It was the perfect September evening – the air was cool and crisp – a blessed respite from the oppressive Kansas summer. I was finishing up my evening walk. Normally my friend Dina was with me, but tonight I was alone. As I gazed up at the stars dotting the black sky, a feeling of dread washed over me.

I felt vulnerable. Exposed.

Someone could fly over right now and shoot at me.

Irrational? Normally, yes. But not this night. This night was September 13, 2001. Barely 48 hours since our world was invaded and changed forever. Normal things like taking walks and getting gas and dropping my kids off at school were now laced with fear and anxiety. Even walking in my ridiculously safe neighborhood left me with a profound sense of uneasiness.

Since that time, I–and all of us–have had to regain our bearings and do normal things without feeling fear. We have had to figure out how to keep moving while accepting the reality that everything can change in an instant.

The anniversary of that awful day—combined with the images of devastating earthquakes and hurricanes and fires that are currently invading our physical and emotional space—has got me thinking a lot about how to find a balance in this reality.

As a therapist, I hear story after story of people trying to manage their own disasters. The mother whose daughter committed suicide; the wife who refuses to bail her husband out of jail because that’s where he belongs; the man who madly loves a woman who abuses alcohol (and him) and can’t decide if life would be better with or without her. The teenager who probably isn’t going to get asked to prom and wouldn’t be able to afford a dress if she was.

Our stories are different, but in one way or another, we all have to face the reality that life just isn’t turning out the way we thought it would. And when the world literally crashes down around us – when the marriage fails, the storm batters, the fire threatens or the earthquake divides – how do we even begin to do normal things like buy bread at the grocery store or brush our teeth or take the dog for a walk?

When we lose anything—a person, a dream, our minds—we can’t help but think how absurd it is that people are still trimming their toenails, stoplights are still changing and banks are still keeping normal business hours.

Whether we like it, understand it or want it to be, the ordinary and the tragic will always end up occupying the same space.

It seems a little much to wrap our tiny brains around.

I’ve found that thinking dialectically can help.

A dialectic refers to the “synthesis of opposites.” It allows us to find truth in two seemingly opposed ideas: I don’t want to go to work, but I need money. My kid drives me crazy but I would give my life for him.

Completely opposite ideas that are true at the same time.

To think dialectically, we have to learn to be “both/and” instead of “either/or.” When we face tragedy, we have to open up our hands and hold the grief and joy side by side. It’s a messy business, but it can be done.

And really, it must be done. I have had one-time appointments with people who couldn’t do it. I have met with them and heard their stories, but then they leave.

“You can’t help me,” one beautiful grieving mother told me as she walked out my office door, “you can’t bring my son back.”

Broke my heart, because I knew she was right on both counts.

People do though – they find ways to grieve and go on at the very same time.  The woman who started Mothers Against Drunk Drivers. The man who dedicated his life to finding missing children after losing one of his; millions of others who, in the face of unspeakable tragedy, wake up each morning and keep doing ordinary and extraordinary things.  These courageous souls decide not to let their pain define them, and instead to allow it to do something good.

So just how do we go about living both/and in an either/or world? Here are some ideas:

Learn to practice radical acceptance—This came from Marsha Linehan, the woman who developed Dialectical Behavior Therapy. Radical acceptance says, “It is what it is. I didn’t choose it, I don’t want it, I didn’t ask for it, but it’s on my plate, so what am I going to do with it?” Joni Eareckson Tada is an accomplished author, speaker and artist. She became a quadriplegic at age 18 when she miscalculated the depth of the lake she was diving into. She draws amazing works of art–with her mouth. This is a woman who has mastered the art of radical acceptance.

Find something to live for that is bigger than yourself – many people find this in spirituality. Like Job, they cry, they scream, and they rage at God, and then, when they are exhausted, they sit quietly and listen. They gain perspective and decide that to build a life worth living, they must find something worth living for.

Invite gratitude to be a part of your life – I know from experience that gratitude is transformational. When I get crabby about being stuck in traffic, I can be grateful for a car to drive and a job to go to. When I get irritable about having to park on the 6th floor of the parking garage, I can be grateful that my legs and lungs work well enough to get me up the stairs. Gratitude takes the edge off my irritability and allows me to see the good in the difficult.

Stop being invested in outcomes – This is a hard one, because we are an outcome-oriented people. But letting go of responsibility for the outcome and living well in the process can slow us down, clear our thinking, and help us figure out what’s most important. Your kid may not go to med school. Your boss may not give you the promotion. Not getting what we want can be enormously disappointing, but it can also lead us down paths we never would have ventured onto otherwise.

