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Here is the truth: BPD, or Borderline Personality Disorder, has a historically bad rap with mental health professionals. I’m going to give you some truths to what you should know to not only think about this clearly, but to consider your options in terms of the person you want to be and the person you want to become. 

BPD was historically known for “bordering” on the lines of neurotic vs. psychotic. In the olden days, clinicians who didn’t know if a person was living in the confines of “reality” could put them in a category that didn’t really fit either one. Historically neurosis has to do with issues related to anxiety, mood, and depression. Neurosis can also be related to trauma, vigilance, and paranoia about bad things re-occurring. Psychosis is related to problems hearing and seeing things that others do not see or hear, and is often associated with schizophrenia. “Borderline” has often been referred to as a category that doesn’t really fit any category, and in some cases has been the in- between of no-place.

BPD is also historically written about from an extremely pejorative and hopeless point of view. Words like “manipulative, gamey, cagey” are often used, and mental health professionals often refer to this diagnosis when talking about people that bug them, that they do not like, that get them enraged, and people that can tie up crisis hotlines and emergency rooms. In many cases, labeling someone with BPD has become a substitute for observing and describing behavior, providing useful feedback, and encouraging people to behave in ways that make them competent and more effective. 

Here are some truths that you should keep in mind if a mental health professional has “informed” you that you have BPD:

Mental health diagnoses are not valid nor reliable. This means that (in terms of validity), if the same professional assessed a person over time (such as an assessment 20 years ago, 10 years ago, and 5 years ago), the likelihood that that professional would give the same person the same diagnosis is unlikely. It also means that if many different mental health professionals assessed the same person it is highly unlikely the all of them would come to the same conclusion about diagnosis. This is assuming that the only measure of giving a diagnoses is a working familiarity with the DSM-TRV, or the “psychiatric Bible” of diagnostic criteria (which is highly controversial. Be aware that homosexuality was once considered a psychiatric disorder, and now it is not). Mental health diagnosis may be more reliable and valid if the diagnosis is given based on a range of valid and reliable assessment batteries; thus if you have had some comprehensive personality assessment and testing this may be less of the case for your situation. Bear in mind that most people in the counseling profession are doing nothing more than giving you their clinical opinion; hence my point about reliability and validity. Also, there are some counseling programs that don’t cover concepts such as instruments of mental health measurement. 

For some mental health professionals, telling someone they have BPD can sometimes be a  communication of frustration. In a helpful world, telling someone what diagnoses they have can be useful and even helpful- it can validate if a person really is depressed or help figure out specific treatments. In the case with BPD, the “right treatment” is more complicated and may not be readily available. If your mental health professional is telling you have BPD, you might want to consider: So what? How it is it helpful or useful? Does it help people have the resources or tools for solving painful problems? Is it specific enough to describe what behavior shows up- and how behavior can be changed? Does it provide access to literature that is actually helpful? For some people, being diagnosed with BPD can only serve to increase shame and self-loathing. Literature is not always helpful and mental health professionals don’t always shore up resources for how to move forward to obtain resources and supports. Is the expectation to hide in a corner the rest of your life and not tell people who you “really” are? And do you seriously want to live this way? 

There is a lot of confusion for most people around diagnosis being a cause. Diagnoses are actually descriptions of behavior, and mainly identify patterns of responding or behaviors that are typical for a person. Many people, including some mental health professionals, actually believe that they are describing reasons or causes of behaviors when giving someone a diagnoses. For instance, if the way that you behave is because you have a disorder, then someone people think they have adequately not only explained the reasons you behave the way you do, but they think they know why you behave the way you do. In terms of diagnosis, this really is not the case. The failure of the mental health system is that people think they are being helpful (“You have problems because you have a disorder”) rather than addressing  causes and potential solutions for behavior change. In this case, many problems of pain are not being solved as the focus of attention is on the “correct” diagnosis, which, in my opinion, is a rather useless pursuit. It can be akin to a parent who has several children; one of them is determined to be “bad.” Instead of figuring out how to prevent problem behavior, solve problems, and tend to the child’s needs; the parent simply attributes all problem behavior to the child being “bad.” 

