BPD & Daily Life: Physical Health

Can Borderline Personality Disorder have an effect on your physical health? Short answer: yes! In fact if you have BPD you almost certainly realised this long ago. Poorly managed mental health is often detrimental to our bodies. Depressive or low moods may lead to us not being able to eat balanced meals, do exercise and take care of our personal hygiene. 

I remember one very hot summer I hid under my duvet, with no water, no showers, and a box or two of pizza for the most part of a week. I think in the end my housemate intervened by bringing bottles of water to me. All I could think of at the time was how I couldn’t face another 20 years of existence. Looking back on it I was emotionally exhausted from learning to ‘mask’ my symptoms, trying desperately to keep up with uni work, and learning to live away from home. I had a lot on my plate and it simply caused me to freeze up. 

These days I have learned to manage my burnout in a healthier way, despite it still hitting me hard at times. I am much more in control of my symptoms, but my physical health has suffered over the years. Let’s talk about a few of the problems people living with BPD encounter: 

• Weight - In my experience this one is very common. This could be either being overweight or underweight. There are lots of contributing factors here: medications that cause increased appetite (or the opposite), lack of motivation to exercise, emotional overeating and even not having the mental stability to cook a healthy meal. It is also vital to mention that those with BPD often have a comorbid eating disorder that can go hand in hand with poor self-esteem and feeling out of control.

• Underlying health conditions - Because people with BPD face a lot of stigma from healthcare professionals and therefore are more reluctant to seek help, things can get missed. Repeated invalidation from services is enough to re-traumatise us and make us avoid getting help from our GPs. Alternatively the BPD diagnosis becomes a distraction and often symptoms of other illnesses are contributed to mental health. I recall one story of a girl with BPD who was going to her GP for months, presenting with chest pains and feeling clammy. The GP put it down to anxiety and did no further investigation. It was only after she had a heart attack in her early twenties, that they realised she had a heart condition. This isn’t an isolated event, I’ve heard many stories like this from friends and other BPD content creators.

• Liver/kidney damage - This is something I’ve heard less about, but if you take a couple of things into consideration it makes sense. Firstly liver damage can be caused by excessive alcohol use. We know that many people with BPD also struggle with substance misuse and impulse control problems. Secondly, we know that overdoses of certain medications can also damage the liver. So we can safely assume that acting on our impulsive urges can cause us some pretty serious physical problems. With regard to kidney damage, I used to work with a woman who developed this through refusing to drink much water due to her low mood. 

• Digestion issues - this one is quite personal to me, but if you’ve read the ACEs study (seriously go research this, it’ll blow your mind) you can see how this could happen. I’ve had on and off stomach problems for most of my adult life, and I’ve suffered a lot of pain in my abdomen. I kept going to the hospital in agony; a roaring burning pain in my stomach that would have me on the floor screaming. No one could ever work out what the problem was - mainly due to the very long waiting times at my A&E. The pain would subside and I would be sent home. Eventually the doctors decided to do some investigating and it turned out that I had developed a stomach ulcer. There are many reasons why someone can get a stomach ulcer, but mine was put down to constant stress. Not really a situation I can fix when I live in a perpetual state of anxiety. I take medication for it and it is better managed now, but I have to be careful of what I eat and drink and take my meds wherever I go. 

• Dental problems - I wasn’t planning to write about this, but as I was thinking I realised how much of an issue this one is. I have been lucky. Countless nights of passing out without brushing my teeth and days where I simply couldn’t get the energy together, haven’t really caused me problems. I’m 29 without a single filling and have never had major work done in my adult life, despite not going to the dentist for a decade at one point. Others aren’t so lucky. It is a known fact that some antipsychotic medications can cause dental problems and weaken teeth. I know a few people who have rotted their teeth beyond repair thanks to not cleaning them, smoking cigarettes and avoiding the dentist. There have even been studies correlating poor dental hygiene with heart disease. 

As you can see, living with BPD and other mental health conditions can take a huge toll on your physical wellbeing. Remember when you are in treatment to talk about your physical health concerns and needs. You’re going to need help with it and you deserve to be looked after holistically.

BPD & Daily Life: Masking

 

Those of us living with Borderline Personality Disorder will be aware of the common experiences we share, but often we talk about our symptoms at crisis point. So what about every day? What’s it like to live with this persistent and pervasive disorder every moment of our lives? 