Get busy creating a life that reflects your priorities – There’s nothing like a good natural disaster to get our attention. Crisis has a way of stripping life down to its most basic priorities. I’ve noticed that when people start to get healthier, they naturally start working on creating a life that is more reflective of their priorities. I once worked with a woman whose husband walked away from a lucrative career in the oil business to go to floral school. Simplify your life, get out of debt, find a job you love, invest your life in people instead of things.

Lean in to the pain – Ugh – one of those overused-but-true clichés. When pain or anxiety or grief or despair overwhelm you, instead of running from it, lean into it. What can you learn about yourself and others? Where are you vulnerable? What do you need? What are you settling for? What are you doing to numb or ignore the pain that is trying to get your attention?

The same sun that melts the wax can harden clay

And the same rain that drowns the rat will grow the hay

And the mighty wind that knocks us down

If we lean into it

Will drive our fears away.

Sharon was a 45-year-old woman who led an idyllic life. Her husband had a good job, her children were healthy and they lived in a desirable neighborhood in a beautiful home. By her own description she was an introvert, but had a few good friends and enjoyed doing crafts and decorating. So why was she coming to see me?

Anxiety. Sharon was experiencing near-panic attacks almost daily—for no apparent reason. She couldn’t identify any real triggers. She led a healthy lifestyle – exercised daily and tried to get enough sleep. Nonetheless she was nearly crippled by an overwhelming sense of dread that accompanied her every move. Medication provided some relief, but not nearly enough.

This is a more common story than you might think. I see clients regularly who struggle with symptoms of anxiety, depression, binge-eating or trouble controlling their tempers. For all intents and purposes their lives are pretty stable – they take medication, they have support, and they have good jobs. And yet they are plagued by feelings they can’t seem to shake.

If you are stuck in your own mental health journey, here are some possible reasons why:

  1. You have unresolved trauma – when I ask people about their “trauma history” most of them say they have never experienced any. After all, not many of us have lived in war-torn countries or have been victims of violent crime. However, from a psychological perspective, the concept of trauma encompasses more than you might think. I’ll be writing a lot more about this in the future, but keep in mind that trauma can be a single event (such as witnessing a serious accident) or a chronic experience (such as being raised by a parent who is an alcoholic). Unresolved trauma can create problems for years and years – even if the brain doesn’t remember the details – the body does, and can cause us to react to even minor triggers as if they are big events. If you see yourself overreacting (road rage?) to minor offenses or experiencing symptoms of unexplained sadness, anxiety or fear, it would be worth exploring the possibility of unresolved trauma with the assistance of a qualified therapist.
  2. You are not getting enough quality sleep – I have experienced transient symptoms of anxiety for years without any real cause. Since I tend to do “all the right things,” I had long ago decided this was just something I’d have to live with. However, this past summer I was diagnosed with sleep apnea. I was surprised to learn I was waking up 14 times every hour (a fairly mild case, though it sounds pretty disruptive to me!). I began treatment and was not surprised to find that my daytime sleepiness decreased dramatically. What did surprise me was a decrease in my anxiety symptoms. As a therapist I know that sleep impacts our mental health – what I didn’t realize was just how much. If you have any concerns about the quality of your sleep, please discuss this with your primary care doctor, because it may be impacting your mental health more than you realize.
  3. You are not exercising or eating right – I know, blah blah blah. I’m not even going to go into all the details, because you know I’m right. Poor diets (high in sugar and processed foods) and lack of movement make us feel like crap. No amount of medication in the world can provide all the benefits of a healthy diet and exercise regimen. If you want to feel better, you have to treat your body with the respect it deserves.
  4. You live in a toxic environment – I wish this scenario wasn’t as common as it is. However, the number of people I work with would take a nose dive if no one had to live in a toxic environment. If you have a spouse, boss, sibling, parent or co-worker who chronically bullies, demeans, mistreats or criticizes you, it is very likely that you will remain stuck—no matter how hard you work outside the relationship. Imagine if I have a special plant that lives in a plant home. I come to visit this plant once a week. I take it outside in the sunshine. I talk to it, give it plant food and water and nurture it. When I leave, I return it to the home, but unbeknownst to me, the caretaker is abusive. He carries it around by the leaves, stores it in the basement and drains all the water from the pot as soon as I leave. Week after week I will return to the plant – dumbfounded as to why it looks so unhealthy. I often feel this way with certain clients. We do such good work in the hour that I see them each week – and yet, appointment after appointment, they return to me in a new state of despair. No amount of TLC can overcome a toxic environment – if you’re in one – get some help. You deserve it.