What you can do if you have, or think you have, or someone else thinks you have BPD:

Don’t think you are permanently impaired, hopeless, or beyond help. Fear and shame keeps may people paralyzed from acting with self-respect, doing things that are meaningful, and putting oneself out there in the universe. Universally, fear and shame can prevent anyone from living a decent life. You are not an exception. 

Learn to talk about yourself and your behaviors in a descriptive, non-judgmental, and matter-of-fact ways. This will make you competent, understandable, and respectable. This also means that if you go around and tell everyone you are disordered, people may treat you as fragile, incompetent, incapable, or helpless. Create and practice ways to talk about yourself outside of the realm of “mental illness.” 

Pay attention to providers, mental health professionals, or family members who attribute your behavior to being “mentally ill” or “bad” or “personality disordered.” Realize that everyone has vulnerabilities and that many, many people struggle with giving accurate, helpful, and specific feedback. Consider how giving and receiving feedback is either helpful or not helpful, and don’t  seek out relationships where blame seems to be an acceptable solution for reducing pain or resolving differences. Finding “fault” only works if the consequence is taking responsibility and making changes; not amplifying shame and paralysis of action. 

Be aware that if you do delve into literature on BPD, you may encounter a wide range of confusing terminology that attempts to define you; which may not only be disconcerting but also downright confusing. You might encounter terms like object relations, transference, countertransference, self-objects, self-soothing self-objects, object mirroring, intrapsychic processes, or projections. Don’t get bogged down by mental health-ese. Bear in mind that some mental health professionals have a lot of trouble observing and describing behavior and giving useful feedback and sometimes hide behind their own jargon. 

Find other things that provide you a sense of identity, that define you, that make you the person you are, and that you value. Consider roles you take on in society; engage in them and be proud of them. What is important to you? Why would you let a diagnoses get in your way with pursuing what is important to you? In what ways do you not “show up” because you have shame around a diagnosis? Life is bigger than the world of “mental health.” 

Bear in mind that many mental health professionals are obsessed with political leaders that they believe to be personality disordered. In truth, political leaders are still political leaders, and political leaders have made great gains, influenced many, changed laws, and maintained power. Being diagnosed with something “bad” hasn’t deterred people from being politically active, advocating, having power, or being influential. There is no good reason why you have to be shamed from participating in the universe just like everyone else- people with a lot of problems still manage to be successful and competent in a myriad of different ways. 

Finally, feel free to visit the National Education Alliance for Borderline Personality Disorder, a nonprofit that may be more helpful than the general google search. Their website (www.borderlinepersonaltydisorder.com) has some useful non-pejorative literature, trainings, and free services for friends and family members. 

The facts are that depressed people often behave in ways that are depressing. When a treatment plan targets not only thoughts and feelings but also behavior, treatment is more effective. Because changing behavior requires willingness, and because depressed people have a tendency to convince others that their situation is hopeless, changing one’s behavior can be a big challenge! However, the willingness to try out different behaviors can actually improve and change mood.

Here are some basic treatment interventions for changing depressed behavior: 

Increase your connection with the things that bring you joy and pleasure. Often, when people are depressed, they tend to withdraw or isolate. If people feel self conscious or down on themselves it is easy to get inside one’s head with negative self talk, and this can drown a person in misery. Here are some smaller steps to take towards joy: 

Find three things a day that bring you pleasure, that you are grateful for, or that you appreciate (and perhaps even take for granted). Identify a buddy and share three gratitudes daily. Find more than one buddy and start a gratitude texting thread. 

Rehearse positives. This means making an effortful focus to share, remember, or tell people about the things in your life that generate a sense of well being, happiness, or pleasure. The practice can be extremely small, such as seeing a wild bird outside of your window or having access to comfortable transportation. Let people know about it, even if it is small talk with strangers in an elevator. 

