Understanding Borderline Personality Disorder "Triggers"

What is Borderline Personality Disorder?

According to the National Education Alliance for Borderline Personality Disorder, "Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to manage emotions effectively.”

BPD may be manifested through the individual's intense fear of abandonment, intense mood swings, anger or rage toward caregivers or partners, suicidal thinking, self-harming behaviors, and sometimes paranoia. Symptom severity may make it difficult for individuals to work toward meaningful academic, vocational, and relational goals. Most often, BPD is diagnosed by using the criteria established by the DSM-5.

Generally, BPD is most often diagnosed in adolescents and young adults. There are strong indications and evidence that the disorder will become more manageable as the individual progresses through adulthood.

What Causes Borderline Personality Disorder?

This is one of the areas in which the psychiatric community is unclear. It's really difficult to pin down exactly what causes someone to be diagnosed with BPD. With that said, there are two schools of thought.

First, there is evidence that some (and potentially all) components of BPD are tied to genetics. Just like we see a genetic component when it comes to physical illnesses, diagnoses such as depression, anxiety, or bipolar disorder may also be linked by family history.

Second, it would appear that many people are more vulnerable to having the diagnosis if they grew up in what we think of as an invalidating environment for some children and teens. An invalidating environment may we one where trauma or neglect takes place. Sometimes emotionally-sensitive children don’t feel like they fit in with the rest of the family and we might also consider that to be an invalidating environment.

Of course, parents don’t set out to “cause” BPD or create a family where trauma is likely to occur. I encourage families to be careful and not assign blame or judgment to themselves or others when someone in the family has been diagnosed with BPD.

As a therapist intensively-trained in dialectical behavior therapy, I believe in the assumption that all people are doing the best that they can. That includes individuals with the diagnosis of BPD and their family members.

All behavior is caused. —Marsha Linehan, PhD, creator of dialectical behavior therapy

What are "Triggers" for Someone with Borderline Personality Disorder?

The word “trigger” seems to bring with it so many negatives connotations. When I’m working with clients and their families, I almost always use the word “catalyst” as a substitute for “triggers.” When we think about some of the behaviors associated with BPD, the word catalyst refers to the events or actions that cause the problematic thoughts, emotions, or behaviors.

Here’s an example:

Kate is an emotionally-sensitive 19 year-old who is away at college for her freshman year. She has several roommates she met on her first day on campus. Like most freshman, Kate is eager to make friends and wants to be liked by her peers. She also fears rejection.

One of Kate’s roommates decides in the first couple of days that she doesn’t like Kate and behaves in a way that is polite and, yet, cool toward her. Because of this rejection, Kate feels a mixture of shame, sadness, and guilt. She’s had the thought, “There’s something wrong with me.” Less than a week later Kate calls her family in tears and says that no one at college likes her and that she wants to come home.

In this particular case, the catalyst for wanting to leave school is the perceived rejection. The thoughts and emotions that surround the event cause the behavior.

One of the most important keys to recovery is understanding how particular emotions, thoughts, or events serve as catalysts for BPD symptoms and behaviors.

It's important to note that the catalysts for a person's behaviors will vary from one individual to the next. There is no one-size-fits-all position here. With that said, some catalysts are more common than others. That list includes the following:

• the perception of being abandoned

• having one’s feelings hurt

• any form of rejection (even from a stranger)

• the loss of an important relationship

• being fired from a job or removed from a group

• memories of a traumatic event

While there are many other events and actions that can cause a moment of intense emotional dysregulation, the fact remains that the fear of exclusion, rejection, and abandonment seem to be most prevalent. When the individual feels they have been abandoned or shunned, it's common for them to react emotionally. Sometimes a person will strike out in anger at the source of the rejection or abandonment. This might also occur when people feel invalidated or dismissed. When that anger turns inward, self-sabotaging behaviors, alcohol use, drug abuse, self-harm, and suicide become real possibilities.

What's most concerning about one's catalysts is the idea a catalyst might not be a significant event in the eyes of a person who is not suffering from BPD. Here is a list of seemingly innocent catalysts that can drive a someone to BPD toward behaviors that invariably hurt them or others:

• not getting a return phone call when requested

• not getting an invitation to a party

• the lack of a response to a simple question

• not being called on in a classroom

• not being included in a decision making process

• being ignored, criticized, or judged

Anything that makes the individual feel they are being disregarded could serve as a catalyst for behaviors that are incongruent with that person’s goals and values. Identifying patterns can help everyone cope in ways that are more effective.

Can You (or Should You) Remove “Triggers”?

It’s probably not possible to identify and then remove all potential triggers—or catalysts—for ineffective behaviors. We don’t need to always shield or protect someone we love from upsetting events or difficult situations since these moments are often an important part of experiencing life as it is. Some people even find that tough situations help them to grow and build our emotional resilience. (I also believe this!)

A healthy (and compassionate) response is to help someone cope with the events that are upsetting. People with BPD can learn to soothe themselves and to understand their maladaptive patterns to approaching problems.

Helping the Individual Who Has Borderline Personality Disorder

Collaboration is key. Telling someone what to do or demanding change in a moment of emotional dysregulation will almost always cause more harm.

What people with BPD are missing is the ability to cope with the catalysts that drive their inappropriate behaviors. If they can learn to recognize and cope with their catalysts, they stand a fighting chance of leading a normal life.

The first thing you can do to help your loved one is to make sure they get a proper diagnosis and understanding about that with which they are dealing. With work with a well-qualified therapist, they can learn new coping skills or ways to understand their thoughts and emotions.

Here are some basic things your loved one can do to help offset the pain and anxiety they might face when feeling rejected or abandoned:

• Listen to some relaxing music

• Use grounding exercises

• Watch a funny movie

• Make chocolate avocado pudding

• Validate

• Relax in a warm bath

• Go for a walk together

• Read or listen to a book

• Review reasons for staying alive

• Seek help when things get really rough

• Color

• Practice self-compassion

What’s important for you to know is that you don’t need to solve all of your family member’s problems and you don’t need to try to say or do the “perfect” thing. You quiet presence is sometimes all that’s necessary in order to help your family member get through a difficult moment.

Think about what has worked for your family in the past. Is there something you could plan to do in the future to help you both?

If you are someone who loves an individual with BPD, please check out my course for family members and friends.

