Thanks for your question. This is a fascinating dilemma, in that many who wrestle with similar issues often have trouble achieving anything, let alone the impressive roster you list above.

I think my first suggestion is to simply get curious about what is happening here. I’m a fan of what I call “emotional mindfulness,” meaning paying close attention to what happens, exactly, when you choose and take action toward a specific goal. When you start job hunting, are you filled with excitement? Anxiety? Dread? Pressure? Are you motivated to not let others down, and does it feel like the very goal itself is instilled by others’ priorities rather than your own? And if you don’t feel pride, what is it you feel? Pressure? Irritation? Emptiness?

Actually, everybody wants to please others to some degree, especially their parents. I’m reminded of this every time my baby daughter does something amusing; I smile or laugh, and she responds in kind. We are born wanting what Kohut called psychological “mirroring,” or having our progress mirrored in the pleased expressions of our folks. In fact, Kohut (founder of self-psychology) called the need for mirroring one of the essentials of human development. But there are other developmental needs, including individuation, or finding your own path, vocation, and values that give you satisfaction. Do you feel the choices given to you by parents, or “society” in general, are too narrow?

You seem to derive little or no pleasure from your very real achievements, and seem to almost blame yourself (“What’s my deal?”). Again, I’m curious as to the disconnect, and to the overall context in which this is happening. I’m sure it’s not your “deal” alone. Perhaps you’ve come to believe, through your experiences, that there are high expectations on you, and a risk of not fulfilling them.

You’re at an age where it’s appropriate to begin a more adult individuation process, to begin to explore what makes you happy, and ask existential life questions such as, “What’s so great about a 9-to-5 job?” and, “Do I really want to be a cog in the big machine?” and, “Is there more to life than wife and kids and paying bills?” and, “What’s it all about for me?” In this sense, your question reflects a very healthy awareness and a hunger for self-expansion, and that’s a good thing. However, the risk is that others may have a different reaction to “the new you.”

Every individual is different, but I traveled a lot when I was your age, wrote (unproduced) plays in cafes, made short films, and lived in Europe for a year. I’m not recommending this by any means, but I experimented quite a bit … with filmmaking, travel, volunteer work, dating, meditation, and so forth. It really helped inform my decisions later on when it came time to “grow up” and hunker down on career and marriage. My parents weren’t always thrilled, but so it goes.

What gives you pleasure or motivates you? Are you concerned that, should you pursue a more individual path, others won’t approve? If that’s the case, it’s a good time to start individuating, and finding your own way and learning to tolerate disapproval. I have found, both personally and with clients, that the people who love you do so unconditionally, regardless of your résumé and achievements. Most disapproval is temporary; people adjust. If not, a conversation needs to happen regarding the rigid “requirements” one feels to continue receiving approval. Self-denial and approval seeking are high prices to pay, and in the long run not a psychologically healthy recipe for love and life.

Perhaps, as with many your age, what lights the inner spark is not yet known to you. If that’s true, that’s OK, but it might be time to do some soul-searching, or consult with a career counselor or even a therapist to look at other options you might find interesting … because now is the time to experiment and explore avenues (safely) that you might not have considered. Perhaps there is some kind of pressure to do what’s expected of you, leading to a feeling of emptiness and/or resentment. Do you feel others will be “disappointed” if you don’t do the expected thing? Is there a risk in doing things for yourself rather than for those in your life? Are you concerned they’ll “reject” or abandon you in some way?

The other possibility—and again, this is highly speculative and to be taken lightly, since I don’t know you at all—is that there is some dysthymic or depressive symptomology here, or other organic condition which might be undermining average serotonin or dopamine processing in your system. You might want to get a checkup to rule out anything medical or psychiatric first.

The first step in any change is the kind of awareness you’re bringing to the situation. Try if you can to be patient and compassionate with yourself, and see this as a process. The question you raise is a crucial and common one at your stage of life; you might not get the answer as quickly as you like, but stay with it and keep seeking—this is precisely the kind of exploration that can open more doors (and perspectives) than you might think. Thanks again for writing.