I’m approaching this as someone who was diagnosed over 8 years ago. I’ve had time to get to know myself and develop some coping mechanisms. I’ve been through several types of therapy and I appear “functional” most of the time. I’m going to address different aspects of my life and how they are affected by BPD over the next few posts.  

I wanted to talk about why many people that know me personally don’t know about my diagnosis and often act shocked when they find out. It’s called “Masking”. If you’re familiar with the autistic community or other forms of neurodivergence you may have heard of masking before. Within the context of personality disorder, masking is hiding your symptoms in an attempt to “act normal” and avoid being detected. For me this involves using bathroom breaks to hide anxiety attacks, dissociating rather than letting people see my emotional reactions, mirroring the likes and dislikes of others so they don’t find out I have no stable sense of self, and simply not talking about any of the struggles I go through. Whilst masking has come in handy for things like holding down a job and fitting in temporarily, there is a price to pay. All that effort put into controlling what others see, leaves me burned out and exhausted. I’ve jeopardized a few jobs and even friendships this way, when I disappear/isolate for a few months to recover. 

So what sort of things do I have to mask about my day to day experience? 

• My intense emotional reactions - these can be triggered by the smallest things, such as someone looking at me the wrong way, me misinterpreting a comment or even feeling as if I’m doing “too well”

• The constant judgemental commentary of myself and others that leads to intense social anxiety

• Trauma flashbacks that can be triggered by smells, sensations or sounds (yes, there are periods where this might happen every day)

• The panic of someone asking me about my likes and dislikes - these days I have a stronger sense of my preferences, but it still causes me to have an internal meltdown

• Intrusive thoughts - these can be around self-harm, paranoias or delusions

More recently I am finding more ways to cope with my symptoms that don’t involve the tiring process of masking. I’m starting conversations with my friends about the “real” me, and looking for ways of working that allow me to be myself. Let’s not pretend that recovery from BPD is easy, but it certainly is possible with the right help and support.

Hey guys, I'm back

And it's great to be back... 

As I mentioned in February, I had a lot on my calendar in the name of career development and self improvement. It's been great for me, but I'm really pleased about finally having some time to sit down and write. 

Recently I've been writing a lot about DBT skills, but I would love to go back to what the core of this blog is about. I'll be writing some short pieces about how Borderline Personality Disorder affects my day to day life. It was originally going to be one post, but it turns out there are so many aspects, I needed to break it up. So look forward to this new content over the coming months. 

Out of Darkness Xx

Brief break in posting

 Hi all,

By now you may have noticed a slowing down in my posts. I just wanted to explain the exciting things going on for me. 

I have worked part time for a couple of years now, which suits my health. This year on top of this job, I started DBT (after many years of waiting) and a level 2 qualification in counselling. I've also been spending a lot of time doing paperwork, because we're also about to become homeowners.

I've been given a fantastic opportunity to work closely with the NHS Personality Disorder team in my area. I will be working to help improve services and deliver awareness training to staff.

Because of all these (positive) things going on at once, my blog might not get content as quickly as usual. I appreciate everyone who enjoys my content. This is not the end of the journey, far from it and I hope in a few months I will have some of my time back.

See you all soon, 

Out of darkness Xx

DBT Skill: How you can create your own emergency self-care kit

Part of the Distress Tolerance module of DBT, creating a Soothe/Distract Kit can really help you out in a pinch. It helps you to put the distress tolerance skills in a more physical place that doesn't require much thought. If you're feeling overwhelmed, but still have the ability to open up your toolkit, then this is the time to prevent your emotions from taking control. Alternatively, you've just used your STOP and TIPP skills, and now you need to bring down your emotional arousal. 

Each person's toolkit will look different and is extremely personal to the owner. It needs to reflect what helps to take you away from the situation and what helps to calm you. Today I wanted to walk you through what's in my Soothe/Distract Toolkit. 

So I think the best way to start is to find a nice box or gift bag. My toolkit resides in a shoebox, but mainly because I love The Nightmare Before Christmas. If you have a more plain box then you can decorate it with patterns or themes you like. 

Under the lid I've put ways to soothe my senses that you can't box up. Such as suggestions to listen to soothing music or using my weighted blanket. There are a list of extra distractions as well. Finally I've put some self-affirming coping statements to help me feel more confident. 