Seven Self-Help Ideas for Borderline Personality Disorder

Borderline personality disorder is a mental health diagnosis that can make it difficult for someone to cope with a variety of emotions and thoughts. Many people with borderline personality disorder live in a constant state of worry or fear over real or perceived abandonment. The diagnosis also leaves people significantly more likely to practice self-harm or die by suicide.

The good news is that, with treatment and support, a person with borderline personality disorder can find new ways of coping and feel better. The not-so-good news is that professional help may be exceedingly difficult to find in many areas of the world. Self-help strategies and tools can often assist a person in coping with their their most distressing symptoms.

Below you’ll find seven ways that people who have been diagnosed with borderline personality disorder can help themselves.

Identify Diagnostic Tools

Unless you are a mental health professional, you probably aren't going to be in a position to diagnose yourself or a loved one with borderline personality disorder. Only a medical professional can accurately give that diagnosis. However, the internet has made it easy for you to take online screenings that can help give you a better idea of whether or not you have a borderline personality disorder.

You can find other diagnostic tools by Googling queries such as: “depression screening online” or “anxiety test online.” I also like to recommend researcher Dr. Kristin Neff’s online questionnaire about being self-compassionate.

Although these tools may not be perfect, they may be a way for you to learn more about yourself and your symptoms. Just make sure the test you take is a reputable one and created based on best scientific and medical practices.

You may also want to check out this article on the pros and cons of self-diagnosing.

Mindfulness Techniques

Mindfulness is a process by which individuals are encouraged to be more "in the moment." It involves being present in things that are happening at any given second, rather than being absorbed in events of the past, future, or our own mind. It also means observing things that are occurring, and sensations that you are feeling, without being too judgmental, critical, or analytical.

Mindfulness, for most of us, is notoriously difficult and requires a great deal of practice and conscious observation. Other practices, like meditation, can help one achieve this state of mind. However, when it comes to mental illnesses in general, and borderline personality disorder specifically, there is good news, as mindfulness can help someone achieve piece and ease their symptoms.

Some people find that something as simple as coloring with pencils or markers can be a way to practice mindfulness.

Furthermore, mindfulness is a core component of dialectical behavior therapy, a specific type of component that has shown promise when it comes to treating borderline personality disorder. It can help individuals regulate their emotions, develop emotional discipline, and concentrate more on their feelings and emotions. It can also help to calm feelings of anxiety and depression.

Perhaps most importantly, mindfulness can help someone change their brain chemistry, thinking patterns, and emotional capacity. For people who are learning to cope with the symptoms of borderline personality disorder, this can be an important skill.

Meditation

Meditation, like mindfulness, can be incredibly helpful to someone with borderline personality disorder. Indeed, meditation and mindfulness often go hand in hand.

Meditation comes with many specific benefits. Meditation is a practice that involves slowing down, concentrating on thoughts, breathing, or a chant in order to ease one's mind. There are many different types of meditations, and all of these can have different impacts.

Many studies show the benefits of meditation on mental health in general. It can ease anxiety and symptoms of depression and make people feel more at ease and at peace. This, in turn, can regulate emotional intensity, calm emotional outbursts, and help people have healthier relationships - this, of course, can have a major impact on people with borderline personality disorder.

Indeed, as noted by a scientific review, individuals who have borderline personality disorder and meditate often show improvements over a number of symptoms.

Podcasts

I’ve loved podcasts for years and know that I learn a lot when I listen to each episode. You can find podcasts about topics that range from mindfulness, healthy relationships, self-care, and coping with anxiety or depression. If you have an interest, there a podcast waiting for you.

Here are some of the podcasts I like to recommend to my clients and their families.

(And if you have a favorite podcast to recommend to me, please let me know. You can write to me at amanda@hopeforbpd.com.)

Distract Yourself

Sometimes, the best thing you can do when you are in a moment of crisis is to distract yourself from whatever pain you are in. This can be exceptionally difficult, but there's good news: With practice, it gets easier.

How can you distract yourself? Thankfully, there are a variety of different ways.

• What's a hobby that you love? Are you a knitter? Puzzles? Drawing? Writing? Find a project and throw yourself into it.

• Is there work that you can do, either around your house or for your job?

This distraction can be tough. It can be painful, difficult to do. It can take time in order to learn how to distract yourself and determine what hobby or method works best. However, the important thing is that you try. You may find that engaging in a hobby is the best way to get yourself through a moment of crisis or an intense period of emotional pain. When that moment passes - and they do pass - you can reevaluate. But sometimes, the key is to push yourself through a problematic experience and bring yourself into a better place.

DBT Skills Training

Dialectical behavior therapy (DBT) is an evidence-based treatment that has been a life-saving therapy for people all over the world. Unfortunately, there are still many parts of the world where DBT is not available or may not be affordable.

If you cannot get access to a therapist or are on a waiting list for DBT, online skills training may provide you with an ideal way of helping to learn the skills you need.

Online skills training can you help you learn:

• ways to soothe yourself when you’re upset.

• how to control your thoughts and emotions.

• what to do when you feel empty, bored, or even self-destructive.

• how you to be a better, healthier version of you.

Seek Online Support

One of the many positives of the advent of the digital world that we live in is that there is no shortage of resources for people who are looking for help. Indeed, there are many Facebook pages and groups for people who are looking for support and information.

I also love to recommend #BPDChat on Twitter. It’s an encouraging and hopeful resource for many people who are seeking connection and encouragement.

These resources can be very helpful in a variety of ways, including helping you share your experiences, discuss coping techniques, and finding people who will be compassionate and validating. Please remember that you aren't alone, and you should find other people to share stories of healing and hope.

Online support, however, should never be confused with treatment with a licensed health care professional. Some online communities are positive and hopeful places to seek support and information but other web sites may contain information that is inaccurate and even harmful.

Note: If you are currently in a mental health crisis, please call your local emergency services or consider reaching out to to someone who is in a position to help. That next phone call or email may be the one that connects you to the resources you need the most.

---

If you want to learn more about borderline personality disorder, I can strongly recommend these books:

• The Borderline Personality Disorder Wellness Planner for Families

• Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder

• Beyond Borderline: True Stories of Recovery

Can Teens Be Diagnosed with BPD?