 

Okay – there are other reasons people get stuck, but these are 4 biggies. By the way – our friend Sharon had some unresolved trauma in her past. Once we worked through it, her anxiety improved dramatically. 

If you feel stuck, don’t you owe it to yourself to find out why?

Want to learn more about getting unstuck? On September 15, 2017, I’m launching my new online course: STOP STINGING START LIVING. This course provides help for people who have problems managing their emotions and their relationships. For more information, email me here.

My baby just left for her first day of her last year of high school. I’ve been doing these first-last parenting moments for a long time—27 years and 1 month—to be exact, so today I am twingy with nostalgia. My brain shows me a snapshot of her first day of kindergarten. She climbs on the bus, bolstered by the presence of her neighborhood buddies, and I am proud of myself her for not crying.

Of course, a couple minutes later, I hop in my car and race down the street, pulling into the parking lot just as the bus stops in front of the school. I hide between cars and wait until I see her skipping toward her classroom. Smiling. I heave a sigh of relief and drive the long mile back home.

I walk into the front door and lose it – there is Blankie, laying on the front bench, so lonely and discarded. I am in a puddle for the rest of the morning.

Every year I look forward to seeing friends’ first day of school posts on social media. I love that we document these important days to mark the passage of time. Marveling at how other people’s kids seem to have gotten older in the blink of an eye. Our school district asked senior parents to send in our kids’ first day pictures with the hashtag lastfirstday…. I love that too. The collective experience is validating and strengthens our communities.

First and last days are happy occasions. Reasons to celebrate. But they are also sad. In my office I hear lots of stories from Moms and Dads who wrestle with the bittersweet emotion that comes with sending kids off to faraway or unfamiliar places. We want them to launch and live their lives and see the world, but our hearts ache at the ripping apart. In one of my favorite books about grief, Walter Wangerin writes, “What causes the sadness—even in seemingly good times? Why, for example, does the mother of the bride, who truly desires best things for her daughter and who genuinely loves this son-in-law weep at the wedding as though it is a funeral?”[1]

It’s a part of parenting for which I was largely unprepared—the love comingled with sadness. My oldest daughter was two weeks old, rocking in her swing, and I sobbed as I thought of how much time had already passed and how I loved her so much I thought my heart would burst. I didn’t expect it to hurt so much.

It’s a dialectic – two seemingly opposite ideas that are both true. When my kids were younger, I lamented about the passage of time. A much older friend reminded me of a family she knew whose profoundly disabled adult daughter would never leave the home. “You wouldn’t want it any other way,” she said. And of course she was right, our kids are supposed to launch, and we are certainly sad when they can’t (or won’t).

At the very same time, we must give ourselves (and others) space to grieve the loss of things that will never be the same. It can be exhausting to try and hold these two truths in balance. But time demands that we must.

How? Whether you are sending your baby off to kindergarten or a big kid off to college and beyond, here are some thoughts:

Lean in-Ugh. I hate using over-used phrases. But this one works so well. I have learned, through a lot of experience, to lean in to pain. There is much to be learned in the dark hours of grief and loss. When you feel sad, resist the urge to run from it. Embrace it. (And by the way, embrace doesn’t mean wallow.) Put words to your feelings. Feel all the feels. Connect your feelings to other experiences and the experiences of others. What is life trying to teach you? How can you grow from this moment?

Avoid comparing– On the first day of school your neighbor does the happy dance and you can’t leave the dark corner of your room. Don’t worry about what everyone else is doing. Don’t assume anything about their experiences. You feel what you feel, and for the most part, you don’t have a lot of control over your initial feelings. They just are. Over time you’ll sort things out, but for now, remember that everyone handles experiences differently and you are allowed to have your experience.

Create space for transition-Transitions are hard. Bad ones and good ones. It takes time to adjust to new routines and empty spaces at dining room tables. Give yourself some time to get used to things. Try not to judge yourself for not moving ahead faster. And if you do seem to be doing fine, don’t judge that either. The important thing is to keep moving forward, even if the pace is slow.

Reframe – The same mother who sends her child off to college and is devastated at the loss can also find joy in having more time to pursue volunteer work or a new hobby. The dad who reluctantly puts his child on an airplane for a semester overseas can enjoy getting to know that child differently through email correspondence. Reframing is about looking on the bright side and making lemonade out of lemons, and finding something—even if it’s a little something—to smile about.

