Managing Intense Emotions and Overcoming Self-Destructive Habits

A Self-Help Manual

Lorraine Bell

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135444792
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

What is borderline personality disorder and what can people with borderline problems do to help themselves?
The treatment of personality disorder is a major concern facing current mental health services. Specialist therapies are often not available and many people with these problems drop out of treatment. Managing Intense Emotions and Overcoming Self-Destructive Habits is a self-help manual for people who would meet the diagnosis of 'emotionally unstable' or 'borderline personality disorder' (BPD), outlining a brief intervention which is based on a model of treatment known to be effective for other conditions, such as anxiety, depression and bulimia.
The manual describes the problem areas, the skills needed to overcome them and how these skills can be developed. It is designed to be used with the help of professional mental health staff, ideally in a group with individual sessions to support and coach the person in the application of the skills taught. A minimum of 24 and maximum of 36 sessions are recommended. Areas covered include:
* the condition and controversy surrounding the diagnosis of BPD
* drug and alcohol misuse
* emotional dysregulation and the role of thinking habits and beliefs
* depression and difficult mood states
* childhood abuse and relationship difficulties
* anger management.
Borderline personality disorder is a complex and challenging condition. This manual aims to explain the problems experienced by people who may be given this diagnosis in a way that clients and staff can easily understand. It will be essential reading for people with BPD and professionals involved in their care - psychologists, psychiatric nurses, psychiatrists and occupational therapists.

1 Understanding the problems and first steps

1 Introduction

Who the manual is for and how to use it

DOI: 10.4324/9780203695555-1

This programme is designed to help a particular group of people who suffer with intense emotional states and have a wide range of problems, including extreme mood swings and instability in relationships. These problems are very difficult to manage and often lead to behaviours such as self-harm, drug or alcohol misuse or eating problems. The programme describes these problems and the skills you need to develop to overcome them, and gives instructions for how these skills can be developed. It is designed to be used with the help of professional mental health staff, ideally in a group, with additional individual sessions to support and coach the person in the use of the manual. Thirty-six sessions are recommended for people with borderline personality disorder (BPD), and 24 for people with impulsive or partial borderline problems.

Common Problems

These are the kinds of problems you may experience:

• getting bored easily and doing risky things ‘for the hell of it’
• losing your temper a lot
• being moody, getting irritable
• hating the way you look, changing your appearance a lot (hair, clothes, make-up)
• feeling desolate and lonely when alone
• feeling uncomfortable in a close relationship, or that people are trying to control you
• flirting habitually and getting a buzz from sexually attracting others
• feeling very jealous of other people, especially if they are liked by people you want to like you
• being suspicious of people and feeling paranoid (e.g. thinking that people are talking about you)
• having sex with people you don't know well in the hope of getting affection
• getting a buzz from doing things you're not supposed to, like stealing, getting lifts from strangers, taking drugs
• hating or blaming yourself at times and/or hating or blaming others
• doing things to try and please people and get them to like you (e.g. buying them presents)
• neglecting yourself and doing things which are not good for you or harmful
• finding it difficult to maintain relationships
• not knowing who you are and looking for something or someone to give you a sense of identity
• changing life goals, priorities, feelings, or confusion about these
• rapid intense changes in mood
• overwhelming urges to hurt or punish yourself
• not coping when people leave you, desperately clinging on to them or going to extreme lengths to try and get them back
• feeling deeply unloved and longing for someone to take care of you.

One common feature in these problems is instability — instability in one's sense of identity, in mood (highs and lows) and in relationships (idealising someone one minute then devaluing them the next). Another is intense states of emotional pain which are difficult to cope with. Many people with these problems try to numb themselves when in such states, or block them out with alcohol or drugs. They tend to have powerful impulses which in states of distress they find difficult to control. Men and women tend to act on these impulses differently. Men are more likely to use drugs and alcohol and women to develop eating problems (Zanarini et al., 1998).

People with such problems may meet criteria for what is known as borderline personality disorder (from now on referred to as BPD) (APA, 1994). This is also called emotionally unstable personality disorder (WHO, 1992), which is a more accurate but less well-known term and is not widely used. ‘Personality’ is made up of your temperament, which is biological and genetic, and your character which develops out of early experience (Vaillant, 1987). The term ‘personality disorder’ refers to a wide range of problems which begin in childhood or adolescence, affect many areas of life, tend to last for many years and are not easily changed. Personality problems vary in degree. All of us have aspects of our personality which may be problematic and persistent, though these may be restricted to particular settings. People whose problems would meet criteria for a ‘personality disorder’ would have more severe problems, and probably in a wider range of settings. There are a number of different personality problems or so-called disorders. BPD is the most common in mental health care because people with borderline problems have acute distress and severe problems in coping. Some people who have intense emotional distress and problematic behaviours like substance misuse and self-harm would not meet the criteria required for a diagnosis of BPD.

Some clinicians would describe people with such problems as ‘multi-impulsive’. In this manual the full range of these problems will be referred to as ‘borderline problems’.

EXERCISE 1.1

At this point it is helpful for you to identify the range of problems you have and how severe they are. Spitzer et al. (1987) converted the diagnostic criteria for BPD into a series of questions. The questions below have been revised to include the most recent diagnostic criteria. People do not always realise they have a problem. (What we are used to may seem normal or we may feel the problem is someone else's fault.) It may be helpful to discuss these with someone you trust who knows you well, or with your ‘guide’. Circle which of the answers describe you most accurately.

1. Do your relationships with people you really care about have lots of ups and downs? Are there times when you thought they were everything to you and then other times when you thought they were terrible? How many relationships are like this?
   1. My feelings toward people in close relationships don't change that much.
   2. I do experience different feelings in close relationships, but these are not intense or frequent.
   3. I have had one prolonged relationship or several brief relationships in which I have experienced changes in intense positive and negative feelings.
2. Have you often done things impulsively? What kinds of things? Tick if you have done any of the following

   

   • buying things you couldn't afford
   • having sex with people you hardly know, or having ‘unsafe’ sex
   • drinking too much
   • taking illegal drugs
   • driving recklessly
   • uncontrollable eating
   • shoplifting or stealing
   • gambling
   Which is true for you?
   1. I am never impulsive.
   2. I am impulsive in one area that could be self-damaging.
   3. I am impulsive in two or more areas that could be self-damaging.
3. Are you a ‘moody’ person? How long do your bad moods last? How often do these mood changes happen?
   1. My mood does not change much.
   2. I am a little moody.
   3. I have frequent mood shifts.
4. Do you often have temper outbursts, or get so angry that you lose control? Do you ever hit people, damage property or throw things? Do you ever provoke an argument or get into fights? Do even little things get you very angry?
   1. I am rarely angry.
   2. I do get angry but it isn't a major problem.
   3. I frequently lose my temper, am constantly angry, or have difficulty controlling my anger. I tend to get into physical fights.
5. Have you tried to hurt or kill yourself or threatened to do so? Have you ever taken an overdose? Have you ever scratched, cut...