Parents and caregivers are increasingly becoming aware of borderline personality disorder (BPD) and its confusing symptoms. BPD is a form of biosocial disorder that begins with temperamental inclination. The degree of BPD a person may suffer is largely determined by the social environment. People suffering from the condition are often weighed down by extreme anger as well as intense shame, self-harming behaviors, and feelings of emptiness.

The other challenge is difficulty connecting with other people. Due to the high proclivity to interpret things negatively, individuals who are hypersensitive to social cues stand a high risk of experiencing heightened symptoms.

The signs of BPD may include:
• Intense emotional reaction, which is often inappropriate and disproportionate to the situation
• Dysfunctional self-image that may lead to serious consequences such as damaged identity
• Constant fear of abandonment and rejection
• Feelings of hopelessness, emptiness, or excessive boredom
• Acting out sexually
• Self-injury
• Suicidal thinking and planning
• Desire to engage in impulsive and risky behaviors as informed by self-destructive patterns
• Turning to substance use as a way to cope with thoughts or emotions
• Engulfing sense of anxiety and worry that creates urges that push the affected person beyond the existential risks

The intense emotional reaction felt by teens with BPD may mean mood swings from a happy expression to a despondent mood in a short time. Fear of abandonment is common among BPD sufferers. This feeling is often exacerbated by the thought of being left alone and can happen if a loved one or caregiver arrives home late or goes away for some time. The self-injury behavior exhibited by BPD sufferers can easily lead to suicidal behavior.

Research suggests that individuals with a diagnosis of BPD are at a greater risk of dying by suicide. The suicidal tendency is normally expressed through attempted suicide and suicidal gestures. The desire to engage in impulsive or risky behaviors may be heightened when the affected person is upset. This is often expressed through reckless driving, engaging in risky sex, binge eating, or using alcohol and drugs to help avoid thoughts or emotions.

While it may be tempting to imagine that a child or teen is threatening suicide as a way to seek attention, suicidal threats or attempts should always be taken seriously. If your teen is threatening to harm themselves or others, please contact your local emergency services.

Can you diagnose a teen with borderline personality disorder?
Yes! There is nothing to prevent a licensed healthcare professional from diagnosing a teen or child with BPD. In fact, most adults with BPD will recognize that their symptoms often began in childhood or when they were teens.

Many studies show that BPD can be traced to neurological factors, trauma, unstable or inconsistent relationships, and genetics.

A licensed mental health professional can diagnose a teen with BPD after an in-depth interview and assessment—including family history. Often it takes several appointments to make an accurate diagnosis.

According to article written by researcher Marie-Pier Larrivée, clinicians often find it difficult to diagnose BPD among adolescents because this is the stage when adolescents experience natural life transition, which is often marked by turbulence. A lot of these changes do not qualify as a personality disorder. For instance, adolescents typically experience moodiness and a certain degree of risk-taking and impulsive behaviors as they grow. This can happen without the teen falling into any serious personal or health problem.

Teens may be compelled to try out sex or alcohol out of individual or peer impulses. Although BPD is largely misunderstood, evidence-based treatment can help diagnose the condition more accurately. To achieve a better outcome, the treatment team constitutes professionals with experience in diagnosing and treating BPD.

The following therapeutic interventions can help achieve sustainable healing:
• Cognitive Behavior Therapy (CBT) – This form of therapeutic intervention helps bring valuable insights to the suffering teen by identifying the emotional issues causing a sense of isolation. CBT can also help the teen overcome self-defeating thoughts.

• Mentalization Based Treatment (MBT) – This is a form of psychotherapy developed by Anthony Bateman and Peter Fonagy in the United Kingdom. It’s designed to help the teen recognize and understand their emotions.

• Dialectical Behavioral Therapy (DBT) – This approach involves the application of mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation skills. Therapist are also available in between sessions to help the client and their family.

• Mindfulness and Self-Compassion Therapy – Several behavioral studies show that a focus on mindfulness and self-compassion training can help people with BPD overcome feelings of insecurities and improve coping skills.

• Experiential Therapies – Although music, art, and adventure therapy are not an evidence-based treatment for BPD, they may be very beneficial. These interventions are often helpful at building self-worth.

When considering therapeutic intervention, it is important to find the right therapist—someone who is experienced in working with teens with BPD. The healing process often involves breaking down the dysfunctional patterns that control the thought or emotional process and cause the teen distress. Family-based approaches are also highly recommended because teens are an integral part of the family. With love and support, family intervention can help facilitate the much-needed, long term healing.

The Role of Medications in Treating BPD
Prescription medication can also be used as part of the overall intervention but is often not necessary. In the United States, the Federal Drug Administration (FDA) is yet to approve any medication to help treat BPD. As a DBT therapist, I often encourage my clients and their families to think about lifestyle and nutritional changes as a potential alternative to medications.

Medications may help but some teens but parents and caregivers should not imagine that a pharmaceutical approach can replace evidence-based therapy, strong family support, and a lot of patience.

Conclusion
Teens can be diagnosed with borderline personality disorder. The diagnosis should not be delayed until after the teen turns 18 or 21. Moreover, families of suicidal or self-harming teens should not be encouraged to postpone treatment and wait to see if the adolescent outgrows the behavior.

Parents and guardians may find it challenging to get the right treatment and will benefit from educating themselves about this diagnosis.

---

If you are looking for additional information on helping children and adolescents with borderline personality disorder, please check out these books.

• The BPD Wellness Planner for Families by Amanda L. Smith

• BPD in Adolescents: What to Do When Your Teen Has BPD by Blaise Aguirre

• Parenting a Teen Who Has Intense Emotions by Pat Harvey

• The Highly-Sensitive Child: Helping Our Children Thrive When the World Overwhelms Them by Elaine Aron

BPD or Bipolar Disorder?

It is common for people to confuse bipolar disorder and borderline personality disorder (BPD), primarily because both diagnoses may have similar symptoms, such as depression, intense emotional responses, and highly impulsive behavior. However, bipolar disorder and borderline personality disorder are two separate and distinct psychological conditions, which means those suffering from them display different symptoms and will have different and, yet, similar treatment options.

When deciding whether a person is experiencing bipolar or borderline personality disorder, it is important to understand the unique traits of each condition.

Bipolar Disorder vs. BPD
Bipolar disorder is a mood disorder, like major depressive disorder, that causes extreme mood fluctuations. Bipolar disorder can strongly impact a person’s activity levels, emotions, thoughts, and functionalities, and episodes can sometimes last months.

