Once I was diagnosed, the first thing I had to do was accept that, as a person with BPD or chronic and severe emotion dysregulation, my symptoms are going to cause me to feel intense emotional pain. My brain is built that way and I don’t know how to stop my brain or the pain. The logical and rational parts of my brain (the cortex) do not have the “correct” connection with the primitive “fight-flight-or-freeze-when-you-sense-danger” part of my brain (the amygdala). This is what we call “the amygdala hijack,” where intense emotions seem to control what I say and do. This is where accurate information about BPD can help you.

The second thing I did was find a qualified therapist who uses an evidence-based treatment to teach me some options to help manage (not get rid of!) the intense pain.

I found that, if I wanted to manage my pain better, I had to do the third thing: commit to doing a lot of hard work.. It will not happen with the passage of time, moving away from your parents, or using substances or other things to numb it, etc. Just like when you have diabetes, you learn to manage your insulin. When you have BPD, I think you have to change the way you do things to help you cope with this intense and chronic emotional pain for what may be for the rest of your life. If I don’t want to commit to this, I am deciding to spew poison into myself and on those I love for a long time.

For me, there were two different Categories of Strategies that I developed. The first general category I work on putting into place daily, when I am not triggered. [Note: I am opposed to the use of the word “trigger” due to it’s connection to firearms, and prefer to use what I call an “emotional storm.”] For this first set of strategies:
1) I find an evidence-based therapist who fits with my symptoms, my personality, my finances, maybe my location (depending on whether virtual or not).
2) I develop and commit to using a safety plan with my therapist if/when needed.
3) I create a “go to” list of activities that I find self-soothing, perhaps with the help of my therapist (e.g. call a friend, watch a movie, listen to music, take a nap, pet my dog, etc.).
4) I then pick some of the options/skills my therapist is mentioning to me that sound good for me personally, and try them quite a few times to see if I wanted to commit to really put them in place. Just like what happens when trying to determine which medication(s) work best for you, it is an art, not a science. I could not know what would work during my extremely emotional times until I tried them.
5) I do anything I can to use the ones I’ve chosen to put in place.
6) I run through a checklist every day to see where I am with my: sleeping, eating, exercising, therapy, and doing mindfulness exercises (to teach my brain how to stay focused on “living in that moment”). I know people don’t want to do all these, and they won’t do many of these things, but I am absolutely much more likely to have an “emotional storm” when I am lacking in even one of these! So, do I really want to set myself up to have storms I might be able to avoid? It’s my choice.

On “mindfulness exercises” that work particularly well for me, I practice them frequently when I am not dysregulated. One is creating a picture in my mind of a place of peace and describing it in terms of what I see, hear, smell, touch, taste. Another mindfulness method I use is, when I take a bite of food, I really think about what the different flavors are like on my taste buds (can I detect the separate ham, cheese, and the bread flavors), describe what the food may smell like, the way my teeth feel coming together, how I am chewing each mouthful into smaller and smaller pieces until it’s ready to swallow, etc. I can do the same thing with brushing my teeth: how the toothpaste tastes, how the bristles are going from the gum up to the top of the tooth and thinking about this for each tooth. I can focus on describing the minutia of many different things I do throughout the day. I do a mindfullness practice for about 5 minutes several times each day, to make this practice more likely to be accessible in times of distress.

My second set of strategies are related to when I am going into my “emotional storm.” In general, my “go to” skills when the storms are less intense are: breathing and radical acceptance. When I am sensing that the clouds of the storm are just beginning to form, I have more access to my logical and thinking cortex and can actually tell myself, “just breathe and think about what I need to radically accept.” When I am in the midst of a tornado-strength storm, I find I have to use my eyes because they are already engaged in seeing and I only have to slightly shift their focus to try to start actively looking at something to try to disengage from my extreme emotions. I can sometimes use my breath, but my lightning-fast reactions are sometimes so strong, I often forget to even think about my breath! I think my own body naturally engages in my sense of sight first, then breath, and, thirdly, moving my body. I find that my body is often just too frozen to even “just go for a walk,” or “just go stick your hands in ice.” Of course, different people’s bodies will have their own unique connections to their senses, so I am only speaking for myself.

In my blog next week, “Living the Symptoms, Part III,” I will go through which skills work for me with which of my particular combination of symptoms.

About the Author: Cathleen is a person who has spent over 50 years on her BPD journey. She is an avid volunteer with NEABPD because it is what gives her a sense of giving back to a community where she feels valued while making a contribution where many are suffering.