Stop rehearsing negatives. While it may be true that not everyone likes you, or that there may be many challenging situations you are facing, interpreting everything as hostile increases a sense of feeling and believing you are defeated. It may be true that there are aspects of your stress or suffering that feel invisible to others. But if you spend the large majority of your social life ranting or reiterating your pain, emphasizing your terrible characteristics, or employing your general incompetence, it will create barriers for others to treat you as if you are competent and worthwhile.

When you do express vulnerably or life challenges to other people, be receptive to what others suggest or offer. Even if their suggestions may not be helpful, most everyone who is paying attention and trying to be helpful wants to feel acknowledged. If you improve your relationships and your connections by valuing what others have to offer and make them feel appreciated, you will be less socially isolated and thus less depressed. If you antagonize, challenge, or undermine others because there is “nothing” they can do about your situation, you invite everyone to feel incompetent right along with you. 

Just because you feel hopeless doesn’t mean you have to generate hopeless outcomes. Feeling discouraged, down, sad or missing someone or something in your life is normal. Rehearsing hopeless outcomes is not.Expressing sadness openly or crying with someone is different from rehearsing negatives, convincing or arguing that your situation will never improve, rehearing hopeless outcomes, or railroading a conversation into futility. You may feel hopeless, but that does not mean you have to act hopeless. Expressing sadness generally connects people to others, while rehearsing hopeless outcomes generally amplifies hopeless feelings. 

If you don’t wish to make changes, notice the impact. If you want supportive relationships, you have to behave in ways that increase or improve your connection with others. Have you burnt out relationships – or are you burning bridges – by constantly rehashing your problems on everyone else? What is it costing you to continue this behavior? What would it cost you to change it? 

If there is something you can do to fix, solve, or improve a situation, why would you not do it? Depressed people often take a passive role in complaining about their lives, or convincing others that they are the only persons who experience suffering. Sometimes this results in other people picking up the slack, stepping in, or fixing/ solving problems on their behalf. Thus, depressed people can be quite keen on making people believe they are incompetent or helpless when they are not. If this is you, what is it costing you to be in this situation? What would cost you to get out of it? If you are someone who relies heavily on others to take care of you (as we are all interdependent to some degree), is there something you can do express appreciation or gratitude? Foster or enhance the connections that you have? 

Learn new skills, solve problems, step up to challenges, and be proactive. When people stop being passive and start being active, they start to gain a sense of mastery, control, competence, and confidence. These experiences generally are in and of themselves a treatment for depression. It is harder to feel depressed when you feel competent, have self respect, and like who you are. Act like a person who likes who they are. Find what there is to like about yourself and let people know about it. Solve solvable problems. Stop avoiding your life. If there are things you can’t do physically, work on improving your relationships. Find joy and pleasure in others. 

If all else fails, do the pros and cons of acting in ways that generate more depression. After all, it is your life. If you are the one who is miserable, you are the one who has to live inside your body. If nothing is done to change or fix a situation, there is no good reason anything should change! Nobody can actually take away your pain and suffering, but if you behaved less like a depressed person, you could actually have a better experience of yourself. 

Here is a cartoon elephant that may not look like a cartoon elephant.

Sort of like an emotion in disguise.

Emotions in disguise are emotions that may not be clearly recognizable.

The best ways to figure out if you have an emotion in disguise include:

1)   Being curious or gentle with that which you do not understand

2)   Find compassion for ambiguity

3)   Gently notice the sensations or discomfort

4)   Find space for the undefined pink

5)   Breath into, with, and through the pink

6)   Allow for the pink to exist in all it’s pinky pinkness

Sometimes your pink will become a cartoon elephant with edges and tusks and lines, and it will help you understand yourself and your situation better.

For more on how cartoon elephants help us solve emotional problems, visit www.cartoonelephantbook.com and buy the book.

Depression often occurs when something that has been rewarding, reinforcing, consistent, or available gets taken away. We get depressed when relationships end, when we lose people we care about, and the things that we were taking for granted are suddenly no longer available. Depression is the lack of something. Depression is often associated with loss, change, or a disconnection with the reinforcing aspects of our life.

People are often depressed when they don’t have enough connections, experiences, interactions, or things in their life that naturally bring about joy, peace, or a sense of well-being. Depression can often be associated with lack of activity, becoming withdrawn, and staying in bed. People sometimes get depressed when they don’t have enough to do, or when they are overwhelmed with multiple demands.