Unlike bipolar disorder, BPD is a type of personality disorder that causes a person to relate, feel, think, and act differently than others. Those with BPD have difficulty regulating their emotions, and often, they experience a constant cycle of varying moods, behaviors, and self-image.

Symptoms of Bipolar Disorder
Individuals with bipolar disorder suffer from profound shifts in mood that vary over time. Patients often alternate between depression (lows) and mania (highs) with intermittent periods of normal mood. Common symptoms of bipolar depression include:

• Feelings of guilt and worthlessness
• Fatigue
• Inexplicable aches and pains
• Crying spells
• Periods of extreme sadness
• Pessimism and indifference
• Noticeable changes in appetite and sleep pattern
• Difficulty making decisions and concentrating
• Social withdrawal
• Thoughts of death or suicide
• Difficulty finding pleasure in usual interests

Common symptoms of mania include:

• Decreased need for sleep
• Elevated mood
• Racing thoughts, speech, or both
• Grandiose ideas
• Poor judgment
• Inflated sense of self
• Impulsive or reckless behavior
• An exaggerated sense of optimism or confidence
• Delusions and hallucinations (in some severe cases)

There are varying forms of bipolar disorder. Patients with bipolar I are more likely to experience extreme highs and lows while patients with bipolar II tend to experience hypomania (a less severe form of mania). Bipolar patients may also experience mixed episodes in which they experience both mania and depression simultaneously.

During periods of depression or mania, patients may need to be hospitalized if they are unable to function or are deemed a threat to themselves or others. Some patients may exhibit rapid-cycling bipolar I or II and experience four or more mood episodes within a year. Rapid-cycling bipolar disorder does not take place over a few hours—these cycles may continue for weeks at a time.

Symptoms of Borderline Personality Disorder
As previously mentioned, individuals with BPD often suffer from an unstable self-image and intense, difficult to regulate emotions. They are often impulsive, and their self-destructive behaviors can place a major strain on their interpersonal relationships. BPD patients may also experience many of the following symptoms:

• Frequently changing values and interests
• A pattern of intense and unstable relationships with others, for whom feelings cycle between love and hate
• An uncertain view of one’s role in the world
• Black and white thinking (the tendency to view situations, thoughts, and people as either totally good or bad)
• Distorted or unstable sense of self
• Changing opinions about others quickly (e.g., believing someone to be an enemy one day and a close friend the next)
• Self-harming behaviors, such as burning, overdosing, or cutting
• Difficulty trusting others
• Attempts to avoid real or imagined sources of emotional pain or abandonment
• Reckless or careless behavior, such as drug abuse, unsafe sex, overspending, and dangerous driving
• Intense fear of loneliness
• Frequent feelings of emptiness
• Constant thoughts of suicide
• Intense feelings of anxiety, depression, and anger
• Dissociation (the feeling of being outside of one’s own body)

It is important to note, however, that not everyone experiences BPD in the same manner. Some people may only have a few symptoms that rarely interfere with their daily functioning, while others may have numerous symptoms that may prevent people from reaching their vocational, academic, and relational goals. Stressful or emotionally painful events can also cause patients to experience BPD symptoms more intensely. From the perspective of others, such events may seem relatively unimportant or disproportionate to the emotions they elicit in the BPD patient.

Diagnosing Bipolar Disorder and BPD
To accurately diagnose a person with BPD or bipolar disorder, a trained mental health professional will ask them a series of questions about the duration and frequency of their symptoms. They may also ask about the person’s drug use and family medical history. Therapists and psychiatrists often use questionnaires or other assessments to collect such information.

If a person has experienced at least one episode of mania that has lasted for at least seven days or required hospitalization, they may be diagnosed with bipolar I disorder. If they have experienced an episode of hypomania and a major depressive episode, they may be diagnosed as bipolar II.

Naturally, there are cases where it is difficult to distinguish between the two conditions. To properly diagnose a patient, a physician or therapist may focus much of their attention on identifying specific symptoms. Some of these symptoms include:

• Self-harm: A significant percentage of BPD patients engage in self-harming behaviors. Although some bipolar patients may also self-harm, it is more common in BPD patients.
• Sleep: Bipolar patients often suffer from disturbed sleep patterns during bouts of depression and mania. Individuals with BPD can maintain a regular sleep pattern.
• Mania: Although patients with BPD can act impulsively, their impulsivity is usually not related to mania.
• Cycling moods: Except for those suffering from rapid-cycling bipolar disorder, individuals with bipolar disorder often have mood cycles that can last days, weeks, or months. BPD mood shifts typically only last a few hours or days.
• Unstable relationships: BPD patients have intense relationships that are often compounded by interpersonal conflict.

Once an individual is accurately diagnosed, they can work with their licensed mental health professional to create an effective treatment plan.

Psychotherapy Options
There is a wealth of psychotherapies available to patients suffering from BPD and bipolar disorder, however, dialectical behavior therapy (DBT) or cognitive behavior therapy (CBT) tend to be the most common. They entail the following:

• CBT (Cognitive Behavioral Therapy): One of the most common types of therapy in the world, CBT therapy helps patients identify certain core believes and behaviors and change them over time. CBT can also help patients learn how to self-soothe without resorting to dangerous behaviors. When working with a CBT therapist, patients will often identify recurring thought patterns and decide whether they are useful or constructive. CBT is also known to be a useful tool for patients suffering from anxiety.

• DBT (Dialectical Behavioral Therapy): Psychologist Marsha M. Linehan developed DBT—an evidence-based treatment that’s also a form of CBT—in the 1980s to treat individuals who were suicidal. Utilizing traditional mindfulness techniques and other therapeutic approaches, DBT is specifically structured to help patients suffering from BPD. Geared towards highly emotional individuals, DBT therapy may help individuals accept their self-destructive behaviors, values, and beliefs, and gradually change them over time. Patients may also learn tactics to avoid self-harming or self-sabotaging behaviors.

For individuals with a diagnosis of bipolar disorder, please check out Sheri Van Dijk, MSW’s book The Dialectical Behavior Therapy Workbook for Bipolar Disorder. (You can buy her book on Amazon.com here.)

