Introduction 1 About This Book 1 Foolish Assumptions 2 Icons Used in This Book 3 Beyond the Book 3 Where to Go from Here 3 Chapter 1: Exploring Borderline Personality Disorder 7 Breaking Down Borderline Personality Disorder 8 Unpredictable relationships 9 Acting without thinking 9 Volatile emotions 10 Confusing thoughts 10 Exploring the Origins of BPD 11 Counting the Costs of BPD 12 Health costs 12 Financial and career-related costs 13 The toll on family and friends 14 Treating BPD 15 Psychotherapy 15 Medication 16 Relating to People Who Have BPD 16 Chapter 2: Defining Personality to Understand BPD 19 Characterizing Personality 20 Differentiating Healthy from Unhealthy 20 Openness: Seeking new experiences 22 Flexibility: Rolling with the punches 22 Emotional regulation: Controlling what you express 23 Ability to delay gratification: Controlling impulses 24 Conscientiousness: Responsible and reliable 24 Interpersonal effectiveness: Having good relationships 25 Emotional resiliency: Bouncing back from tough breaks 25 Self-acceptance: Seeing yourself as you really are 26 Accurate perception of reality: Seeing the world as it is 26 Moderation: Avoiding extremes 27 Chapter 3: Describing BPD 29 The Nine Symptoms of BPD 30 1 Sensation seeking (impulsivity) 30 2 Self-harm 31 3 Roller coaster emotions 31 4 Explosiveness 31 5 Worries about abandonment 32 6 Unclear and unstable self-concept 32 7 Emptiness 32 8 Up-and-down relationships 32 9 Dissociation: Feeling out of touch with reality 33 Diagnosing BPD: Like Ordering from a Chinese Menu 33 High or Low Functioning 38 BPD Over the Life Span 38 Other Personality Disorders 39 The odd and eccentric 40 The dramatic and erratic 43 The anxious and fearful 46 Emotional Disorders That Accompany BPD 50 Anxiety 51 Trauma and stressor-related disorders 52 Obsessive-compulsive and related disorders 53 Depressive disorders 54 Bipolar and related disorders 54 Other emotional disorders 56 Chapter 4: Exploring the Root Causes of BPD 59 Beginning with Biology 60 Genetics 60 Brain chemistry and functioning 61 Psychological Factors 62 Problematic parenting 63 Abuse and trauma 66 Separation and loss 67 Disorganized and disrupted families 67 Social and Cultural Influences 68 The neighborhood 69 Friends and peers 70 The teen years 70 Social media 70 Cultural factors 71 Mixing and Matching Risk Factors 74 Biological and psychological factors 75 Biological and social influences 76 Psychological and social causes 76 A full biopsychosocial mix 77 Part 2: The Major BPD Symptoms 79 Chapter 5: Sensation Seeking and Self-Harm: The Impulsivity of BPD 81 Living Dangerously: Impulsive Behavior 82 Hurting for Help 84 Types of self-harming acts 84 Why hurt yourself? 85 Suicide: Seeking the Ultimate Escape 88 A cry for help or an attempt at revenge? 89 Who''s at risk? 89 Chapter 6: Explosive Feelings and Moods 91 Emotions 101 91 Primitive emotions 93 Thoughtful emotions 95 Emotions -- Borderline Style 95 Struggling to recognize and express emotions 97 Having emotions about emotions 98 Chapter 7: Missing Persons: Identity Problems and BPD 99 The Concept of Identity 100 What is identity? 100 How does identity develop? 102 Borderline Identity: Unstable and Fragile 104 Waffling identities 105 Worries about identity 106 Chapter 8: Perceiving, Understanding, and Relating to Others 107 Standing in Other People''s Shoes 108 Understanding other people 108 Seeing yourself through other people''s eyes 110 Causing unintended hurt 111 Busting through Boundaries 113 Disrespecting partners and lovers 114 Slighting friends and co-workers 115 Straining relationships with helpers 115 Riding roughshod over kids 116 Chapter 9: BPD and Extreme Thinking 117 Understanding How You See the World 117 How schemas develop 118 Types of schemas 119 Why schemas are hard to change 120 BPD Schemas: No Middle Ground 121 Self-concept schemas 121 Relationship schemas 124 World schemas 127 Chapter 10: Slipping Away from Reality 131 Discovering Dissociation 132 Feeling Paranoid