October 15, 2010

Turning Self-Injury into Self-Soothing

Posted in Borderline Personality Disorder, Depression, DID Education, DID/MPD, Dissociative Identity Disorder, emotional pain, Physical Abuse, Self Injury, sexual abuse, Therapy and Counseling, Therapy Homework Ideas, Trauma, trauma therapist tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , at 2:12 pm by Kathy Broady


Self-injury is a problem all too common for trauma survivors with dissociative identity disorder (DID / MPD) or borderline personality disorder (BPD).  For that matter, self-injury (SI) is an issue for other populations of people as well.  This discussion will focus more on the effects of trauma and abuse and how self-injury can be addressed effectively.  However, because self-injury is actually a very complicated topic, this particular blog article will reach only a few of those layers.

In my years of working as a trauma therapist, I have noticed that many DID survivors self-injure when they are in emotional pain.  They are hurting, their heart feels broken, they feel betrayed or abandoned, or they feel incredibly sad (but can’t cry).  Turning to various forms of self-injury and self-harm sometimes helps to temporarily relieve their emotional pain.  (Trauma survivors also self-injure when they believe they need to be punished, or when they are extremely anxious, or when they are feeling strong compulsions or hearing internal instructions, etc.)

One of the reasons self-injury works is because the brain cannot distinguish between a self-caused physical injury and any other type of physical injury and upon recognizing a body injury, the brain releases all the necessarily chemicals and hormones.  Dopamine, serotonin, and neural structures are significant in this process.  I’ll refer all the complicated medical explanations to others more qualified, but the point being is that the act of self-harm creates a reaction in the brain that allows the hurting person to feel a little more calm and numb.

In other words, when self-injuring, survivors are trying to feel better.  They know they are in emotional distress, they recognize the emotional pain, and they know they are hurting.  And they want to feel better, or at least to feel differently.

Self-injury can be a quick fix for these intense feelings.  In that sense, self-injury is not a lot different from having a few shots of whiskey, or a shot of heroine, or a plateful of doughnuts, or a pound of chocolate.  Many addictive behaviors are centered around finding a way to feel better when hurting.

Typically speaking, this has been a life-long issue.  From even their youngest days, most dissociative trauma survivors were neglected or ignored when they were hurting.  They were not comforted, and their pain was not acknowledged.  Even as very young children, they were left alone with their pain and injuries.  All too often, they were not properly tended to, they were not cared for, they were not hugged, they were not given medical aid.  They were hurt – physically and emotionally – and they were left on their own to manage.

In my opinion, this lack of comfort and the years of neglect are some of the biggest crimes committed against young children.  Neglect is as significant in causing harmful life-long effects as any direct trauma.

So, when working with trauma survivors who experienced significant pain and next-to-no comfort, a critical and crucial part of their healing process is to teach how to accept and create healthy and positive comfort.

Children who are injured in healthier environments are very much comforted by their mothers or fathers or other caregivers.  Their hurts are recognized and acknowledged appropriately.  These children are given hugs and gentle affectionate kisses.  They get band-aids — sometimes they get the fancy special band-aids with Snoopy or Spiderman or pretty flowers on them!  They are checked on repeatedly, they are allowed to sit close to their caregiver, they are given other little treats (such as stickers, or the chance to watch their favorite cartoon), etc.  These injured children learn that positive forms of comfort can help them feel better.

Since traumatized dissociative survivors were typically not taught these ways of receiving comfort, this becomes an important treatment goal in their healing process.  They need to know their wounds can be tended, that their hurts matter, that someone hears them, and that they can be treated gently during times of pain.

Tending to the hurts and the wounds often has to be modeled to dissociative trauma survivors.  In many situations, this will be completely new experience for them, and the process of having their hurts be important, can be a profound experience.

As trauma survivors start to experience genuine comfort and caring from others (this may start first in the therapeutic office setting), these survivors will eventually learn to copy these same kinds of behaviors and apply them towards themselves and their other insiders.

Emotional pain is no different, and in some ways, addressing and comforting emotional hurts is even more important.

Teaching trauma survivors to sit with their emotions and to increase their ability to endure intense emotions is an essential part of the healing process.  In early stages of therapy, most DID survivors can barely touch their feelings.  In the later stages of the healing process, DID survivors can sit with their feelings, no matter how intense they feel them, and not turn to anything destructive or harmful.

In order to sit with those feelings, survivors need to learn what to do during those moments.  They need to know and understand that they matter and that bringing more harm and pain to their selves and their bodies is not the answer.  Learning how to comfort themselves – how to self-soothe, instead of self-injure – is a significant process in their healing.