Inside you'll want to include items that either distract you from the way you are feeling, or that help to soothe your body and mind. In DBT we talk about soothing the 5 senses, which are: Vision, Hearing, Smell, Taste and Touch. Try to include as many of these as you can to give you more options. 

Taste is probably my 'go to' way of soothing myself in a crisis. As someone who has always struggled with binge eating the key to balance is to use these food items for mindfulness. I put down everything I am doing to purely focus on the food. The way it looks, the texture, the aftertaste. Sugar free lollipops are especially good for this as you have to eat them slowly. Another tip is to find foods that take you back to a pleasant, safe memory.

The sense of hearing is slightly harder to embody physically in your box. I only have one item which was a gift from my godmother for my 18th birthday. It's a metal heart filled with small pins, which create a pleasant, mysterious sounding jingle. It's actually a larger version of a baby rattle that made the same sound she'd gifted me at my christening. I find the noise it makes really soothing. Another way you can incorporate your sense of hearing is to make yourself some playlists of both soothing and distracting (upbeat) music. You can make a note instructing you to use these and put it in your toolkit. 

Sense of smell can be incredibly powerful. It can bring us back to certain places and times with just one sniff. I've often experienced perfumes or aftershaves bringing on panic attacks if they remind me of people/situations I don't want to remember. However, you can use this to your advantage! Look for smells that take you back to good times or just those you enjoy. Scented candles or incense are brilliant for this. I really like the smell of dragon balm so always keep a pot of that around. The perfume is good, because I can still smell it on me when I'm away from my toolkit. 

I have quite a few items for touch. I have some more physical distractions here. The green thing is called a tangle. It's bits of plastic that you can rotate and make different shapes with. I find it to be good for channeling anxious energy or grounding yourself. You can get them online, but I got mine for free during one of my mental health admissions. You can see some bath items here such as salts and a bath bomb. If you can manage to run a bath whilst you're feeling overwhelmed then they are good for focussing your senses. Again the dragon balm and a lip balm can be used for the sense of touch. Smooth stones or other textured things can also be good. 

Here are some visual items. Anything you enjoy looking at. I have a stone I found on a beach walk with my partner some years ago (it also holds a happy memory). Some people use pictures of loved ones or maybe stickers you can put over the inside of your toolkit if it's a box. 

Not everyone will want to do this and it's not necessarily covered in DBT, but for years I have kept letters to myself. Usually they talk about better times and self-encouragement. I've found them helpful when I'm in a crisis and don't feel like I know who I am. Letters from loved ones can also be helpful, but I'd be wary about using ones from partners incase of a breakdown in the relationship or the crisis being triggered by something related to them . 

Items for soothing can be easily kept in your toolkit, but distractions need a bit more creativity. I bought a really small flip book and wrote a distraction activity on each page. That way I can flip through and see what I land on. If I don't feel like doing that one I can move to the next. It doesn't take long to do and you can always add to it. 

So there you have it. My emergency self-care kit based off of what I've learned in DBT. You don't have to be involved in DBT or even have BPD to use one of these. Personally I think we should all be taught skills like this as children. Learning how to distract and soothe myself rather than relying on others has been a godsend. It has also made it easier on my partner, because there is a physical aid he can give me to help me cope better. I'd highly recommend creating one of these toolkits, as I get so much use out of mine. 

Here's to 2021

Somehow we've made it through yet another year. Highly commendable considering the rough ride that 2020 has been. 

I started off hopeful, as many of us did, but as March rolled around a worldwide emergency gripped us. Enter lockdown, the likes of which none of us in this country had seen before. The idea that governments could force people to stay in their homes was something I'd only ever seen in apocalyptic movies. Working for the NHS was scary. In mental health services we weren't seeing the Covid numbers rising in our inpatients, but staff were getting it left, right and centre. The shops were chaos. Two hour queues to get into our local supermarket. We resorted to shopping in pound shops and getting our fresh produce from the less busy markets. I remember the first time I walked into Basildon high street since the lockdown. Not a soul in sight. The quiet was eerie and even the pidgeons seemed scarce. My partner started a new job working at an airport, considered stable one week then almost certainly non-existent the next. It was then I started to truly realise the scope of the whole thing. 

