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personality

 Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In my July Blog post, I referred to what happens when certain personality traits are too high or too low, causing life difficulties. Borderline Personality Disorder (BPD) is one psychological diagnosis or label that mental health care professionals and clinicians use to describe a specific pattern of problems. Typically, this pattern involves intense, chaotic relationships with both the self and others. Even though some of the traits involved are amplified versions of normal personality traits, many people with BPD will experience problems that are serious, and that most people never experience (Paris, 2017). Although there are some commonalities and a general pattern, individuals with BPD do not all have the same problems or experiences.

Let’s think of Jessica for example. She was recently diagnosed with BPD. She’s always felt something was “off”. She suspected early in life that she wasn’t feeling the way others around her felt: her emotions have always been so intense, it was as though she was walking around with no skin. She’s noticed she reacts impulsively to these intense feelings, which change from one moment to another. One moment she can be thrilled, the next, filled with sadness or rage. Along with these strong emotions is also an emptiness inside that she’s not sure how to describe to others.

Sometimes she feels her life is not real and asks herself “what’s the point?”. She often thinks of suicide, wondering if it’s the only way to stop her suffering. She’s even attempted to end her life a few times by taking pills, with mixed feelings when hospitalized and treated for these overdoses. She questions who she is, often feeling like a bad person who isn’t worthy of love. When she gets into a relationship, she’s afraid the person will leave and looks for ways to prevent this, or to have her partner reassure her that they won’t. Eventually, the ups and downs and efforts to avoid being broken up with cause a lot of stress in the relationship and it ends.

Jessica has received many diagnoses by health professionals in the past, including Generalized Anxiety, Depression, Attention Deficit and Hyperactivity Disorder, and Bipolar Disorder. She has tried therapy numerous times and felt frustrated because nothing seemed to “stick”. Recently, a new psychiatrist she was seeing diagnosed her with BPD.

Receiving a BPD diagnosis

It’s important to remember that a diagnosis, especially one of BPD, is not an identity: it describes a cluster of problems in someone’s life—what’s not working for them. Receiving the BPD diagnosis can be the key to getting the right help. When Jessica first got diagnosed, she went home and looked it up online. She was angered to find that much of what she was reading suggested there is something wrong with her personality and that she would be “difficult to treat”. She felt ashamed and angry with her psychiatrist, who she had no intention to return to see. She felt as though another health professional had let her down.

Despite this, she also felt some relief that she could make sense of what’s been going on, and eventually decided she would go for another visit to ask a few questions. Although she was hesitant, she told her psychiatrist how angry she was and was surprised that this led to a conversation during which she felt understood and even hopeful about the future.

Jessica learned that this diagnosis would allow her to get more specialized help, and together she and her psychiatrist came up with a plan. With treatment that fits (and some patience), Jessica can go from being diagnosed with BPD to no longer meeting any of the criteria and leading a more satisfying life. It’s also important to remember that when the label no longer describes someone’s current problems, it no longer applies.

Unfortunately, because of stigma around BPD, many people are reluctant to accept or disclose their diagnosis, which can get in the way of receiving appropriate help.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

Why the stigma?

Compared to other disorders, BPD is a fairly new diagnosis, with treatments having only been developed in recent decades. There are times individuals with BPD feel like their experience is unbearable. Their symptoms often reflect the intensity of their distress; When Jessica went to see the psychiatrist, she had cut herself badly and said she wanted to give up on life. Although her psychiatrist identified her diagnosis, some health care professionals may not recognize BPD or know how to help, leaving all parties feeling frustrated. In fact, people with BPD are often not diagnosed or treated at all. Sometimes, they are offered treatments that do not fit their problems. Since intense emotions are part of the experience, speaking about what’s most painful with a health care professional, who is often a stranger, can be quite challenging.

It is not surprising that there would be friction between someone consulting for a situation that feels urgent and impossible, and a health care professional who isn’t sure how to help. Sometimes, the clinician may themselves react unfavourably when feeling unsure or helpless. As you can imagine, these reactions would not be well-received by someone in distress who already feels let down.