Self-soothing means that the person is doing something that brings comfort in a helpful, positive way.  Feeling better can become about comfort instead of numbing.  Survivors can learn that they are worth being comforted, instead of being feeling unvalued and ignored.

Each time trauma survivors are comforted in their pain, instead of ignored or injured more because of their pain, they are experiencing a corrective emotional experience.  Correcting the neglect by experiencing proper comfort, including self-soothing comforts, is incredibly significant in the healing process.

Comfort actually works much better than numbing, especially in the long run.  Comfort allows for pain to heal.  Numbing (or self-injury) means that the pain is just postponed until it comes back again.

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Ways to Self-Soothe Include:

Self-soothing is unique to each person, just as any other preference is unique to each person.  There are dozens and dozens of healthy options — explore a variety of different options to see what works best for you.  Some ideas to try include:

  • Listening to music that matches your mood – if you are feeling sad, listen to music that will help you express that sadness.
  • Sing to yourself (even if this means making up your own songs, or singing sounds), or play musical instruments as a way of expressing your feelings.
  • Wrap yourself up in your favorite comfy clothes or in a warm blanket and snuggle up somewhere safe, quiet, and protected.
  • Hold or hug a pet, a stuffie, or a pillow.
  • Sit close to someone safe.  Lean against their shoulder, or find some way to have physical contact that is in no way sexualized or dangerous.
  • Sip on your favorite tea, or any other gentle beverage, and treat yourself to a few simple snacks that are not heavy, but are tasty and nutritious.
  • Rock in a rocking chair, or sit in a swing, and let the movement relax and calm you.
  • Walk slowly or sit quietly in areas of nature that are beautiful and inspirational.
  • Make your room, or your home feel particularly cozy – have nice smelling candles, or soft lighting, or bring out your favorite treasures to look at, sit by a calming fireplace (not for injury purposes! But yes, sitting by a warm fireplace can be very beautiful and calming).  If you need to clean up an area first, that is ok, because it is important to be in an area that you can feel calm and quieted.
  • Take a warm shower or a warm bath, using very nice smelling soaps and body washes.  Dry off with your favorite most soft towels.  The more you can make this a “spa-like” experience, the better.
  • Bring in fresh flowers, or fresh greenery, or pretty leaves.  Looking at something beautiful from nature, even while you are indoors, can be calming and soothing.
  • Allow yourself to cry, uninterrupted, when the feelings come.  Crying really is allowed, it really is ok, and it is a natural expression for pain.  Use soft tissues, and don’t punish yourself for having real human emotions.  Give yourself permission to feel, permission to heal, and permission to respond naturally to your pain.  The more you can express your emotions in natural ways, the healthier you are.

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Trauma survivors — you really can help yourself to feel better without bringing more pain and injury to yourself.  The key is to surround yourself with lots of nice, positive moments that help you feel better through the course of the day. Practice self-soothing every single day, especially on painful days.  It will get easier, even when if it doesn’t feel easy or natural to you at first.  You can learn this, and when you do,  it will make a huge difference in your life.

—–

By:

Kathy Broady LCSW

www.AbuseConsultants.com

www.SurvivorForum.com

Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation

August 28, 2009

The Love / Hate Relationship for Borderlines

Posted in Borderline Personality Disorder, DID Education, DID/MPD, Dissociative Identity Disorder, mental health, Self Injury, therapy, trauma therapist tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , at 1:50 am by Kathy Broady


There are distinct differences between Dissociative Identity Disorder (DID) and Borderline Personality Disorder (DID).  There are many overlapping symptoms, and some therapists believe that all trauma survivors with DID are also BPD.  I, however, do not hold that perspective.

In my opinion, not all trauma survivors with DID are BPD.  However, I will guess that the greater portion of DID’ers are also borderline.  This makes the discussion of borderline behaviors an important topic for dissociative trauma survivors.

Borderline survivors are frequently characterized with black and white thinking, self-injury, impulsive behaviors, repeated crises, intense abandonment issues, suicidal behaviors, inappropriate anger, mood instability, irritability, paranoid thinking, an unstable self image, etc.  There are a wide variety of BPD behaviors that could be discussed over a series of posts.  I’ll save those topics for another day.

For this blog post, I want to focus on a particular aspect of BPD:  having a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (see the DSM IV).

Unstable and intense relationships.

People with borderline personality disorder may idealize potential caregivers or lovers [or therapists] at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.
http://psychcentral.com/lib/2007/symptoms-of-borderline-personality-disorder

Ok, that’s a lot of psychobabble talk, so what does that mean?

