For many years, I have had to work through the symptoms of Borderline Personality Disorder (BPD). Until just a couple of years ago, I was intensely resistant to getting a formal diagnosis because I felt that would be a type of life sentence with no hope. To the exact contrary, it has been so life-changing since being diagnosed, being able to now gain the skills to manage my BPD.
I thought I’d share some key ways I manage my BPD symptoms which I learned in Dialectical Behavioral Therapy (DBT). Please note that while these tactics help me with my BPD, they may be helpful for anybody.
1. Mindfulness: WHAT and HOW
If you’re having trouble with impulsivity, it may be helpful for you to practice mindfulness. WHAT and HOW are two popular techniques that help keep you in the moment and help you focus on what is in the here and now. WHAT is about what to do when practicing mindfulness and HOW is how to do it.
WHAT consists of three parts: Observe, Describe, and Participate. The first step, Observe, is about noticing your environment and what is around you without placing labels on it. Observe without reacting, just noticing. Describe is the step where you describe your observations. You can say “I notice that the car is red” or “I am observing that I am feeling anxious.” The last step, Participate, is engaging in what is happening and staying in the moment while doing it.
The HOW skill is how one can practice mindfulness. It has to be done non-judgmentally, one-mindfully, and effectively. Non-judgmentally means noticing and releasing judgment about yourself and your environment; it is also about making sure not to judge your judging! One-mindfully means being fully present in the moment, and effectively is doing what works in the here and now. If you feel the need to do something that “just can’t wait,” try to practice these skills and focus on what is going on currently. Notice if the thing that you “must” do is actually going to be effective and helpful, or if it’s ineffective and harmful.
When I have the feeling that something must be done now, like an impulse, I use these skills. I take a deep breath and observe what is going around both in my surroundings and within myself, and then I describe it and find a way to participate in the most effective way. Sometimes this means taking a step back or taking a break and sometimes it means approaching whatever the situation is and problem-solving it.
2. DEAR MAN
DEAR MAN is an acronym used in DBT that helps you learn how to say no and how to ask for what you want–problems that I, like so many others, struggle with. The DEAR part is what to say and the MAN is how to say it. The DEAR stands for (D)escribe, (E)xpress, (A)ssert, and (R)eward. Describe is when you say the facts of the situation with no judgements or accusations. Express is when you state how this makes you feel. Others might not know how you feel, so it’s really important that you let them know. Assert is when you ask for what you want or say no. If you don’t say it outright, others might not know what you want or need. Then comes reward, which has to be something others want. It could even be you saying, “It will make me happy,” because if they care about your feelings, your happiness is a reward for them too.
The second part of DEAR MAN is MAN, which is what to keep in mind and do while you’re asking for something. It stands for (M)indful, (A)ppear confident, and (N)egotiate. The first few times when using this technique, it’s helpful to write out a script. It might sound robotic at the beginning, but it will become smoother and more natural over time.
My first time using DEAR MAN was when I was trying to get my parents to let me drive. My script went as follows: “It is my turn to drive in the rotation; I would feel so guilty if I wasn’t able to drive. Would it be possible for me to drive tomorrow? If I drive, I will be on my best behavior for the rest of the week.” I also continued to be mindful and appear confident while I was talking and negotiating when my parents were questioning and leaning towards saying no.
When you’re in crisis, try the TIPP skill–there are different parts for different types of situations. TIPP is also an acronym and stands for (T)emperature, (I)ntense exercise, (P)aced breathing, and (P)rogressive muscle relaxation. Temperature is when you hold your breath and submerge your face into a bucket of ice-cold water. If you don’t have a large bowl of ice water, you can hold your breath and put ice or an ice-cold cloth on your face, mostly on your sinus area. This enacts the dive reflex and helps slow your heart rate. This can help when you’re in the middle of a panic attack or are really anxious. (*Side note: This part of TIPP is not good if you have a heart condition or a low heart rate.)
The temperature part of TIPP is an actual medical solution. When I was 13, my heart rate started to go really fast–as high as 255 bpm. My heart was in a state of supraventricular tachycardia and they couldn’t figure out how to lower it. The doctors tried IV medication and other solutions, but nothing was lowering it. One doctor decided to put an ice cube on the bridge of my nose, and that is what lowered my heart rate when nothing else could. This is a very helpful medical tip and it saved my life.
I find the intense exercise to be helpful when I feel anger; it is when you do short bursts of really intense exercise–about 10-15 mins. This kind of exercise can be something as easy as jumping jacks or a quick sprint. Intense exercise can help release your stored-up energy in an effective way, which is why it is helpful.
Paced breathing is about breathing out for longer than you breathe in. It is recommended to breathe in for 5 seconds and out for 7, but it could be 4 and 6 or whatever works best for you. The breaths during the exercise should come from your abdomen. This can help regulate your breathing if you’re in an intense situation and you feel like you can’t catch your breath. Personally, I used to find paced breathing to be difficult; it felt like I was suffocating when I tried to breathe like this, but I soon realized that, just like everything, it takes practice.
The final step of TIPP is progressive muscle relaxation, which is when you start from either the top or bottom of your body and tense each muscle group, hold, and then release, continuing in order throughout the rest of your body. This is great for calming down your body and it’s especially helpful to do before bed if you have trouble falling asleep. (There are plenty of good voice recordings on YouTube of people going through the whole process that you can listen to and do it along with them.)
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