• Self-Compassion Training: As a DBT therapist, I’m particularly fond of self-compassion as a therapeutic approach that can help people with both bipolar disorder and BPD. Regardless of any diagnosis, becoming self-compassionate is an important life skill.

Christopher Germer, PhD is a leader in this field. I love his books The Mindful Self-Compassion Workbook and The Mindful Path to Self-Compassion. (You can find his books on Amazon.com here.)

• Peer support groups: Often underutilized tools, peer support groups can be of immense help for both individuals who have been diagnosed with BPD or bipolar disorder. A peer support group is typically composed of several people with lived experience who can help, and groups are often led by certified peer support specialists. During a group session, individuals can expect support and encouragement while learning how to manage their symptoms. Some support groups may help guide participants to additional mental health resources in their communities.

In particular, I love recommending NAMI Connection, Recovery International, and organizations such as Emotions Matter as a great place to start when people are looking for information and support.

The type of treatment a patient chooses should be based on their own unique mental health needs and goals. Individuals with BPD or bipolar disorder should be encouraged to play an active role in their treatment.

The Importance of Proper Diagnosis and Treatment
Although bipolar disorder and BPD have many commonalities, there are several key differences between the two conditions. A licensed mental health professional can help diagnose and then provide treatment recommendations.

Both BPD and bipolar disorder are highly treatable and most people will have a good (or even excellent) prognosis with evidence-based treatment.

---

For additional information, please check out:

Who Can Diagnose BPD?

Emotionally-Sensitive or BPD?

Treating BPD Without Medications

DBT for Family Members and Friends

Sometimes obstacles can become opportunities. Please email me today at amanda@hopeforbpd.com for additional information about treatment consultation.

DBT: What Does it Mean to Be "Dialectical"?

Dialectical behavior therapy (or DBT) is an evidence-based treatment developed by psychologist Marsha M. Linehan and was designed to help people who sometimes experience overwhelming emotions.

One of the first questions people often ask is: What does it mean to be dialectical? Most say it’s a discussion, dialogue, or manner of speaking between two people or groups. While all are partly true, none capture the core essence of this very important idea. So, let’s explore its meaning, how it applies to DBT, and what the DBT skills can offer you if you or someone you love.

Defining Dialectical

The concept of dialectical thinking was first established by German philosopher Georg Hegel in the 1800s and he was the originator of the thesis —> antithesis —> synthesis model of logic described below.

The developer of DBT, Marsha M. Linehan, describes dialectical thinking or the dialectical process as synthesizing or integrating opposites. In essence, she believes that opposites can be simultaneously true or—in her words—there’s a “kernel of truth” in opposing ideas. When we recognize (and honor) that kernel of truth, we help ourselves and, subsequently, start creating healthier relationships. It’s a way to bring people together.

This can be a very important skill to learn if you are someone who has a lot of all-or-nothing or black-or-white thinking. Sometimes it’s okay to let go of the absolutes (the “musts” and the “shoulds”) and embrace the nuances of life.

We can identify dialectical thinking with a fairly simple formula:

• thesis
• antithesis
• synthesis (<— This is the dialectic.)

Here’s a very easy way to think about the synthesis of opposites:

• Red
• White
• Pink (<— This is the dialectic.)

Or we can use a different color:

• Black
• White
• Gray (<— This is the dialectic.)

One of my favorite examples of dialectical thinking comes from author Glennon Doyle Melton in her 2013 TedX talk, Lessons from the Mental Hospital. She says:

• Life is beautiful.
• Life is brutal.
• Life is brutaful. (<— This is the dialectic.)

Another favorite way to think dialectically comes from Kiera Van Gelder. Kiera is the author of the memoir, The Buddha and the Borderline. (You can buy her book on Amazon.com by clicking here.) She has used this example of dialectical thinking:

• I have borderline personality disorder.
• I don’t have borderline personality disorder.
• Either way, there’s more to me than just a diagnosis. (<— This is the dialectic.)

Marsha M. Linehan suggests that our states of mind can even be dialectical.

• Emotion mind
• Reasonable mind
• Wise mind (<— This is the dialectic.)

In my article titled How to Recover from Borderline Personality Disorder, I discuss a “dialectic of recovery,” or a way to understand recovery from BPD in a way that is balanced. I’d love you for to take a moment and share it with others.

We all have examples of dialectical thinking. As an intensively-trained DBT therapist, I often encourage my clients to come up with their own examples of dialectics in their lives. Marsha M. Linehan has many more examples in her book DBT Skills Training Handouts and Worksheets. (You can buy her book on Amazon.com by clicking here.)

“And” Not “But” in DBT

Another way to think about dialectical thinking is to notice how we talk about ourselves or others.

Are you a “Yes, but…” person? Do you reject ideas by pointing out the potential flaws or by suggesting that the idea isn’t “good enough”?

It’s interesting to think about the language we use each day and how it can make a difference when it comes to our emotional health.

For example, perhaps someone has suggested to you, “Go for a walk. You’ll feel better.” If you’re like most people, you may have responded with something like, “No, that won’t work. I might feel better but it will only last for a few minutes.” Those little buts can keep us stuck in patterns that are not a part of a life worth living.

A commitment to dialectical thinking may help us by learning to respond with something like, “Yes, I’ll go for a walk and if I feel sad again, I’ll go for another walk.” Or maybe we’ll say, “I’m willing to take a walk and see if it helps.”

It’s a small difference in the language that we use and it can be pretty powerful.

This is a dialectical couple—separate and, yet, working together.

The Ultimate Goal of DBT

The ultimate goal of DBT is pretty simple: create a life that is worth living. You are the one who gets to decide what that life worth living looks like. If there’s a particular goal you want to reach, there’s probably a DBT skill to help you.

Thanks to the ideas inspired by Georg Hegel 200 years ago and developed in the 1980s by Marsha M. Linehan, we have a very effective evidence-based treatment for individuals suffering from emotional dysregulation, depression, anxiety, addictions, suicidal thinking, and self-sabotaging behaviors. DBT can help give you the emotional and cognitive freedom you’ve been looking for in your life.

Perhaps today’s the day for you to embrace dialectical thinking.

---

Interested in learning more about DBT? I’d love for you to check out My Dialectical Life or my course for family members and friends by clicking here.

Is Exercise a Treatment for Depression in BPD?