This is when the BPD survivor alternates between thinking someone is wonderful – excellent – the very best, and then thinking that very same person is horrific – awful – horrible.  The BPD survivor will show or feel excessive attachment to a new person, and in a sense fall madly in love with this person.  They put this new person on a pedestal, believing the person to be more incredibly perfect and wonderful than they could possibly be in real life, and they crave constant attention and special recognition from their new perfect person.  (But don’t ask the BPD survivor to admit that. All too many BPD survivors deny their craving for more, more, more.)

But of course, no one can stay “perfect” for long.  The perfect person will inevitably do something that just doesn’t measure up.  Typically, the “errors” created by the perfect person are that they did not shower the BPD survivor with enough individual, specialized attention.  This is nearly always the fatal crime – just not doing enough to keep the attention-starved BPD person happy with unquestionable importance.  So, before they know it, the perfect person will suddenly become the hated target, responsible for all evils of the world.  And when BPD survivors swing from the feelings of intense positive adoration to the angry hateful place, they are willing to, and actually desirous of, utterly destroying the same person they once loved.

Does anyone remember the movie, Fatal Attraction?  That movie portrays a Hollywood version of the love-hate relationship experienced by borderlines.  Hollywood was extreme in their portrayal, of course, but the love-hate flip-flop is easily seen.

For trauma survivors with both BPD and DID, the love-hate flip-flop can happen quickly and easily.  Remember, as DID survivors, they are very used to switching and to containing opposite life perspectives in opposite extremes.  So, when the dissociative BPD feels abandoned by their treasured “good object” and becomes upset with them, the flip into hatred might not be that far away.

The abandonment can be experienced in any number of ways.  Being very sensitive to any rejection of intense connection they desire, simple things can be interpreted as huge emotional offences — for example, if the once perfect person sets limits by saying “no” to a specific request, or by not offering extra time, or by going away themselves. Even if the reasons for being away are valid, no reason is good enough – every reason still means they are left behind, and that is not acceptable.

Jealousy is frequently an intense motivator too.  When BPD survivors want a cherished relationship with their new perfect person, they have all kinds of jealous pangs if they believe someone else has a more treasured place than they do.   Instead of doing the work it takes to keep their own relationships in a positive place, they focus outwardly on relationships that belong to others, drowning in their jealousy and anger, and inevitably destroying the relationships they wanted to cherish.

For dissociative trauma survivors, the therapeutic relationship is an incredibly important relationship.  Developing and protecting this relationship is both central and crucial to the entire healing process.  DID’ers can spend years of time with their therapist, and cultivating the skills to keep this relationship in a workable, positive place is critical.

For BPD survivors, the therapeutic relationship is equally important.  However, these survivors often lack the skills needed to maintain positive long-term relationships, even with therapists.  Therapists very frequently become the target of the love-hate flip-flop dynamic.  Many therapists refuse to work with clients with BPD precisely because of this dynamic.

This love-hate borderline behavioral pattern should help to explain how any therapist can be the most dearest of therapists, and then a short time later, be the most hated. It’s a behavioral symptom of BPD. It doesn’t mean that the therapist is actually wonderful or horrible. It just means BPD survivor is acting out the black-white, love-hate, attachment-abandonment issue that is central to BPD.

When you know to look for it, you’ll see it happening all over the place in the trauma survivor population.

So when you hear someone attempting to destroy or bad-mouth someone else, consider the bigger clinical context of what this kind of behavior is about.

And please – work very hard to NOT do this to your therapist.  Your therapist will not likely become your worst enemy unless you make that happen.   Instead of destroying your cherished relationships, it is much better to protect them with all that you have.  Don’t believe lies.  Don’t tell yourself lies.  Remember who your therapist is and do not confuse your therapist with any other person (mother, father, perpetrator, etc). The disordered dynamics related to BPD are a complication, but they do not have to become an insuperable obstacle — you really can choose not to let these dynamics dominate your relationships, with your therapist or anyone else.

___________

By:

Kathy Broady LCSW

www.AbuseConsultants.com

www.SurvivorForum.com

May 3, 2009

Abandonment

Posted in DID Education, DID/MPD, Dissociative Identity Disorder, Online Therapy, therapy, Therapy and Counseling, Therapy Homework Ideas, Trauma, trauma therapist tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , at 3:30 pm by Kathy Broady


Abandonment is such a tender issue for trauma survivors.  Most survivors with Dissociative Identity Disorder (DID/MPD) and Borderline Personality Disorder (BPD) have had more than their fair share of genuine abandonment instances.