Kind regards,
Darren

Major depression (MDD) is known to affect numerous cognitive and behavioral domains. People with MDD often have pessimistic attitudes about future events and guilt over past events. They tend to isolate and withdraw, and choose to engage in activities that provide immediate reward over those that promise future enjoyment. This leads to impulsive and even risky behavior, like overeating and substance misuse.

Posttraumatic stress is an anxiety condition that has some similarities to MDD, but is unique in that risk/reward choices tend to be quite different. Understanding how people with MDD, PTSD, and MDD+PTSD value risks over rewards is an important area of clinical research and can provide insight into the behavioral and cognitive processes that take place in people with these mental health problems.

To get a closer look at the differences in decision making that occurs in these conditions, Jan B. Engelmann of the Department of Economics at the University of Zurich in Switzerland recently conducted risk/reward decision making experiments on 20 individuals. All had either MDD or MDD+PTSD. Engelmann compared their choices to those of 16 control (HC) participants.

The results showed that both MDD groups discounted long term rewards compared to controls. For gains, both MDD groups selected immediate versus long-term gains more than controls. However, when Engelmann looked at the subgroups of MDD participants, the findings revealed significant differences. The MDD only group demonstrated a preference for taking larger losses in the long term if it meant decreasing immediate losses. This was in contrast to the HC and MDD+PTSD groups, who chose smaller immediate losses over larger losses in the future.

Engelmann believes this difference in the MDD and MDD+PTSD group is due to anxiety. The PTSD group may be more willing to accept minimal losses today if it means avoiding larger losses later. This avoidant behavior is a symptom of anxiety and in the case of risk/reward may actually benefit individuals with respect to decision making.

For people with MDD+PTSD, although anxiety may decrease antidepressant efficacy, this negative consequence may be offset by the positive effect anxious symptoms appear to have on risk/reward processing. “Together,” added Engelmann, “These results inform future research investigating the underlying affective and cognitive processes, as well as related neural mechanisms, of the observed choice distortions in patients with MDD.”

Reference:
Engelmann, J.B., Maciuba, B., Vaughan, C., Paulus, M.P., Dunlop, B.W. (2013). Posttraumatic stress disorder increases sensitivity to long term losses among patients with major depressive disorder. PLoS ONE 8(10): e78292. doi:10.1371/journal.pone.0078292

If you’ve ever seen A Christmas Story, then you probably remember the words of the yellow-eyed, redheaded Scut Farkus as he taunts and tortures 9-year-old Ralphie Parker: “Come on, cry baby, cry!” As Farkus jeers with a maniacal laugh and violence flashing in his eyes, Ralphie finally snaps and fights back, pummeling his bully into the snowy earth.

While it is understandable to feel a sense of satisfaction watching someone overtake a bully and feel vindicated in a classic film scenario, this scene in A Christmas Story, as Ralphie’s mother insists, is not the ideal for those fighting to raise awareness and effect societal change where bullying is concerned.

Bullying of both a physical and psychological nature are realities many youth face on a day-to-day basis. StopBullying.gov states that for a behavior to be considered bullying, it “must be aggressive” and include “an imbalance of power” and “repetition” or the potential to become repetitive. Bullying may manifest as physical violence and abuse against those perceived as weak or different; it may also appear in the form of words and phrases used to hurt those same individuals. It happens in schools, homes, and the community at large, and is primarily associated with youth who are 18 and younger.

National Bullying Prevention Month, which was initiated in 2006 by PACER’s National Center for Bullying Prevention, encourages supporters and advocates to stand up and say, “The end of bullying begins with me.” Whether as a perpetrator, as a bystander, or as someone who has experienced bullying, everyone can play a part in putting a stop to the damaging effects of bullying.

Unity and Respect: Valuable Bullying Prevention Lessons

A variety of campaigns and opportunities to stand united with the movement to prevent bullying are accessible online. StopBullying.gov provides the public with resources and educational materials pertaining to bullying, and at StompOutBullying.org, those who wish to show their support can purchase wristbands, as well as access information on what’s been happening when and where regarding bullying prevention awareness.