Teens can often be depressed because they do not get enough things in their life throughout the day that give them a sense of well-being or joy. Being able to take mental breaks, have activities that they look forward to doing, and have enough “down” or “me” time is critical in mitigating depressive symptoms. Taking a plethora of classes that one really dislikes, being behind in homework, and having non-stop activities scheduled until bedtime can sometimes be enough to get a teenager depressed. Social losses, such as a recent break up, an exclusion from a friend group, or navigating the unfamiliarity and changes of a demanding schedule can negatively impact mood. Try to keep in mind that depression has to do with what is lacking. If your teen is comfortable in social situations, feels as if he or she has choices in making his or her schedule, is not expected to work nonstop outside of school, feels a sense of contribution/ effectiveness/ mastery in some area of his or her life, and engages in activities he/she looks forward to, then he/she will be less likely to be depressed.

What could be more reinforcing for your teen? Try to think of reinforcement as something rewarding, enjoyable, energizing, or even peaceful. Don’t limit your thinking to only adding things, as the demands of having too many things can in and of itself be a problem. Balance is key. Consider how these simple things might really matter: Sleeping in, taking a long hot shower, watching a favorite TV show, hanging out, or interacting with a parent in way that feels appreciative or warm. Consider that finding happiness is not the key to treating depression; rather it is creating a life that is rich, full, balanced, and meaningful.

In addition to time management, scheduling, and navigating opportunities that are reinforcing, a parent might also want to consider key biological factors that really matter when it comes to managing mood. Consider your teenager’s sleep schedule. Is he or she getting enough sleep? Sometimes teens think they can overcome their biological limitations by staying up extremely late and thinking it doesn’t impact mood. Sleep should be a priority, because a lack of sleep often precipitates a big blowup, a heated argument, or other behavioral issues that are clearly difficult for parents. Is he or she getting adequate nutrition, eating at regular intervals, and relying on something besides caffeine, carbohydrates, and sugar for energy? French fries and Coca-Cola will not be adequate. Skipping breakfast or lunch doesn’t help either. Sometimes we like to attribute mood problems to conflict at home, problems with stress, or the demands of homework. However, taking some simple steps to increase pleasant experiences, take enough “breaks”, and manage biological factors can go a long way in treating adolescent depression.

Notice what you feel without judging. Sometimes people believe that if they don’t feel a certain way, they are missing out on some kind of grand, spiritual, or wonderful experience. I am reminded of the Charlie Brown Christmas special in which he doesn’t feel like he “should”. Not everyone is awed, exhilarated, or spiritually “moved” this time of year.

Accept and acknowledge the mundane, the everyday, or the not-so-wow experiences this season. Remember that the glue that holds us together in the smaller, everyday nuances of our existence and our relationships also has meaning. Foster the relationships that matter.

If you want to feel more connected and less detached, practice ways to participate willingly, go with the flow, risk being open, and become involved. Volunteer, show up for the holiday parties, attend services, and remain attentive and awake to what is going on around you. Although it is possible that exerting energy takes effort (and may not completely diminish loneliness), it gives you an option to temporarily shift your mood.

Find the stillness within– Crowds, shopping, to do lists, and holiday planning can be overwhelming. Finding stillness within yourself can help you cope adaptively, slow things down, find your wisdom, and stay grounded. Bear in mind that you have the ability to find inner wisdom, but sometimes emotions and other people can get in the way of finding it. Try the suggestions below:

Find 2-5 minutes once a day from now until Christmas to sit quietly, observe your breath, and gently pay attention to whatever sensations arise within you. After sitting quietly, try writing: I notice… I would like… I feel…I sense…I think…I am aware of…I am most worried about…

If you are out shopping or involved in intense holiday planning, make sure that you don’t skip meals or shop on an empty stomach. Take periodic breaks that include sitting down and being away from loud noises, bright lights, and crowds. Consider what you need and the cost/ benefit of overestimating your energy and pushing yourself too hard.