In fact, it is likely that someone seeking help for these symptoms has already had many frustrating experiences in the health care system. As a result, they might express anger (even rage) or withdraw from treatment, which in turn might lead to the clinician distancing themselves even more. This can become a continuous self-fulfilling cycle and can help explain some of the frustrations that people with BPD as well as clinicians face (Aviram, Brodsky & Stanley, 2006). Unfortunately, cycles like this one perpetuate the stigma and contribute to a reluctance toward both pursuing treatment (on the part of those seeking help) and providing treatment (on the part of clinicians).

Maybe you relate with parts of (or all of) Jessica’s experience, and you’ve experienced these frustrations yourself. If you’ve been feeling helpless, hopeless, and chaotic on the inside (and maybe outside too), or like no diagnosis has made sense so far: Remember there is the right kind of help out there—help you can use to help yourself.

What to do if you think you might have BPD and want to consult:

1- Take a deep breath. Remember these are words to describe problems you are experiencing, and that having these words means you can communicate to get the help you need.

2- Look for someone who is qualified to assess and work with personality in therapy, or ask for a referral to someone who does. You can look online, or ask your GP or most health care professionals.

3- Be prepared to speak with someone by taking note of what’s most important to share about what you are experiencing.

4- When meeting a health care professional, observe whether you are feeling intense emotions, and challenge yourself to be open—to stick around and share your experience as best as you can, even if lots of uncomfortable emotions rise to the surface. Ask yourself: how can I help this person help me? Sharing your difficulties and what you are looking to work on are some ways to collaborate.

5- Give the person time to get to know you and figure out how to help. They may not know right away.

Don’t give up on getting the help you’re looking for. Sometimes, it takes meeting with a few different professionals before you feel you’re on the right track.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard review of psychiatry, 14(5), 249-256.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.

Personality Disorders: What’s a “Disordered” Personality Anyway?

Personality Disorders: What’s a “Disordered” Personality Anyway?

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We all have personalities. What makes someone’s personality “disordered?”. Personality is made up of traits; ways of being that make each individual unique. For example, those high on introversion (see Dr. Samuel’s post) feel most gratified when creating space to delve into their thoughts or activities on their own, whereas extroverts feel energized and at their best around other people. Another example: some people think and ruminate for a long time before they make a move, whereas others, who are more impulsive, make the move with little thought of outcome or consequence. Traits like these give rise to patterns of emotions, thoughts, behaviours, and relationships. Now picture these traits like an equalizer on your music player. Imagine the bass being at such a high level that you could hear nothing else and barely recognize the song. Or (perhaps worse?), imagine a song with only treble—no depth. The song could not be heard at its best without a balance of treble and bass. I like to think of personality as formed by the collection of traits at different intensity levels on our own personal equalizer. When a trait is so high or so low that it creates difficulties, it becomes a personality-related issue. For example, Joe often acts before thinking, constantly doing things he regrets and gets into trouble for. Joanne is the opposite; thinking and ruminating about each choice for so long, that she ends up getting nothing done!

When groups of traits are off balance, it can create a pattern of difficulties that can be described as a personality disorder. This is because being extremely high or low on certain traits can lead to day-to-day problems as well as complications with relating and connecting with others. These dysfunctional patterns originate and evolve from an interaction between genetic predisposition and life environment, often becoming more apparent as we reach adolescence. Some of these combinations of trait patterns and resulting problems have been categorized by psychiatrists in the manual of psychiatric disorders (DSM-5; American Psychiatric Association, 2013). These “personality disorders” are essentially specific groups of traits that whether too high or too low, have come to cause life difficulties.  

So what does that mean?

Is a disordered personality destined to be disordered forever? We used to think personality was stable (Costa & McCrae, 1980)—meaning that it does not change over time. More recently, we are learning that this is not entirely true (e.g., Ardelt, 2000; Caspi & Roberts, 2001; Roberts et al., 2017). While Joe isn’t likely to become a self-doubting ruminator, he can learn to pause before he acts (i.e., lower the level of impulsivity on that equalizer). Joanne will never be the reckless thrill-seeker Joe is; she won’t book a last-minute skydiving trip in a foreign country. But she might learn to limit the time she spends ruminating about decisions, taking the chance to act even when she doesn’t feel she’s done all her due diligence. Even though Joe is aiming to reduce his impulsivity, and Joanne’s goal is to be less prohibitively cautious, they would both aim for what’s in between: spontaneity. The in-between, or the grey zone is often where our traits work best for us. Most people can learn to bring their traits into balance and be more in-between (in Joe’s case, going from reckless impulsivity to reasonable spontaneity). Learning to move away from extremes to a reasonable and workable middle is the key to making personality our best asset. 