And speaking of…practice gratitude. As a person who can lean toward the anxious and depressed side of things, I have to say that my number one tip for getting out of a funk is to be thankful. There is always something to be thankful for. If you’re not sure about that, stop what you’re doing and take a look around. What do you see? Your hands? Your puppy laying at your feet? The sun high in the sky or a big oak tree? Now try to imagine your life without it. Gratitude has a way of settling us down and helping us focus. Gratitude doesn’t take pain away, but it is a balm to soothe an aching soul.

In the past 27 years and 1 month I’ve sure had a lot of firsts and lasts with my four kids. I have said a lot of good-byes and cried a lot of tears and had lots of happy hellos with big open arms. I’ve spent many a sleepless night worried about whether they would fit in or have someone to eat lunch with or fearing they’d leave their backpack in an airport terminal. I’ve been stretched and grown in ways I didn’t know was possible. Today I’m feeling especially grateful for the privilege of holding both the joy and the sadness in my very full heart.

[1] Mourning into Dancing, by Walter Wangerin, 1992

The first time I remember having a panic attack, I was in my 20’s. I was between jobs and staying with my parents for a few weeks before moving to Chicago. My days were lazy – I’d sleep in, watch a little TV, hang out with my siblings, and stay up late reading the stacks of Reader’s Digests on the coffee table.

One evening, sitting in my car in a grocery store parking lot, I was overwhelmed by a sense of doom. Paralyzed, I couldn’t get out of the car – I was terrified someone might attack me on the way in. Later that night at home, I couldn’t stop obsessing about how easy it would be for someone to break into the house.

That was my first real taste of anxiety and it was miserable. Desperately in need of relief, I did some sleuthing, and wondered if maybe my steady diet of daytime talk shows and true crime mysteries might be contributing factors. Not to mention my routine of staying up late reading and sleeping until late morning.

I decided to keep a better schedule and change up my routine. I spent more time outside and went blueberry picking with my mom. I turned off the television and learned how to can peaches. And I started feeling better.

Since that time I’ve learned I’m not alone.

Anxiety is a debilitating disorder that affects over 40 million of us and is the most commonly diagnosed mental health disorder. Symptoms can be as benign as a mild sense of uneasiness or as serious as an inability to leave the house. The physical manifestations of anxiety can make us feel like we are dying (read more about why here). In fact, people often think they are having a heart attack when it’s actually anxiety.

While benzodiazepines (such as Ativan, Klonopin and Xanax) are often prescribed for anxiety, there are a lot of good reasons not to take them. For one, they function more like a band-aid, meaning they may provide some short-term symptom relief, but do not address the root of the problem. Two, these medications are highly addictive and can easily be misued. Withdrawal symptoms are miserable. (Some of the worst anxiety I’ve seen is in people who were unable to obtain Xanax after taking it for a long period of time.)

Ultimately, with a few exceptions, medication is not the answer. Lifestyle changes and behavioral interventions are far more effective. These don’t always provide the instant relief so many are looking for, but they will help address underlying causes, and hopefully prevent future symptoms from escalating. I’ve found a lot of people fail to see the connection between lifestyle habits and their anxiety symptoms, but the reality is, the choices we make can have a significant impact on our mental well-being.

If you are suffering from anxiety, ask yourself if any of these common habits could be exacerbating your symptoms:

  1. Staying up too late/interrupted sleep – according to the National Institutes of Health, 40 million Americans suffer from sleep disorders. (I can’t help but notice this is about the same prevalence of anxiety disorders.) The sleep/anxiety problem is a vicious cycle—poor sleep habits can cause anxiety and anxiety can disrupt our sleep. If you have trouble sleeping, try first to adjust your routine. Experts recommend avoiding screens within 2 hours of bedtime, going to bed the same time each night, keeping your room cool and dark, and developing a pleasant bedtime routine. If you have tried all these things and continue to have trouble sleeping, consult your doctor. Getting regular, quality sleep needs to be a priority in all of our lives. For more information, click here
  2. A diet high in sugar, processed foods – Full disclosure – there aren’t really any studies exploring the effects of food on anxiety. However, we do know that sugar and processed foods aren’t good for our overall health. We also know that the mind and body are connected, so what is bad for your body is bad for your brain. If your diet is heavy in sugar and processed foods, you probably aren’t consuming enough fruits and vegetables, which we know make us feel better. If you’re not convinced, keep track of your anxiety symptoms on your regular diet for 3-5 days. Then eliminate sugar and processed foods from your diet for 3-5 days and see how you feel.
  3. Lack of routine – Keeping busy can definitely help ward off anxiety symptoms. Many people tell me their symptoms of anxiety (and depression) can be worse on the weekends. As much as we may despise routine, it really is good for our mental health to have some order in our lives. Routine gives us purpose, helps keep us grounded, and can provide security. Again – if you’re not sure about this, try implementing a simple routine – even on the weekends, and see if there’s an impact on the way you feel.
  4. Unrestricted electronic time – As wonderful and convenient as it is to be able to access any piece of information we could possibly need any time we want, it can be overwhelming. Even now, I have my computer in front of me, my iPad playing music and my phone at my right hand. You’d think that staying on top of every phone call, email and penny in our bank account would provide a sense of relief and free us up to do other things. In reality, it typically just creates more anxiety. Try to put some limits on your media/music/electronic time. Stop watching the news before bedtime. Declare one day a week to be “device-free.” Delete the computer games from your phone. Just because you can access it doesn’t mean you need to.
  5. Procrastination – I confess, when it comes to procrastination, I am the worst. So I know from experience that how putting things off adds fuel to the fire of anxiety. Granted – we need a little anxiety to help get things done. But the more we put them off, the more anxiety snowballs. When we procrastinate, all we’re doing us dumping our current problems on our future self. If you’re a procrastinator, resolve to be better to your future self. Commit to doing one hard thing every single day. (Preferably as early in the day as possible.) This will give you a sense of accomplishment, and might even spur you on to do other hard things. I guarantee this will help decrease your overall anxiety level.

While many people hope that taking a pill can alleviate their symptoms, the relief provided is temporary at best. If you want to get a handle on anxiety, start by evaluating your daily habits and see if there are some adjustments you can make

 

When I was 7 years old, my family took a road trip from Indiana to California via Arizona. There was a sandstorm and we went to Disney. Those two things are about all I remember—well—except for the Pacific Ocean.

Although I had grown up near Lake Michigan (which sure looks like an ocean to a 7-year-old), I seemed to understand that there was something far more majestic and dangerous about the Pacific. I stood respectfully at its edge, next to my mom, who was holding my sister; who stood next to my dad, who was holding my brother.

Then—a violent wave.

I ran.

For my life.

To the car.

Even though it’s been a few decades, I can still remember standing there gulping for breath, terrified, but grateful to be alive. Momentarily I heard my mother calling my name. Actually she was screaming.  Then it occurred to me that my mom thought I had been swept out to sea. Honest mistake on her part, given the swiftness with which I had disappeared. When that wave hit the shore, there was no rational thought. My brain shut off, my body went to work.

This response to danger is called fight-or-flight and was first identified in animals. It is a God-given, physiological response that is quite amazing. When we sense a threat to our survival, our brains and our bodies are flooded with stress hormones. These chemicals heighten our senses, increase our heart rates, shallow our breathing, quicken our muscles and pour every ounce of strength we have into one singular task: survival.

Fight-or-flight makes us run faster and/or stand to face our enemies. It allows mothers to lift cars off children and unleashes physical capabilities that would otherwise be dormant. All non-essential bodily functions are temporarily shut down. Digestion, reproduction and rational thought are irrelevant. Can you imagine pausing to eat a cheeseburger, get pregnant, or solve a calculus problem while fighting off an angry bear?

Intense as they are, these stress hormones are designed to subside the moment we no longer need them. Once the danger has passed, our brain is supposed to release a chemical to signal the “all-clear.” At that point, everything goes back to normal. We can return to our dining and procreating and pursuing world peace. But here’s the problem: our brains have a real tendency get confused. Our stressful environments combined with our habits of abusing our bodies leave many of us in a constant state of arousal. Traffic jams, parking tickets, screaming babies, long lines at the grocery store or irritable mothers feel as threatening to us as an angry bear or 10-foot wave.

We are well-aware there is a link between stress and infertility, digestion problems and trouble concentrating. This is why. The stress chemicals that are so useful to us in very concentrated and very temporary doses leak out into our bodies at inopportune times and marinate our brains and other vital organs. With no place to go, these chemicals can begin to suck the very life out of us.

In order to thrive well in this world, to regulate emotions, tolerate discomfort, express ourselves appropriately and have meaningful relationships, we must learn to manage these stress hormones.