For severe trauma survivors, abandonment would have been experienced over and over in various situations:

  • Each time your parents or caregivers turned a blind eye to the sexual abuse or physical abuse that was occurring to you right there in your own household
  • Each time your parents or caregivers abandoned their role of safety and became the perpetrator of your abuse
  • Each time your parents or caregivers ignored your physical needs, leaving you to be hungry, cold, unkempt, improperly dressed, neglected in any way
  • Each time your parents or caregivers handed you over to someone else that was physically or sexually abusing you
  • Each time your parents or caregivers left you alone for extended periods of time, leaving you to tend to your own care when you were too young to be taking care of yourself by yourself
  • Each time your parents or caregivers refused to give you proper medical attention or medical treatment
  • Each time your parents or caregivers ignored your pleas or cries for help, turning a deaf ear, and leaving you to deal with your crisis without their assistance


For survivors with DID, these kinds of instances of abandonment happened on a frequent basis.  All too many survivors were abandoned on a weekly basis, and for some people, on a daily basis.

How does this kind of abandonment affect people?

Excessive, repeated, severe abandonment teaches survivors to not trust.  It teaches that other people cannot be counted on.  It teaches them that they are alone in the world.  It makes them believe that no one will help, or no one will be there for them.

What’s worse, it gives deeper emotional messages to the survivors, drilling in feelings about worthlessness, unworthiness, unimportance, having no value, being bad, being stupid, being invisible.  It eliminates and destroys any self-esteem the survivor could develop.

It creates a deep-seated anger, an ongoing emptiness, a constant sense of isolation.

It scars the heart and pierces the soul.

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How can survivors of extreme abandonment recover from such emotional wounding?

First of all, to heal from extreme abandonment, it is important to realize and understand that your parents and caregivers were truly in the wrong for neglecting your needs.  When parents and caregivers make such huge mistake in their roles of tending to children, the mistake belongs to them.  It is not a message about the child, it is a message about the parent.

Parents are wrong, sometimes criminally wrong, legally wrong, in some of their abandoning behaviors.  Do not assume that your parents were “right” in their abandoning behaviors.  They were very likely doing something wrong.

Once a survivor truly hears and understands the fact that their parents and caregivers are responsible for the improper treatment of a child, then that survivor can begin their own path for healing.

But healing from abandonment is not easy.  The wounds went deep into your core existence, and overcoming that level of emotional wounding takes a lot of time and repeated effort.

Some of the steps involved in healing from abandonment are:

  • Remembering again and again that the abandonment was not your fault
  • Remembering again and again that you are not a bad person because your parents or caregivers committed crimes against you
  • Learning that while some people are criminals, not all people are criminals, meaning, while your parents were willing to abandon you to such a huge degree, not all people will act in the same manner
  • Learning to trust again, ever so slowly, little bit by bit.  Dare to try.  Dare to reach out.  Dare to build relationships.
  • Finding people, even if only one or two, that you can build meaningful relationships with
  • Being a trustworthy, reliable person so that other people will develop trust in you
  • Addressing your anger issues at the true offenders of your pain.  If you go “on the attack” to people that make small errors in your relationship (while refusing to address your feeling at your parents or caregivers who committed grave errors), then you will find yourself alone time and time again.  Work hard at showing the appropriate amount of anger equal to the level of the mistake.  Going overboard at people in the current day will not be helpful.
  • Working really really hard at separating the issues that belong to people in your past versus attributing your pain to people in your current day world
  • Develop relationships with pets or animals if you are too scared to trust people.  Building connections with another living being, where you each rely on each other, is a great starting place
  • Remembering and realizing that safe people will come back to you time and time again, unless you do something to push them away over and over again.  You can keep good people in your life if you want to.
  • Finding little treasures / trinkets / small reminders of people to help you maintain that sense of object permanence.  Out of sight does not mean that they are gone from your life.
  • Working on extended your comfort zone in terms of how often you need to hear from someone in order to feel secure in that relationship. Repeated contact, vs. excessive contact, is an acceptable way to maintain relationships.
  • Finding safe but creative ways of building relationships.  For example, if you are afraid to meet with people face-to-face, build online relationships.  Use an online therapist or an online support group as a starting place.  Connect through blogs, twitter, facebook, etc.

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Abandonment is painful, but it is still possible to build positive and healthy relationships with other people.  It will take consistent work on your part to overcome the negative, damaging teachings given to you by neglectful parents and poor caregivers, but you can do it.

Unless you really want to be alone, you don’t have to be left alone anymore.

__________

By:

Kathy Broady LCSW

www.AbuseConsultants.com

www.SurvivorForum.com

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