The Parent Advocacy Coalition for Educational Rights website (PACER.org) is also an excellent resource. In addition to informational links and materials, the site encourages concerned citizens to sign their “The End of Bullying Begins with Me” petition. And perhaps most useful with regard to practical, long-term application and prevention is PACER’s free, online, student-focused curriculum launched on October 1, 2013, called “The We Will Generation.”

Designed with student leaders in mind, the hope is that under the guidance and mentorship of adult advisors, these young people will carry the message of bullying prevention to other middle and high school students in an ongoing, interactive educational format. Schools can sign up online to pilot the new curriculum, which includes a series of lessons, activities, a student-created video, student advice, and other resources for how to approach bullying in the school system from a student-to-student perspective.

The lessons cover topics like “Respecting differences and everyone’s right to be who they are,” “Ways in which students can reach out to their peers,” “Sharing ideas about how students can show that everyone matters,” and “How to move a situation from a negative into a positive.” The overall messages of The We Will Generation, which focuses its foundational teachings on the acceptance and appreciation of individuality, are to respect differences, unite together, and take action.

Growing Concern over Cyberbullying

An increasing trend in the rapidly advancing technological world is cyberbullying, also known as e-bullying, online bullying, and Internet bullying. The Cyberbullying Research Center defines cyberbullying as “willful and repeated harm inflicted through the use of computers, cell phones, and other electronic devices.”

Stopbullying.gov adds that the electronic technology used in cyberbullying includes “social media sites, text messages, chat, and websites.” Rumors, embarrassing photos, and fake online profiles are just a few examples of the tactics used in cyberbullying.

As with other forms of bullying, StopBulling.gov reports that victims of cyberbullying are more likely to abuse substances, skip classes or refrain from attending school altogether, receive poor grades, have self-esteem issues, develop health problems, and experience in-person bullying.

Both the Cyberbullying Research Center and StopBulling.gov offer helpful information on how to identify, prevent, and report cyberbullying as a parent, educator, counselor, peer, or youth worker. IBM is also currently offering a free downloadable activity kit for those who wish to present, teach, or somehow train others to recognize, prevent, and intervene in cases of cyberbullying. Resources like these are important in tackling the complex issue of cyberbullying, which is the subject of much media attention and discourse these days.

A Little Empathy, Please

There are a range of explanations as to why someone may end up physically or verbally attacking and putting down his or her peers, but one thing is agreed upon by researchers: Children and teenagers who bully others exhibit “a lack of appropriate concern for the other, commonly considered a lack of affective empathic concern” (Borgwald & Theixos, 2013).

Various efforts have been launched over the years in an attempt to eradicate bullying behaviors and rehabilitate those who engage in it. Some are more effective than others. In a recent article published in Social Influence, the authors argue that the federally instituted “zero-tolerance policies,” which involve systematic punishments and expulsions to deal with bullying are “ineffective, counterproductive, and unjust” (Borgwald & Theixos, 2013). They instead suggest the implementation of “inclusion and empathy training” as an effective approach for integrating those identified as bullies in the school system and community at large.

This approach is largely inspired by the notion that there is danger in automatically assuming that a child who bullies is somehow flawed or lacking. As Borgwald and Theixos point out, “[B]ullying is a complex behavior closely linked to an abusive/chaotic home life, and . . . we are concerned that bully-labeling further hinders these children from adequately developing pro-social behaviors” (2013). Hence the significance of empathy, which theories on the subject suggest “can be nurtured through counseling, teaching, and modeling.”

Empathy is defined by Merriam-Webster as,

the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experiences of another of either the past or present without having the feelings, thoughts, and experiences fully communicated in an objectively explicit manner.

In other words, someone exhibiting empathy will feel the pain of another without being overtly told what that other person is feeling. It follows that if a child or adolescent is starting off with little to no sensitivity or concern for the feelings of others, then teaching him or her to experience actual empathy is going to require massive amounts of time, effort, and energy on the part of the student doing the bullying as well as the teachers, therapists, and parents or guardians trying to help that person. Regardless, Borgwald and Theixos assert, “If a lack of empathy is central to the problem of bullying, and empathy can be taught and learned, then empathy training in schools is a better (more just, more inclusive, and likely more beneficial) response to bullying” (2013).