Here are five things you can start doing today to get things in check:

  1. Breathe. When our bodies are in fight-or-flight, our breathing becomes quick and shallow (called over breathing). This is quite helpful if we need to take off and run, but otherwise, it just exacerbates feelings of anxiety. When you consciously slow your breath down, by inhaling and filling your lungs with air, and slowly exhaling, it reminds your brain that everything is okay. You wouldn’t be breathing like that if you were being chased! A simple breathing exercise, called square breathing, is to inhale for four counts, hold it for four counts, then release for four counts. Do this four times to make a “square.” 
  2. Be mindful. Mindfulness means using all 5 of our senses to engage with current moment. Take a moment to notice your surroundings. What do you see, hear, taste, touch and smell? Mindfulness doesn’t solve your problems, but it can give your brain a much-needed distraction so you can think a little more clearly. One simple mindfulness exercise is to find 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can touch.
  3. Be grateful. No matter how bad things are, there is always something you can be thankful for. So your car may not have A/C, but aren’t you grateful you can drive to work? The quickest way to be grateful for something is to try to imagine your life without it. I am typing madly away on my keyboard — I can’t imagine not having my 10 fingers! Gratitude doesn’t make our problems go away, but it does allow us to co-exist with them a little more easily.
  4. Exercise. All those fight-or-flight chemicals swirling around in our bodies can make us feel extremely restless. So go out and take a walk! Ride your bike. If you can’t get outside, run up and down the stairs a few times, or do some gentle stretching. Help your body release those chemicals naturally.
  5. Talk about it. It’s amazing how just speaking our fears out loud can make them less scary. Sometimes all we need is a friend to look us in the eye, nod their head, and say, “I’m so sorry you’re feeling this way.” It’s obviously important to share with someone you know will validate you (past history is a good indicator!) But support groups and therapy can also be an excellent source of validation. If talking’s not your thing, try writing your feelings on paper. The idea is to get them out of you.

When triggered at appropriate moments, the body’s fight-or-flight system is an amazing response. However, it is all too easy for this system to malfunction, leaving us feeling completely out of control. These five strategies can help you calm your body down so you can work smart, not hard.

First a bit about personality disorders in general…

The Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5), published by the American Psychiatric Association in 2013, has identified ten personality disorders, along with three other “unspecified” categories of personality disorders.

A personality disorder is a pattern of “inner experience and behavior” that is significantly different from the person’s cultural expectations of behavior.

Individuals with personality disorders have major problems in at least two of the following categories: thinking, mood, relationships, or impulses. These problems typically start in adolescence or early adulthood and are evident in a wide range of areas in the person’s life. They tend to affect work, school and social functioning and impact the way a person cares for themselves.

A diagnosis of a personality disorder is usually only given after all other possibilities are ruled out, including other serious mental health diagnoses, substance abuse, or certain medical conditions.

Borderline Personality Disorder (BPD) is characterized by problems in relationships, self-image, mood and behavior and is noticeable in almost all areas of a person’s life. Individuals with BPD typically struggle with:

  • Fears of abandonment (real or imagined) – they will frantically try to avoid the abandonment of others
  • Unstable and intense relationships – they bounce back and forth between loving and hating people and typically experience a lot of “drama”
  • Personal identity – they feel unstable and have a hard time figuring out who they are
  • Impulsivity – they may have trouble with self-damaging behaviors that include sexual activity, substance abuse, risk-taking, binge-eating
  • Suicidal ideation and behavior – a pattern of thinking about suicide, making suicidal gestures or threats, or self-harm
  • Unstable mood – their moods can go up and down within hours or days, and they can be very reactive
  • Feeling chronically empty inside
  • Difficulty controlling anger
  • Sometimes feeling extremely paranoid or “detached” from the world around them.

At least five or more of the above symptoms must be present to qualify for this diagnosis.

According to the National Education Alliance for Borderline Personality Disorder (NEA BPD), BPD affects about 14 million Americans (or 5.9% of adults) at some time in their life. 20% of patients admitted to psychiatric hospitals likely have BPD, and BPD affects about 10% of people in outpatient mental health treatment.

What if I think I have it?

If you think you might meet the criteria for BPD, you’re probably feeling some mixed emotions. On the one hand, it may be a relief. There’s a name for your struggles and other people have similar problems. It might be nice to know you’re not alone. On the other hand, figuring this out could bring more questions than answers. A BPD diagnosis is serious, and should not be made or taken lightly.

So what should you do if you think your symptoms may apply?