or Delusional 134 Having Hallucinations 135 When You Have BPD and Feel Crazy 137 Part 3: Making the Choice to Change 139 Chapter 11: Researching and Choosing BPD Treatments 141 Exploring BPD Treatment Settings 142 Working individually with a therapist 142 Giving groups a chance 142 Spending more time in treatment: Partial hospitalization 143 Needing more care: Inpatient psychiatric wards 143 Combining and changing treatments 144 Researching the Treatment Strategies That Work for BPD 144 Dialectical behavior therapy (DBT) 145 Mentalization-based therapy (MBT) 145 Transference-focused psychotherapy (TFP) 146 Cognitive therapy 146 Schema therapy 147 Transdiagnostic treatment 148 Metacognitive therapy (MCT) 148 Systems training for emotional predictability and problem solving (STEPPS) 148 Acceptance and commitment therapy (ACT) 149 Compassion focused therapy (CFT) 149 Medication 149 Common factors in therapies 149 Choosing a Mental Health Professional 150 Primary healthcare providers 152 Psychologists 153 Psychiatrists 153 Counselors 154 Marriage and family therapists 154 Psychiatric nurses 155 Social workers 155 Starting Treatment 156 Evaluating your therapy 156 Giving therapy some time 157 Chapter 12: Breaking Through Barriers to Change 159 Overcoming the Fear of Change 160 Losing who you are: It''s not going to happen 161 Opening up: No need for cold feet 161 Dreading even more loss: Try not to test the ones who want to help 162 Fearing treatment: Don''t let therapy myths hold you back 162 Looking at fears of change in action 164 Taking Charge and Giving Up the Victim Role 165 Ending the blame game 165 Thinking like a victim: It doesn''t help 166 Finding forgiveness and coping 167 Stop Procrastinating 167 Dismantling excuses 167 Debating the decision 169 Getting Comfortable with the Process of Change 171 Chapter 13: Explaining BPD to Others 173 Deciding Whether and Whom to Tell 174 The benefits and costs of telling 174 Figuring out whom to tell 176 Deciding What to Tell 180 Educating yourself 180 Deciding how much to say 181 Telling Your Story Effectively 184 Chapter 14: Taking Care of Yourself 187 Dealing with Stress 187 Reviewing how stress affects health 188 Managing and reducing stress 189 Taking Better Care of Your Body 190 Revising your diet 191 Energizing with exercise 192 Getting enough sleep 192 Taking healthy actions 195 Finding More Time for Yourself 196 Part 4: Treatments for BPD 197 Chapter 15: Inhibiting Impulsivity 199 Increasing Your Awareness of Impulsive Behavior 200 Write down your impulsive acts 200 A case study of working on impulsiveness 202 Putting the Brakes on Impulsivity 206 Putting time on your side 206 Putting off your impulses 208 Doing something different 209 Fire drilling 209 Seeking Healthier Alternatives 211 Chapter 16: Calming the Storms Within 213 Putting a Name Tag on Feelings 214 Understanding the thought-feeling connection 214 Practicing emotional regulation 215 Forbidding Feelings from Ruling Over Thoughts 216 Doing the opposite of what you feel 217 Calming down with coping self-statements 218 Relaxing and Practicing 219 Making muscles relax 219 Soothing through the senses 223 Visualizing calm 224 Discovering Meditation 225 Benefits of meditation 225 How to meditate 226 Types of meditation 227 Meditation myths 229 Acquiring Acceptance 230 Discovering your observant mind 231 Playing with your judgmental mind 233 Chapter 17: Creating an Identity 235 Clarifying What''s Important in Your Life 236 Finding your personal priorities 236 Creating a personal life mission statement 239 Finding Forgiveness and Self-Compassion 242 Forgiving yourself first 242 Going from self-forgiveness to self-compassion 243 Fumbling to forgive others 244 Chapter 18: Putting Yourself in Other People''s Shoes 247 Understanding Others'' Points of View 248 Projecting: Thinking others feel what you feel 248 Practicing perspective taking 250 Noticing Your Impact on Others 255 Decreasing Defensiveness 255 Taking the "I" out of interactions 256 P.