For people who are looking for alternatives to medications or for those who are looking to integrate physical and emotional health therapies, exercise may be something to seriously consider.

It’s often encouraging for people with BPD and their families to know that there’s lots of evidence to suggest that exercise can make a positive difference in their moods. In fact, there’s research to show that those suffering from attention-deficit disorder (ADD or ADHD), impulsive behaviors, sleep problems, memory issues, depression, post-traumatic stress disorder (PTSD), and anxiety can all potentially benefit from regular exercise.

The Benefits of Exercise in Treating BPD

As a DBT therapist, I’m always interested in finding different ways to help my clients feel better faster.

Recently I came across an article about exercise as a treatment for attention deficit hyperactivity disorder (ADHD) and the authors concluded that exercise may also be beneficial for individuals with a diagnosis of borderline personality disorder—a research area that received very little attention.

But there are many reasons why exercise might be helpful for people who have been diagnosed with BPD.

We know from research published in 2019 that excessive screen time may put people at a “significantly higher risk of depression.” Another article from 2018 showed that sedentary teens may be vulnerable to an increased risk of depression. If too many hours of gaming, watching Netflix, or using apps like Instagram or Facebook may be contributing to depression we can imagine that getting outside and engaging in exercise might help reduce depressive symptoms—without the side-effects or potential long-term consequences of antidepressant medications.

It’s important to note that teens who are more sedentary are also at a greater risk for feeling lonely. Unfortunately, we know that feelings of loneliness may increase suicide risk. This evidence is another excellent reason to think about the positive benefits of group sports or exercise classes where people have an opportunity to connect socially with others and potentially create friendships.

An evidence-based approach to the treatment depression called behavioral activation can be very helpful when combined with exercise. The authors of this particular research concluded that, “Participants who engaged in more exercise also evidenced greater and faster declines in depression.” You can read more about behavioral activation by checking out this book on the science of behavioral activation by Christopher R. Martell, Sona Dimidjian, and Ruth Herman-Dunn.

We also know that exercise may help reduce the symptoms of depression very quickly. One study published in 2016 concluded that, “Exercise reduced depressed mood 10 and 30 minutes following exercise.” For people who want to manage daily depressive symptoms, we can think about the benefits of a few minutes of exercise twice daily. A quick walk in the morning and then again around noon may help people to manage their energy and remain productive during a major depressive episode.

Finally, we know that regular exercise can help to prevent future depressive episodes. The authors of this 2018 study wrote that, “Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.”

The Cons of Exercise in Treating BPD

There are also potential obstacles in using exercise to help treat borderline personality disorder.

It’s important to acknowledge that asking someone to exercise during a major depressive episode is like asking them to ride a unicycle uphill in the rain. It’s much easier to stay in bed, binge watch The Office (again), or ruminate about how this feeling may last forever. Even when the pros outweigh the cons, exercise may be emotionally and physically exhausting—especially in the beginning.

It may be also true that sedentary individuals should be cautious in starting any exercise program. When in doubt, I encourage my clients to make an appointment with their doctor or nurse practitioner before undertaking any intense training goals. No one needs to go from zero to CrossFit in one week or even one month. Because stress fractures are not a part of a life worth living, incremental and moderate progress is a reason to celebrate.

Recovery from BPD

The people I work with who have the best prognosis are individuals who prioritize their emotional and physical health. They exercise, pay attention to diet, put themselves to bed at a reasonable time each night, avoid drugs and alcohol, and think about preventative care. Moreover, they recognize the deep connection of body and mind. How we care for our physical health really does affect our emotional well-being.

If you are someone looking for treatment options for BPD or alternatives to traditional treatment, regular exercise may be something to seriously consider.

Today you can ask yourself:

• Is there a small change I can make today to help myself feel better?

and

• Do I need to ask for help in making this change?

Asking for help is one of the bravest things you can do. If you are looking for a DBT therapist, this directory may be a smart place to start.

---

Want more? Check out these resources about BPD and DBT:

• My Dialectical Life

• How to Recover from BPD

• Seven Self-Help Ideas for BPD

• Treating BPD Without Medications

Can Dating and BPD Mix? Creating Healthier Relationships When Someone Has Been Diagnosed with Borderline Disorder

As a DBT therapist, sometimes I have clients who wonder:

• Should I be dating while I’m in treatment?
• Will I ever be in a healthy relationship?
• How can I find someone who is validating and supportive?
• Will my partner judge me if I tell them about borderline personality disorder?

These are all great questions.

I encourage my clients to think about their goals when it comes to dating and even marriage—even early in treatment. Because a life worth living means creating or cultivating healthier relationships, I want for my clients to have the tools they need to accomplish this important goal.

Creating healthier and lasting relationships always starts with us—not the other person.

Sometimes we have unrealistic expectations in relationships. If you are looking for the perfect person to make everything all better, you may be in for a very long wait. In my experience, being in love or being loved does not make everything all better. Love certainly doesn’t “cure” BPD, addiction, domestic violence, or any other problems. Other people cannot do the hard work that it takes to recover from borderline personality disorder, depression, anxiety, or another mental health diagnosis.

I believe that it’s impossible to have a healthy relationship unless we define what a healthy relationship looks like.

Here’s a check list of the qualities of someone who has the capacity to be in a healthy relationship.

How many of these are true for you?

☐ I can validate others.

☐ I am comfortable saying no.

☐ I am mindful of others when we are having a conversation.

☐ I don’t expect perfection from others.

☐ I respect myself.

☐ I work hard at not judging others.

☐ I give as well as take.

☐ I don’t try to “rescue” or change others.

☐ I take care of myself (physically, emotionally, financially, and spiritually) so that I can be there for others.

☐ I am compassionate toward others.

☐ I recognize when I am judging others.

☐ I am confident in asking for what I want or need.

☐ I don’t have to be “right” or always get my way.

☐ I don’t apologize for my values or beliefs.

☐ I don’t threaten others—even when I have a right to be angry.

☐ I can be kind toward myself.

☐ I keep my word.

☐ I am responsible and don’t expect others to take care of me.

☐ I am thankful for others in my life.

☐ I don’t give advice unless I ask for permission first.

☐ I work to resolve conflict quickly.

☐ I don’t use others for my sexual gratification.

☐ I check the facts before I make assumptions about what others are thinking or feeling.

☐ I refrain from yelling.

