SYMPTOM MANAGEMENT FOR BORDERLINE PERSONALITY DISORDER
The Wellness Plan
Our basic health determines so much of the way we treat ourselves and others. Maslow's Triangle identifies five areas we can focus on to improve the foundation of our daily lives. Starting from the bottom, we have the most important: our physiological needs. If we want our brains and body to work to their best ability, we need to ensure our physiological needs are adequately met. This often means following the very cliché advice of: • Eat 3 meals a day, or 6 smaller meals • Sleep 7-8 hours • Exercise regularly Then, we have our basic safety needs. Here, we need to think about: • If we feel safe and comfortable in our home and if not, what we can do about it. • If our relationships are healthy and how to improve them • What support needs do we have and whom do we have in our support network Then we have belonging and love. For this, we need to consider • The kind of friends and family we have • What relationships do we desire to create • The relationship we have with our communities • How accepted we feel Closest to the top, we have esteem. To meet our esteem needs we need to • Feel healthy and strong • Be educated and knowledgable • Feel independent but also supported • Recognised for our achievements • Engage in self-fulfilling hobbies When you've begun improving all of the components of Maslow's Triangle, you will naturally begin to reach self-actualisation.
Dissociation
I dissociate quite often and over the years, I've found a few ways that help me to "snap out of it", so I'm going to share them in the hope they might help you, too. Allow yourself to dissociate. I know this may seem redundant, but hear me out. Sometimes our brains and bodies need to rest and the only way they can is by taking a literal break. Let yourself dissociate and set a timer for 10–30 minutes. After this, do an activity - shower, draw, write, paint, take a walk, and clean up the house. Do anything. Keep restarting when you notice the dissociation taking over. Doing this may help you gain more control over the duration and severity of your dissociation. Cold water can be a great tool. Of course, before doing this, check with your healthcare provider (drastic changes in temperatures can be dangerous, even deadly, so take this seriously). This method is part of the DBT skill TIPP. When I recognise I am beginning to badly dissociate, I will fill up a bowl with really cold water and dunk my head into it for a few moments. This triggers the divers response which means your blood is redirected to only your essential organs. It’s like a little computer restart. Reset your senses. Bite into a lemon, or eat/drink something you know you will react to. This will bring you back to the present moment almost immediately. Smell essential oils or strong scents(that are not tied to any memories you have). Please don’t do this if you’re asthmatic or have breathing issues. Peppermint oil is my favourite so I’ll just grab the bottle and take a few deep sniffs. I sometimes mix a tiny amount (TINY amount - a drop, if that) into some vaseline and put it on my face and neck (this helps sinuses) and the tingling can be a bit of a wake-up call. Just don’t use too much peppermint oil otherwise your eyes will be forced shut and stream like a waterfall. Trust me on that. The most important thing: Notice what grabs your attention and what happens in the moments before you begin to dissociate. (You’ll likely have to do this after your dissociation episode). These will likely play a role in your trigger to dissociate. Weirdly, in my experience, if I’m already feeling stressed and I watch a very vividly colourful and fast-paced film, I will absolutely dissociate. My brain cannot take that in so it shuts down. Muted-coloured, slower-paced films appear to allow my brain some rest. I love complex music, but when I am already feeling stressed or upset, music with multiple layers will make me dissociate. Strip it down to something acoustic and my brain can relax. Noticing these really small details has helped me to recognise that, if I’m stressed I need to avoid vivid colours, lots of noise and a fast-paced environment. This is one way to avoid dissociation and it isn’t foolproof, but when you know your triggers, you can start managing them more effectively.
Splitting / Devaluation
If you struggle with idealisation and devaluation/splitting/black-and-white thinking (truth be told, it has far too many names) then some of the following tools and techniques may help you. If you find yourself splitting on those you love for no apparent reason (probably to test their boundaries and if they'll fight for you and stay), and you want that to stop - then here's what you can do. Spend some time thinking about your relationship objectively. How do you feel when you're around them 90% of the time? Is this relationship healthy? How often do you argue and disagree? Do you feel safe around them? Can you fully express yourself? Do you trust them? If the relationship is overall positive and your splitting truly is unjustified then you can: • Write down all your good memories and thoughts about this person (include all the things they've done for you, even the smallest things) • Write down their good qualities and the things you love about them • Write a letter to them (don't worry, you don't ever have to send it!) • Write down the reasons you don't want to 'split' on them anymore • How would you feel if you lost them? Now, when you feel a "splitting episode" coming on, you'll have plenty of things to remind you why you need to take a deep breath and choose a different direction. What to do when you feel like you're going to split: • Create a physical cue for yourself that aligns with the thought "Splitting is not worth the damage." I tend to slap my thigh and repeat the phrase in my head. • Excuse yourself from the situation however you need to, just avoid aggression. "I am feeling angry and I need some space" or "I need you to leave me alone" is perfectly okay. • Avoid using your phone if you find yourself wanting to text or call the person to vent or let your emotions out on them • Distract yourself - it is good to have a distraction tool kit which I'll link my guide to at the bottom of this article
Fear of Abandonment
Fear of Abandonment is no joke. I ran a survey that currently has 65 participants (as of Feb 2023). When asked "out of the 9 symptoms, which ones do you struggle with the most?" 69.2% of the participants responded with "Fear of Abandonment", slightly less than Chronic Feelings of Emptiness, which 72.3% of participants cited difficulties with. Fear of Abandonment is incredibly difficult to manage and it will take tonnes of trial and error. You can use some of the "splitting/devaluation" skills to help avoid the fear of abandonment (by using the positive lists you wrote about your loved ones) and remind yourself why the fear of abandonment isn't worth it either. The facts of Fear of Abandonment: • It often has the opposite of the desired effect and forces people to leave • It creates an unhealthy, codependent dynamic • It impairs our ability to assess whether the relationship is objectively healthy Things to consider about your fear of abandonment: • How do you behave when your fear of abandonment kicks in? • What do you feel before your fear of abandonment kicks in? • When has your fear of abandonment ever actually helped you keep someone? • What are the positives and negatives of having a fear of abandonment? • What behaviours does your fear of abandonment drive? (Do you become verbally abusive, inconsolable, have panic attacks, self-harm etc) When you feel your fear of abandonment creeping in, what can you do to redirect yourself? • Look at happy photos/videos • Read your positive lists of why you don't want to lose this person • Take a physical step back • Use your distraction tool kit • Turn your phone off • Ask someone you feel safe with to help