  1. Don’t assume it’s BPD before ruling out other possibilities. Other diagnoses, such as bipolar disorder or anxiety disorders can have similar symptoms. Additionally, many individuals who meet the criteria for BPD have significant trauma in their past. Once they work through the trauma, the problematic symptoms may improve. It is important to get an accurate diagnosis, because diagnosis informs treatment. An experienced mental health clinician can help sort this out (see #4).
  2. Track your symptoms. Keeping a mood/behavior log can be helpful. (Find one here.) It doesn’t have to be fancy. For 5-7 days, try keeping track of your habits: hours of sleep, exercise, and eating, as well as your mood throughout the day, making note of any triggers, strong emotional reactions, and behaviors. This can help you identify predictable patterns as well as provide valuable information for your mental health provider. 
  3. Take care of yourself. We all need to do this, but for those who have chronic mental health conditions this is especially important. Sleeping (not too much, but enough), eating right, exercising, taking your meds and avoiding drugs and alcohol are essential for individuals with the symptoms of BPD, and can make the symptoms less intense.
  4. Seek professional help. Most importantly, do your due diligence and find a mental health professional who is familiar with this condition and who has experience treating it. (A good resource is the therapist listing at Psychology Today,where you can enter your zip code and filter results by interests and experience.) You will most likely need a team, which ideally would include an individual counselor, group therapy and a psychiatrist.

Borderline Personality Disorder can be a confusing and overwhelming condition, but symptoms can be managed. If I can answer any questions, please contact me here.

My little Belle at 3 years old

Learning from BEauty


One of my all-time precious memories is watching Beauty and the Beast with my oldest daughter. Born in 1990, she is the quintessential fan. I can’t listen to the theme song without tearing up (especially the Angela Lansbury version). It takes me back to dancing in the living room (I always had to be Beast) and looking in the mirror with her to find Father.

A couple weeks ago I got to take both my girls to see the newly released version and sure enough, I got weepy. (This isn’t a movie review, but I’ll just say that even though the new version is very well done, the 1991 original will always be my sentimental favorite.)

Like all great stories, Beauty and the Beast is more than a fairy-tale. There is some real wisdom in there about building a life worth living. Here are four important lessons:

  • In our desperate search for comfort and survival, we are vulnerable and can easily get in over our heads. When Belle’s father stumbled into the castle on that bitterly cold night, he was oblivious to the danger. Despite the creepy noises and the magically appearing dinner with no people around, Belle’s father was compelled by his misery to stay in a dangerous situation. Desperation makes us vulnerable – when we are miserable we are less likely to notice the warning signs of unhealthy relationships or dysfunctional dynamics. We may brush them aside or rationalize and justify our decision to stay because we feel we have no other options.
  • Fear keeps us imprisoned. The Beast is a prisoner in his own home – a slave to his selfishness and lack of empathy for others. For all those years, the Beast makes no attempt to change his fate. He is resigned to living and dying in the castle – and taking everyone else down with him. However, beneath his beastly surface, the Beast is actually very small and afraid. Until he confronts his fears, he has no chance of being free. Change is scary and typically involves enormous risks. Staying put in the same old prison can be a lot less scary than risking it all to break free.
  • If we want to break free, we must ignore the lies. Belle is told she is odd. Father is told he is crazy. Gaston tells Belle she has no choice but to marry him. Beast tells Belle she has to stay in the castle forever. If Belle had believed all these lies, this story would have never made it to the big screen. The Bible says that the Truth will set us free. For every Truth, there are dozens of lies being thrown our way every day. (And by the way, we believe the ones about which we are the most insecure.) Knowing the truth about ourselves and others, and acting on that truth is the only ticket to freedom.
  • Beauty can transform us. “We don’t change until staying the same becomes unbearable.” I don’t know who said it, but there’s a lot of truth in those words. Before Belle, the Beast had no beauty in his world. Once he experienced true Beauty, his prison became unbearable. What he tolerated before was no longer acceptable. His love for her transformed him, and once he tasted of what life could be, he was no longer desperate to hold on to the past. Love caused him – and later, Belle – to risk everything. When we catch a glimpse of what life could be, we are compelled to take action. Staying the same is no longer an option.

 

Are you imprisoned by something? Maybe you’re in an abusive relationship (emotional abuse hurts too). Perhaps you are a slave to binge-eating or alcohol or anxiety and depression. You may feel you have no other options – you’ve been doing this so long, you have no idea what else you would do. What are you afraid of? (Change is scary!) What lies are you believing? Has someone told you that you are fat, or unworthy or that you will never make it?

