleptics 285Mood stabilizers 286Anti-anxiety medications (minor tranquilizers) 286Problems with the Polypharmacy Strategy 286Making the Medication Decision 287Part 5: Advice for People Who Care 289Chapter 21: What to Do When Your Partner Has BPD 291Understanding Borderline Behaviors within Relationships 292Going to extremes 292Giving you the silent treatment 293Gaslighting 295Initiating isolation 296Shaking up the present 297Expressing entitlement 297Acting impulsively 298Feeling rejected and abandoned 299Misinterpreting threats to self-esteem 300Staying Safe: Emotionally and Physically 301Dealing with your partner’s self-abuse 302Knowing what to do when you’re the recipient of abuse 302Walking Away from BPD 304Debating the decision 304Leaving abusive relationships if you decide to do so 306Leaving nonabusive relationships if you decide to do so 308Remaining in a Relationship 309What does love have to do with it? 309Hanging in for the long haul 310Chapter 22: Befriending People with BPD 311Recognizing Warning Signs of BPD 312Determining When You’re Vulnerable to BPD Influence 315Detecting Serious Symptoms 316Handling Friends with BPD 317What you can do 317What you can’t do 319Dealing with Dangerous Situations 321Ending a BPD Relationship 322Making your exit 322Wrangling with guilt 323Sticking with a Friend Who Has BPD 324Chapter 23: Parenting Children at Risk for BPD 325Heeding Early Warning Signs 326Identifying problem behaviors 327Pursuing a diagnosis 328Looking at Risk Factors 329Finding the Right Help 330Loving Tough 332Supporting without fostering 332Setting limits 333Dealing with a dangerous or out-of-control child 335Managing screen time and social media 336Taking Care of Everyone Else — Including Yourself 337Parenting Adult Kids with BPD 338Chapter 24: Advice for Adult Children of BPD Parents 339Mourning the Perfect Childhood 340Understanding the impact of BPD on children 340Reviewing your relationship with your parent 342Moving on with Your Life 344Setting boundaries 344Soliciting support 346Becoming resilient 346Chapter 25: Advice for Therapists of People with BPD 347Detecting BPD in the Early Stages of Therapy 348Maintaining Objectivity 350Keeping your therapist ego on the shelf 351Keeping therapist expectations within bounds 352Understanding Boundaries 353Dealing with Boundaries 354Taking Care of Yourself 358Part 6: The Part of Tens 361Chapter 26: Ten Quick Ways to Settle Down 363Breathing Away Distress 363Chilling Your Hot Emotions 364Picking Up Your Pace 364Massaging Away the Blues 365Surfing for Distraction 365Reading (or Listening to) a Great Book 365Mellowing Out in a Movie 366Playing to Improve Your Mood 366Phoning a Friend 366Getting Outside 367Chapter 27: Ten Ways to Say You’re Sorry 369Saying the Words Out Loud 369Asking for Forgiveness 370Running an Errand 370Sending Flowers 371Sending a Card 371Doing a Chore 371Writing Your Thoughts 371Finding a Poem 372Sending a Small Gift 372Making Amends: Giving or Volunteering 372Chapter 28: Ten Things You Shouldn’t Do 375Expect Quick Fixes 375Stay Stuck 376Choose Chiropractic Medicine 376Stick Pins and Needles 376Find a Life Coach 377Fill Up Emptiness with Food or Drink 377Try Too Hard 377Gaze at Crystals 378Get the Wrong Therapy 378Hope That Medications Will Cure BPD 379Appendix: Resources for You 381Index 385