☐ I don’t expect others to anticipate my physical or emotional needs.

☐ I am open to receiving help with problems I cannot solve on my own.

☐ I am accepting of others when they have different values.

☐ I am self-validating.

☐ I don’t have to change to make someone like me.

☐ I don’t make excuses for abusive, mean, or controlling behaviors.

☐ I am truthful with others.

☐ I assume that others are doing their best.

☐ I am proactive about reaching out to others who are important to me.

☐ I am forgiving.

☐ I don’t rely on one person to meet all of my emotional needs.

These ideas don’t apply to only romantic relationships. Many of these attributes can also be important indicators of healthy relationships with friends and even work colleagues.

Of course, there are no perfect relationships. I believe that we are all doing our best and—at the same time—we all have room to grow and change. You have the freedom to make decisions about any changes that may help you to be the partner or spouse you want to become. Don’t allow someone else to tell you what you should or shouldn’t do in relationships. You don’t have to let others decide how your relationship should look.

Using the above check list requires a lot of honesty and self-awareness about areas where we may need additional help. I encourage you to share your answers with the people you care about the most.

Above all else, guard your heart, for everything you do flows from it. —Proverbs 4:23

Finally, please be careful about being in a relationship where violence or the threat of violence occurs. If you are in an abusive or dangerous relationship, please contact the experts at The National Domestic Violence Hotline. They can help you take the first steps toward safety in your relationship. Taking a break from hurtful relationships or remaining single for a predetermined period of time can be a way for you to take care of your emotional health and increase your self-respect.

---

Interested in reading more about creating healthier relationships? Please check out some of my favorite books to recommend to my clients and their families.

How to Be Single and Happy: Science-Based Strategies for Keeping Your Sanity While Looking for a Soul Mate
This book is by Jennifer Taitz, PsyD—a super-smart DBT therapist. I love her optimistic and encouraging approach to future relationship success.

The Science of Trust: Emotional Attunement for Couples
John Gottman and his wife are experts at helping couples save their relationships. This is a must-read for anyone who is looking to better understand themselves and others in romantic relationships. Also check out Dr. Gottman’s book The Relationship Cure.

The Highly Sensitive Person in Love: Understanding and Managing Relationships When the World Overwhelms You
Elaine Aron, PhD is the foremost expert in the field of emotional sensitivity. She has several books that may also be beneficial for someone who is in a relationship with an emotionally sensitive person.

Are We Doing the Best That We Can? An Idea from Dialectical Behavior Therapy

Within dialectical behavior therapy (or DBT), there exists many assumptions that therapists and clients are asked to make. The first one is that all people are doing the best that they can.

But is this true? Are others doing the best that they can? We can also ask ourselves, “Are we doing the best that we can?”

It’s an interesting question to explore but, first, there are other assumptions we are encouraged to make in DBT. These include:

• People want to improve.

and

• People need to do better, try harder, and be more motivated to change. (It’s a nice reminder that we all have room to grow and change but we may need a little extra help.)

Most people will say that they are doing the best that they can—at least most of the time. I think that people can also identify with the desire to improve their lives while also realizing that it takes a lot of hard work to change the parts of ourselves we do not like.

If this is true for us, it may also be true for others in our lives.

And there may be some exceptions. For instance, sometimes people really do have the intention to cause harm to us or others. Understanding that most people are doing the best that they can does not mean, however, that we excuse or are quick to forgive others. You already know that it wouldn’t be the wisest choice for us to stay friends with someone who has stolen money from us or taken advantage of us in some other way. The same is true for people who may have physically harmed, abused, or neglected us. We can understand why people may hurt others but that doesn’t mean that we want to continue to remain on the receiving end of someone else’s pain, trauma, or addiction.

If you are in a relationship with someone who intentionally physically or emotionally hurts you, please think about reaching out to an expert who can help you make a smart decision about weighing the pros and cons of staying in that relationship. The compassionate and nonjudgmental people at The National Domestic Violence Hotline can help get you started or you can look for a therapist who specializes in helping couples create healthier relationships. Locating therapists who have been trained by The Gottman Institute can be a great place to start.

If we’re honest with ourselves, we may also think of a time in our past when we intentionally hurt others. This is especially true if we’ve been hurt ourselves. We might think, “I’m going to get back at them,” or “I want him to suffer as much as I have.”

Sometimes we inadvertently harm others when we are in emotional pain. We don’t mean to blow up relationships, invalidate others, yell, threaten, or cause people to worry about us but it does happen. All of us are guilty of this at one time or another. It’s actually a pretty normal part of been alive. If you have hurt someone else (either intentionally or unintentionally) you could apologize and work hard to change any future behaviors that may be harmful toward others.

Of course, it’s a choice to harm others. We don’t have to act on these urges. In fact, refusing to engage in these kinds of urges is a sign of being an emotionally-healthy individual. As a DBT therapist, becoming healthier is an important goal for the people I work with each day.

When I think about the idea that people are doing the best that they can, I often think about the wisdom of writer Maya Angelou:

Do the best you can until you know better. Then when you know better, do better.

I know that this has certainly been true for me as a therapist, wife, sister, and friend. Perhaps you find that it’s true for you or for someone you care about.

---

If you’re interested in learning more about DBT, I’d love for you to check out My Dialectical Life—an affordable DBT self-help tool.

I love recommending Marsha Linehan’s book DBT Skills Training Handouts and Worksheets (Second edition), for additional information about assumptions in DBT.

Emotionally Sensitive or Borderline Personality Disorder?

Are you someone who is emotionally sensitive? Have you also been diagnosed with BPD but wonder if it’s an accurate diagnosis?

A diagnosis of borderline personality disorder can be hurtful to many people. When I’ve talked about the diagnosis with many of my clients, they will often ask, “Do you mean that there’s something wrong with my personality?” People may also ask, “Will I have this for the rest of my life?”

In short, no, there is nothing wrong with your personality (really!) and again, no, with good treatment, hard work, and patience most people will find freedom from the symptoms of BPD.

Borderline personality disorder is an imperfect name for a cluster of symptoms that may include:

• mood swings
• suicidal thinking or planning
• depression and/or anxiety
• self-injury
• intense anger
• black and white thinking patterns
• self-hatred
• excessive shame or guilt
• self-sabotaging or self-destructive behaviors
• paranoia or dissociation
• emptiness, boredom, and loneliness

Please note that this is not a complete list of diagnostic criteria and I urge people to be cautious in self-diagnosing. It’s also important to recognize that not all individuals with BPD are alike. Unfortunately, stereotypes of people with BPD exist and these myths make getting treatment more challenging.