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So, how do you begin to make your personality work for you?

  1. Notice which traits might be too high or too low. Ask yourself: What’s working? What’s not? Use your emotions and life experiences to guide you here.
     
  2. Experiment behaving as though the traits were higher or lower to see what the outcomes would be. This will give you more information about what works for you and what does not. What would it be like to be more in the middle with traits that are too high or too low? Does that work better?
     
  3. Seek professional help with someone specializing in personality work. It can be difficult to see the big picture when you’ve always done things a certain way in the day-to-day. This is not a journey you have to take on alone. Although self-help books are an option, having a professional along your side can help you fine tune your equalizer.

Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References and Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Ardelt, M. (2000). Still stable after all these years? Personality stability theory revisited. Social Psychology Quarterly, 392-405.

Caspi, A., & Roberts, B. W. (2001). Personality development across the life course: The argument for change and continuity. Psychological Inquiry, 12(2), 49-66.

Costa Jr, P. T., & McCrae, R. R. (1980). Still stable after all these years: Personality as a key to some issues in adulthood and old age. Life-span development and behavior.

Roberts, B. W., Luo, J., Briley, D. A., Chow, P. I., Su, R., & Hill, P. L. (2017). A systematic review of personality trait change through intervention. Psychological Bulletin, 143(2), 117.

4 reasons why travel is good for our mental health

4 reasons why travel is good for our mental health

For those of us who love to travel, the days we spend exploring are just about as meaningful and fulfilling as they come. Traveling is a time to disconnect from the daily hassles and stress of work, experience the way other cultures live, try new flavours (a highlight, of course), and, ideally, escape the cold Northeastern winters. It is also becoming increasingly clear that traveling has a number of psychological benefits. Planning ahead and taking that vacation we have been dreaming about can have a positive impact on our well-being, relationships, and maybe even our personality.

1. Traveling can improve our mood and well-being

We all have an intuitive sense that taking a break or trip can help us feel recharged. The good news is that this feeling is supported by research. Taking a vacation actually does improve our well-being and mood (1-3). In addition to helping us feel happier and more relaxed, traveling can reduce burnout and make us feel like we are better able to handle our jobs when we return (4-6). In addition to improving our mood, taking time off work for a vacation is associated with a number of better physical outcomes, including fewer health complaints and improved sleep (2,4,7).

In most studies, we return to our pre-trip state about 3 to 4 weeks after returning home (2,5). However, even if some of the benefits are short-lived, taking a vacation can really help us cope in times of stress and there are plenty of other reasons why travel is good for our well-being.

2. Traveling can have a positive impact on our relationships

Building new connections and strengthening the relationships we already have is a big reason why so many of us are passionate about traveling (8).

For starters, it can sometimes feel much easier to meet, and even approach, new people when we are in a new environment and operating outside of our normal routine and comfort zone. Whether it’s through an organized tour or a chance encounter with a stranger at a café or museum, engaging with fellow travelers or locals can lead to meaningful interactions and even long-lasting friendships. There are also a lot of great apps and resources available for those who are committed to meeting new people while on the road, including Meetup, TravBuddy, and backpackr.

Traveling with our partner or family can also improve our existing relationships. Taking a vacation with our partner or spouse can actually increase our relationship satisfaction (9). Moreover, given that participating in leisure activities as a family can improve feelings of connectedness, it is likely that bringing the kids along can have a positive impact on family functioning (8). At the very least, traveling as a family will no doubt lead to stories and experiences that will be remembered for years to come.

3. Traveling can help us to practice gratitude

Traveling is also a great way to help us recognize how fortunate we are. Through interacting with different people and ways of life, traveling can help us realize our privilege and all of the things we have to be thankful for. Gratitude has been shown time and time again to help us live happier and healthier lives (10). Reflecting on the differences between the places we visit and our life back home, and being grateful for all that we have, including the means to travel, can help us feel more content. As a bonus, traveling and having the opportunity to meet others from different cultural, linguistic, and socio-economic backgrounds can also help us to be more accepting of diversity and compassionate toward others.