A little kindness can go a long way. And it would appear that developing a sense of compassion and understanding for the perpetrators of bullying is just as important as it is for those who have been bullied. Considering the human capacity for change and transformation, perhaps it is possible that if someone notorious for being a bully is given the opportunity to acknowledge, feel, and accept his or her own sensitivity and weakness, then an improved sensitivity toward others will naturally follow.

References:

1. Borgwald, K., and Theixos, H. (2013). “Bullying the bully: Why zero-tolerance policies get a failing grade.” Social Influence, 8: 2–3, 149–160. doi: 10.1080/15534510.2012.724030.  Retrieved from http://www.tandfonline.com/doi/full/10.1080/15534510.2012.724030
2. Cyberbullying Research Center. “About us.” Retrieved from http://cyberbullying.us/about-us/
3. IBM. “Cyber-bullying. Explore the dangers and signs of cyber-bullying with parents and teachers.” Retrieved from https://www.ibm.com/ibm/responsibility/initiatives/activitykits/cyber_bullying/
4. Merriam-Webster.com. (2013). Empathy. http://www.merriam-webster.com/dictionary/empathy
5. PACER. “October is National Bullying Prevention Month.” Retrieved from http://www.pacer.org/bullying/nbpm/
6. PACER. “The We Will Generation: Students leading the bullying prevention movement.” Retrieved from http://www.pacer.org/bullying/wewillgen/curriculum/
7. StopBullying.gov. “What is bullying.” Retrieved from http://www.stopbullying.gov/what-is-bullying/definition/index.html#types
8. StopBullying.gov. “What is cyberbullying.” Retrieved from http://www.stopbullying.gov/cyberbullying/what-is-it/index.html

Recently I watched a YouTube video of comedian Louis CK being interviewed by Conan O’Brien in which he was discussing his reasons for not allowing his kids have cell phones. It was really funny but also quite profound. He talked about how cell phones (and other gadgets) prevent us from feeling sadness. He described an experience he had while driving down the road listening to the radio. He said a song came on that reminded him of his past and made him sad. He noticed the urge to pick up his phone and text his friends in an effort to derail the emotion. Instead, he decided to let the emotion come. He said he pulled over on the side of the road and cried, then felt a surge of happiness afterward, which he explained as gratitude for his ability to feel. He pointed out how when we cut off our ability to feel sad, we cut off our ability to feel happy, too. We coast along in an emotionally dulled state, not feeling too much of anything.

How often we distract ourselves with technology, eating, substances, sex, shopping—and the list goes on—when we feel a pang of sadness heading toward us. It’s understandable; sadness doesn’t feel especially good. But there is a price to avoiding it. When we don’t allow ourselves to feel sad, we stunt the intensity of our other emotions (including joy and happiness) as well. It’s impossible to selectively repress an emotion, so when we limit one, we limit them all. Also, by dodging sadness, we may lose confidence in our ability to handle difficulty. We may start to think sadness is too much for us to deal with, and facing it becomes an overwhelming proposition. However, when we allow ourselves to move toward difficult emotions, we are reminded that we can handle it, and that it usually isn’t as bad as we expected. In my experience as a chronic sadness avoider, I find that when I move toward the emotion instead of running as fast as I can away from it, I’m often surprised by how quickly the sadness comes and goes. I’m reminded that emotions are like waves; they start small, build, crest, then begin to subside. Of course, some waves are bigger than others and go on for longer, and they may return over and over again; but they are usually less difficult to navigate than I expected.

I’ve also come to believe that by avoiding sadness, we stunt our ability to connect with others. In times of profound sadness, I’m reminded of the commonalities of the human experience. It is something we feel physically in a similar way. The throat feels restricted and sometimes painful; there is a pressured feeling in the chest; an empty feeling in the stomach; sometimes we cry. By allowing myself to experience sadness, I’m able to feel more compassion for others. From this compassion comes a sense of gratitude and equanimity. When we move through life emotionally numbed out, we are likely to feel disconnected and alone. Western culture makes it really hard not to avoid emotions. There are so many enticing distractions immediately available and pushed on us every day. Attending to emotion is definitely moving against the cultural current.