The unfortunate thing about understanding what is going on in the world, is the adverse effect it has on your mental health. After half a year of what can only be described as the Covid restriction hokey cokey, I was feeling exhausted. I wasn't the only one. Unable to see our loved ones, living in isolation and fear, many of us were (maybe still are) wondering why stick around to see the end? This environment is rife with triggers for those of us living with a mental health condition or disability. For me watching the news would bring on paranoias I had long forgotten. The feeling of being watched constantly was only re-enforced. I distinctly remember sticking blue tack over my laptop's webcam for at least 3 months. The monotony of going to work, but not being able to see my friends or family, caused me more emotional instability and I was often feeling at crisis point. The uncertainty was probably the worst experience for me. I'd be happy to have been in lockdown for the whole summer if it had meant we could see our families at Christmas. 

Despite the disruption that Covid has caused in our lives, there were positives in my life. I started my DBT and honestly it could not have come at a better time. I don't think I would have survived this year without it. I started training to be a Counsellor in September, which is going well. I've also started working with mental health services in my area to help fight stigma against patients with personality disorders. In a normal year I would have felt incredibly proud of myself, but I'd sort of forgotten about my acheivements until now. A really helpful task is to do a timeline of your year, writing down everything significant that happened. It just helps to process things for me. 

There is light on the horizon for us. Life may never truly return to normal, but a few vaccines have now been approved and are rolling out. I'm due to get mine by the end of January, because of my job. We are going to see our friends again. We're eventually going to be able to hug our parents and grandparents without fear. It is coming and we have all been so strong throughout this. Even if we lost our fitness, we started drinking more or felt as if we might break, we are still here. 

The next challenge for us is not to turn away once we emerge from isolation. It is likely we will find ourselves in the middle of a national mental health crisis. The fear and separation we have faced will cause many people to experience issues they never have before. Those of us living with a condition may find ourselves slipping back into crisis. During the next few months it is important that we take care of ourselves, be kind to others and to reach out if we need to. Give yourself time for the chaos to pass. 

Stay safe everyone. Wishing you all a better year. 

Outofdarkness Xx.

DBT Skill: TIPP

During various stages of my struggle with BPD, professionals have told me to stop. Stop overreacting, stop self-destructing, stop harming myself, just stop. My response has always been how? Most of them couldn't tell me, but the rest of them gave me weak solutions such as, make a cup of tea, go for a walk, have a bubble bath. Now I'm not saying that these are completely unhelpful, but they are not meant for that moment in a crisis when you are about to engage in a target behaviour. They fit into the category of soothe and distract, which I'll be showing you another day. What I needed in this moment are what we call TIPP Skills. 

TIPP Skills are different from soothing and distracting yourself with baths or walks. They're practices that are proven to actually change your body chemistry. For me this has now been a life saver several times. I was shocked that no one had ever taught me to do any of these before, so I wanted to share what I've learned. 

Use these to reduce extreme emotion mind fast. 

Temperature - The ice dive is the TIPP skill that works best for me. What I would advise you do is get a bowl big enough to put your face in. Fill it with very cold water and if you have it, put a bunch of ice in there too. You need to put your face under the water for 30 seconds, coming up for air ofcourse! What this will do is activate your dive response which slows your heart rate and helps 'shock' you out of that mental state. It's not going to get you out of crisis, but it will give you a chance to use distractions and soothing. If you don't like your face being under water then you can get a cold can or some ice in a bag and press it against your wrist for 30 seconds. 

Intense Exercise - This can help to calm your body down, when it is revved up by emotion. The DBT manual suggests 30 minutes of exercise. This could be an exercise video or just a mixture of star jumps, sit ups, squats and whatever else you can think of. For most people just walking isn't enough, if you're capable go for a run. If nothing else, this will distract you for a bit. 

Paced Breathing - This exercise slows your breathing and therefore can be helpful if you're panicking. Breathe deeply, slowing your breaths. Exhale for longer than you inhaled e.g. 4 seconds in, 6/7 seconds out. 

Paired Muscle Relaxation - Whilst breathing in tense up your muscles. Focus on your body as you release the tension whilst breathing out. Notice how it feels. You can do this throughout your body e.g. tense the muscles in your hands and release, then tensing your arm muscles, shoulder muscles etc. 

As I mentioned earlier, TIPP Skills alone will not be enough to get you through your crisis, but they give you a fighting chance to use other skills. Next post we'll be looking at creating a care package to aid in using soothe and distract skills.

*Consult your healthcare provider before using the ice dive or doing intense exercise if you have: a heart or medical condition, a lowered base heart rate due to medications such as beta blockers, an eating disorder.