Another important characteristic of BPD, however, is often emotional sensitivity.

Emotional Sensitivity in BPD

People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement. —Marsha Linehan, PhD

Most people with BPD are emotionally sensitive but that doesn’t mean that all people who are emotionally sensitive have BPD.

So what’s the difference? And does it really matter?

First of all, it’s okay to be emotionally sensitive in a world where people aren’t always open to emotional sensitivity. There is nothing wrong with being a sensitive person. The goal isn’t to become a less sensitive person. You don’t even have to medicate emotional sensitivity!

The truth is that the world needs people who feel deeply and are in touch with their emotions. Emotionally sensitive people make contributions to the world through design, art, writing, and dance. Many professional healthcare workers are also emotionally sensitive. And what would we do without the therapists, doctors, and nurses who deeply care about others and work so hard to help?

Emotional sensitivity, however, may become a challenge when:

• emotions get in the way of important academic or vocational goals—again and again
• people are hurt and then end positive, healthy friendships or romantic relationships prematurely
• individuals reject or push away their emotional sensitivity (self-acceptance is very healthy)
• people expect to be hurt by others
• emotions keep people from making new friends
• people have a hard time trusting others

If your experience in being emotional sensitive is often hurtful, it’s okay to think about getting a little extra help from a mental health professional. We know that therapeutic approaches such as self-compassion, mindfulness, and self-validation may be very beneficial in helping people care for themselves. Even dialectical behavior therapy may be helpful for people without a diagnosis of BPD.

In the end, it may not make a big difference if someone has BPD or is emotionally sensitive. We can understand that feeling better and creating healthier relationships is what really counts.

Understanding yourself—or someone you love—can lead to more happiness.

Interested in reading more about emotional sensitivity? Please check out some of my favorite books to recommend to my clients and their families.

The Emotionally Sensitive Person: Finding Peace When Your Emotions Overwhelm You
This book is by Karyn Hall, PhD. She’s a terrific DBT therapist in Houston, Texas and specializes in an approach called Radically Open DBT.

The Highly Sensitive Person
Elaine Aron, PhD is the foremost expert in the field of emotional sensitivity. She has several books that are also beneficial for parents and partners of individuals who are emotionally sensitive. Please check out her workbook for highly sensitive people.

The Empath’s Survival Guide
Judith Orloff, MD writes from the perspective of an empath. This is a smart book with lots of practical ideas for navigating emotional sensitivity.

Please note: I participate in Amazon's affiliate program. That means that I may receive a small commission from items purchased through many of the links contained in this article.

Grounding Exercises for Individuals with BPD (Who Sometimes Dissociate)

(Please bookmark this page now. You, or someone you love, may need it in the future.)

Are you someone who feels detached or separated from your surroundings? Do you often have moments where things don’t seem real—especially when life is stressful? Perhaps people tell you that you’re not paying attention or daydreaming when you’re really trying hard to stay connected?

These may be symptoms of dissociation. (Ask your therapist, doctor, or nurse practitioner for more information if you have questions.)

Some people with a diagnosis of borderline personality disorder dissociate often, but for others, it’s rare or something they don’t experience at all. Dissociation may be voluntary (you might “shut down” to protect yourself if someone is yelling or if you have a disturbing memory), or it can be involuntary. A lot of people can tell when they are vulnerable to dissociation and then can take steps to help themselves stay mindfully present. This may be a way to help prevent dissociation or shorten the duration of dissociative episodes.

“Grounding” refers to a set of strategies that can help us to cope more effectively with whatever is happening inside or outside of us. If you are someone who is familiar with the skills from dialectical behavior therapy, you may already know about some of these ideas.

Here are some ideas to help you ground yourself with your five senses:

Taste
• Tasting something warm like an herbal tea may be soothing.
• Or you could use something cold like a popsicle, ice, or a frozen drink (like a Slurpee or an Icee).
• You might also decide to ground with something that tastes sour or bitter (a lemon wedge or a piece of sour candy could help).

Touch
• Holding or petting your dog or cat may help you to feel “real” and in control.
• You could also touch something that is soothing (a favorite river rock or a photograph of someone you love).
• Massage your scalp.
• Go barefoot outside.
• Sometimes heat helps people. If you have a heating pad or a hot water bottle, you could try that as a way of grounding yourself.
• Using a weighted blanket might be another way for you to feel safe and cope with dissociation.

Scent or Smell
• What is a perfume or scent that makes you happy? Now is the time to use it.
• You can make your entire home smell like a French or Spanish garden if you drop a little lavender oil in a pot of simmering water.
• Baking cookies or bread can also create a relaxing and soothing aroma.
• Go outside and smell the air. Can you smell the grass? Can you tell if it’s about to rain or snow?

Sound
• Listen to music that makes you happy at full volume. (Check out these songs if you need ideas.)
• Call someone who has a soothing voice and talk to them for five minutes.
• Sing loudly.
• Put on your headphones or earbuds and listen to a podcast about DBT. (Don’t do anything else. Just listen.)
• Go to a quiet room or shut off any potential sources of noise. Allow yourself to be quiet for a few moments.

Sight or Vision
• Find pretty Instagram accounts or start an Instagram account where you collect relaxing images.
• Look at old photographs that create feelings of happiness and connection.
• Watch videos of baby animals playing. (Corgi videos increase my happiness.)
• Paint or color. Create something pretty now.

Movement
• Jump on a rebounder or trampoline. (I have a bellicon rebounder in my office. I love it!)
• Use a balance board.
• Practice gentle stretching.
• Do a headstand.
• Run up and down your stairs as quickly as you can.
• Stomp your feet—hard.
• Practice progressive muscle relaxation.

Want more? Check out these resources about BPD and DBT:

• My Dialectical Life

• BPD Crisis Resources

• Seven Self-Help Ideas for BPD

• Changing Your Emotions with Music

• Coping Statements for Self-Harming Behaviors

Please note: I participate in Amazon's affiliate program. That means that I may receive a small commission from items purchased through many of the links contained in this article.