[fat_widget_left]Finally, by allowing ourselves to fully experience all of our emotions, we have the opportunity to connect with inner wisdom that informs us about who we are and what we need. For example, recently a client in my practice felt a wave of sadness and allowed herself to explore it in the session. Through this process, she identified her feelings of loss around a disappointing relationship with a parent. As she sat with this emotion and allowed it to run its full course, she uncovered a need to accept this reality—that her parent couldn’t and would never be the ideal parent she had always wanted. Even though this was a tough realization, it allowed her to move forward exploring ways she could parent herself as an adult rather than being paralyzed by a desire for what was not possible.

As an experiment, consider intentionally focusing on your emotional “waves” for a few days. See if you can identify your urge to avoid or distract (whether you choose to distract or not), and if a good moment presents itself, spend some time sitting with it, observing what it is like for you to feel this and reflecting on what information or insights you glean from it. You may benefit from journaling about these experiences as well.

Practically speaking, most of us won’t be able to be mindful of every emotion that comes our way. The realities of our lives interfere with that. Maybe we feel a wave of sadness coming during the middle of a business meeting or in a conversation with our boss when it would be to our detriment to allow the feeling to take hold. Also, emotions are always present and quickly shift and change, so to be constantly mindful would be a full-time job. There are as many ways of practicing emotional mindfulness as there are people, but I can tell you how I do it. When I notice a particularly strong emotion present at a time when it isn’t in my best interests to fully allow it, I make some time later to recall the incident that triggered it and allow the emotion to come forward again. Though it isn’t “in the moment,” I’m often able to recreate it in a context that works better for me. Also, at times when I start to feel sad and there is an opportunity to allow the feeling, I create some space for it by minimizing distractions and choosing not to pick up my cell phone or look up something random on the Internet (my frequent go-to escapes). I also work on not judging myself harshly when I avoid emotions; after all, I am human, and humans by nature don’t like to feel pain.

We are familiar with the grief associated with death. Denial, anger, and acceptance are part of the grieving process as it pertains to death. But what about grief that is unconnected to death? What about the loss and grief that occurs with expected and even happy events?

A few years ago, at a friend’s wedding, I was surprised to find her mother sobbing in the restroom. She was happy for her daughter and liked her son-in-law, but she was pained by the loss of her daughter. She was grieving the transition of her relationship with her daughter, who was no longer fully hers. Her daughter’s primary relationship was now the one she shared with her new husband. While her mother did celebrate and have joy for her daughter, she also had sorrow and grief for her own loss and transition. But she had no place to put her grief.

Marriage and partnerships, moving, new jobs, and graduations are often joyous occasions that we readily share and celebrate with others. We have traditions associated with these transitions in life. There are weddings and housewarming parties and happy hours organized to commemorate these events. But there aren’t any traditions or processes to acknowledge and assist with the natural grief and loss that comes along with these occasions and transitions.

As it does following the death of a loved one, grief during joyous occasions impacts all aspects of your life and of you. As a society, we have great traditions and markers of change, but we do not have ways to encourage and support people after the actual transition. What happens after the wedding ceremony or six months into the new job? What do you do with your sadness and grief about what you have lost even while you are happy or satisfied with what you have?

First, acknowledge the complexity of the situation. Identify the bittersweet emotions of enjoying your new job while simultaneously missing your old one. Grief is not solely comprised of pain. For example, even during the most tragic deaths there can be moments of joy and laughter during the funeral service. This speaks to the varied emotions associated with grief, the mix of pain with moments of pleasures.

Also, remember that grief is fluid and changes with time. The way you feel at the beginning point of change is different than in the following month, in six months, or years later. Your feelings of sadness, pain, fear, and loss transform and become less gripping and more integrated into you and your life. The grief and feelings of loss can recede over time.