4. Traveling can impact our personality

If that’s not enough, research has also shown us that traveling can impact our personality in some pretty interesting and unexpected ways! We know that personality traits, such as openness to new experiences, can influence how likely someone is to seek out travel opportunities. Even more interesting, is that taking an extended trip can actually influence our personality. For example, long-term travel abroad can lead to increases in our openness to experiences, agreeableness (e.g., warm, empathetic, giving), and emotional stability (i.e., easygoing) (11). Oftentimes, the driving force behind these changes are the experiences and interactions we have with others while on the road.

Taken together, traveling can be an exciting and fulfilling experience, especially when we seek out meaningful interactions and connections. That being said, traveling isn't always in the cards. This is often true during the times when we feel like we need a vacation the most. The good news is that there are things we can do to recreate some of the benefits of a vacation while on a staycation.

  • The main benefits of travel come from disconnecting from the stressors of our everyday life. If you are planning a staycation, make sure you disconnect in the same way you would if you were actually out of town. Refrain from using your phone or the internet (especially for work-related tasks).
  • Take care of yourself. Eat well, sleep in, and try to be physically active. These are all things we are better at prioritizing while away on vacation and a big reason why we find travel so relaxing (3).
  • Schedule social and leisure time. As tempting as it is to stay home and relax on the couch for a week, chances are this isn’t going to help you recharge. Instead, pretend to be a tourist in your own city. Try new restaurants, check out the local museum exhibit, and get lost wandering around a new part of town. Setting aside time for leisure activities is a large part of what allows us to feel the positive impacts of vacation and travel (12).

Ultimately, regardless of whether it is a staycation or vacation, the key is to try and be mindful and in the moment. It can be tempting to count down the number of days we have left, or to feel pressure to document each moment so that we can share it on social media. The more we can resist these urges and focus on the present, the more likely it is that our vacation will end up being the experience we hoped for. Finally, planning our staycation or trip is a large part of the fun, so remember to enjoy this process too!


Miriam Kirmayer is a PhD Candidate in the Clinical Psychology program at McGill University in Montreal, Quebec, and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.


REFERENCES

1. Chen, C. C., & Petrick, J. F. (2013). Health and wellness benefits of travel experiences a literature review. Journal of Travel Research, 52, 709-719.

2. Strauss-Blasche, G., Ekmekcioglu, C., & Marktl, W. (2000). Does vacation enable recuperation? Changes in well-being associated with time away from work. Occupational Medicine, 50, 167-172.

3. Strauss‐Blasche, G., Reithofer, B., Schobersberger, W., Ekmekcioglu, C., & Wolfgang, M. (2005). Effect of vacation on health: moderating factors of vacation outcome. Journal of Travel Medicine,12, 94-101.

4. Fritz, C., & Sonnentag, S. (2006). Recovery, well-being, and performance-related outcomes: The role of workload and vacation experiences. Journal of Applied Psychology, 91, 936.

5. Westman, M., & Eden, D. (1997). Effects of a respite from work on burnout: vacation relief and fade-out. Journal of Applied Psychology, 82, 516.

6. Westman, M., & Etzion, D. (2001). The impact of vacation and job stress on burnout and absenteeism. Psychology & Health, 16, 595-606.

7. Gump, B. B., & Matthews, K. A. (2000). Are vacations good for your health? The 9-year mortality experience after the multiple risk factor intervention trial. Psychosomatic Medicine, 62, 608-612.

8. Pearce, P. L. (2012). Relationships and the tourism experience: challenges for quality-of-life assessments. In Handbook of Tourism and Quality-of-Life Research (pp. 9-29). Springer Netherlands.

9. Durko, A. M., & Petrick, J. F. (2013). Family and Relationship Benefits of Travel Experiences A Literature Review.  Journal of Travel Research, 52, 720-730.

10. Wood, A. M., Froh, J. J., & Geraghty, A. W. (2010). Gratitude and well-being: A review and theoretical integration. Clinical psychology review, 30, 890-905.

11. Zimmermann, J., & Neyer, F. J. (2013). Do we become a different person when hitting the road? Personality development of sojourners. Journal of Personality and Social Psychology, 105, 515.

12. de Bloom, J., Nawijn, J., Geurts, S., Kinnunen, U., & Korpela, K. (2016). Holiday travel, staycations, and subjective well-being. Journal of Sustainable Tourism, 1-16.