Have you ever allowed yourself to experience real beauty? The smell of a newborn baby, the first glimpse of spring, the sound of a child’s laughter, the smell of lilacs wafting in the breeze, the gentle touch of warm raindrops on your skin? Hold on to that beauty. Let it transform you and give you a glimpse of what life could be.

 

 

 

 

 

 

 

 

So…it’s February 2. 

How are you doing on your New Year’s Resolutions?

 I read today that only about 8-9% of those who make them are able to keep them. This quote by Viktor Frankl, one of my favorite authors, might shed some light on the issue:

“What man actually needs is not a tensionless state, but rather the striving and struggling for some goal worthy of him. What he needs is not the discharge of tension at any cost, but the call of a potential meaning waiting to be fulfilled by him…Life can be pulled by goals as surely as it can be pushed by drives.”

Using Frankl’s rationale, here are three reasons we might not be succeeding:

1. We may not have enough struggle and striving in our lives. Most of the people I work with (including myself on most days) are very interested in DECREASING tension. We want less stress and strife and more peace. Right? Well, we may have it wrong. We may actually need to start looking for fights. The key is finding the right things to fight for.

How to think about this differently: Consider whether tension may actually be a good thing in your life. What if I told you about a new movie, where there was a guy and he really wanted a girl. So he found a cute on in a coffee shop, and he asked her out, and she said yes and then they got married. You wouldn’t watch the movie and neither would I. Where’s the struggle? The drama? The tension? As fiction goes, the greater the struggle, the greater the story. If we won’t settle for plain-vanilla-peaceful-easy in fiction, then why do we work so hard for it in real life?

2. We may sabotaging our best efforts to reach our goals. We say we want to lose weight/get in shape/be more active, but when the alarm goes off, all we really want to do is stay in bed. If we stay in bed, what we are actually saying to ourselves is that our current state of comfort is MORE IMPORTANT to us than that other goal. In making this choice, we give into our drives (which push us into corners) rather than into goals (which pull us where we want to go). This is self-sabotage, and you’re probably at least a little bit familiar with it.

How to think about this differently: Consider whether you are being “pushed by your drives” or “pulled by your goals.” If I am standing at the edge of a deep pool, and you come behind me and push me in, I have no choice but to go into the deep water. Sink or swim. Being pushed from behind leaves me absolutely no choice but to go with the momentum. For me, not a strong swimmer, that is not a good place to be.

On the other hand, I have a 60+ pound Husky-mix who can pull so hard on the leash it practically yanks my arm out. If I hopped on a sled, she would gladly pull me anywhere I wanted to go. It would just be a matter of me gently guiding her in the right direction. Same kind of momentum as being pushed in the pool, but the difference is – I’m in control. If she goes rogue and tries to take me down a bad path—worst case—I let go of the rein. I’m still in control.  

When we give into the feeling of momentary comfort (staying in bed) – we are pushed into feeling distressed and defeated because we didn’t reach our goal. On the other hand, if we grab onto the rein of “going to the gym” we are in control and pulled a little farther on the path of where we want to be.

 

 

3. We have not perfected the art of tolerating discomfort. The clichés are plenty: “no pain no gain,” “Anything good is worth fighting for…” We know these things are true. Problem is, most of us do not like to be uncomfortable. Many of us were never really taught to tolerate discomfort, and were not challenged to solve our own problems. But I promise you this: people who can tolerate discomfort are more successful than those who cannot.

How to think about this differently: One of the things I do is teach emotional survival skills. One set of those skills is called “distress tolerance.” These skills help us manage – rather than run away from – discomfort. I often tell people to “lean in” to their pain. They never like this, but they also come back later and tell me that it is helpful. What I mean by this is to think about what the pain is trying to tell you. Ask why it is so upsetting. Think about what you might be learning from it and how it could be making you a better person.

This is also where we learn to breathe deep, to count sheep, to listen to soothing music, take a long hot shower, call a friend, or take naps. Distress tolerance is about learning how to peacefully co-exist with discomfort until it passes – because it inevitably does, especially when we are on our way to something greater

If those resolutions you made a few weeks ago are really worth accomplishing, then take a few minutes to answer the following questions to help you figure out what might be holding you back:

  • What do you want?
  • Why is this so important to you?
  • How far are you willing to go to get it?
  • What people or things might you have to struggle with in order to make it happen?
  • What could you be doing that may sabotage your efforts?
  • Can you think of some examples of how you let drives push you rather than let goals pull you?
  • What is making you super uncomfortable right now?
  • How might your life change if you could lean into the pain a bit more
  • Make a list of a few things you can do to help you co-exist with distress instead of frantically trying to push it away.