One of the ways people get stuck in their grief—meaning it is unchanged and unmoving—is when they have no place to express it. Silent grief makes the process of grieving much worse. Being able to talk about the grief not only eases the pain but moves the process forward. Talking about and sharing the grief makes it possible to be sad but not stagnant.

Whenever you are in the midst of change and transition, consider what you are losing as well as what you are gaining. This is not to focus on the unpleasant or negative aspects of change, but rather to be more prepared when the inevitable feelings of loss and grief rise for you.

How do you navigate the intersection and bitter sweetness of joy and grief? How do you celebrate the newness while also recognizing and honoring what passed?

A colleague of mine encourages people to consider the first day of every month a “New Year’s Day” of sorts: Instead of one New Year’s resolution, why not mindfully attempt change every month? Imagine what you can do for yourself in only a year.

While popular wisdom has long suggested that habits can be formed in about 30 days, recent research reveals the process is more nuanced, with habit formation typically taking 18 to 254 days, with an average of 66 days. However, the beauty of a 30-day challenge isn’t just about permanent habit formation—it’s about creating momentum, building awareness, and experiencing positive changes that can motivate longer-term growth.

Having challenged myself to new habits 30 days at a time in 2013, I’m challenging you to begin your own changes today.

Accept this invitation to tackle a 30-day challenge to enrich intimacy in your relationship. Start now—don’t wait until the first of the month. Consider which habit(s) would benefit you and your relationship to enrich or enhance intimacy. I’ve drawn up a possible list, pulled from research as well as my professional and personal experience, to help inspire ideas:

Within 30 days, read a book to improve your relationship—people who seek relationship counseling with me are encouraged to read Hold Me Tight by Dr. Sue Johnson. This groundbreaking book on Emotionally Focused Therapy has sold over 1 million copies and continues to help couples strengthen their relationships through evidence-based approaches. Another favorite is The Truth About Love by Dr. Pat Love, which explores the predictable stages of love relationships.

Commit to kissing hello and goodbye. In a fast-paced culture, romantic partners are often like “two ships passing in the night.” We miss simple, everyday opportunities to slow down and reconnect with loved ones. For the next 30 days, make a new rule in your relationship: kiss hello and goodbye—no exceptions! (Already doing this? OK, try this one. Make each kiss last at least five seconds; trust me, it’ll feel longer and more intimate than you assume. Imagine your lips on your loved one’s lips, cheek, or neck for the count of one … two … three … four … five. Now THAT’s a kiss.)

Add the “hug to relax” or “five-minute hug” to your day, every day, for 30 days. Recent research confirms that couples with higher comfort levels around physical affection report significantly better relationship well-being, with private touch being particularly important for relationship satisfaction. Set a time, and in a standing hug enjoy the waves of experiences you have in your partner’s arms. Notice what each of your five senses is sensing. Notice the smell of your partner’s neck, shirt, hair, etc. What do you hear in the hug? A heartbeat, breathing, or sounds of the environment? Notice the touch of your bodies: Where do you touch? Where do you not touch? Notice the sensation of standing on your feet for a period of time in one place.

Reduce your complaints and increase praise of your partner for the next 30 days. Dr. John Gottman’s extensive research has identified a “magic ratio” of 5:1—for every negative interaction during conflict, happy couples have five or more positive interactions. As with good parenting, we need to balance negative feedback and interaction (“Go do your homework!”) with positive feedback and interaction (“Thanks for getting to your chores!”) in our intimate relationships. I often explain to people that we are born to particular caregivers, but when we mature into adults and commit to a relationship, we choose and become “chosen caregivers.” It’s essential that we remember that our spouses are sometimes just “tall kiddos” who need and desire more praise than complaints.

Last but not least, consider sexual, engaged activity every day for 30 days. Now, this doesn’t have to mean intercourse, orgasm, or even nakedness, the goal is to foster closeness, affection, and mutual comfort. There is an array of activities we can indulge in to ignite and nourish our sexual selves. Recent research highlights the strong connection between active, satisfying intimacy and overall relationship wellbeing, with studies showing that couples who engage in regular intimate connection report higher relationship satisfaction. Body rubs, hand massaging, bathing together, undressing your partner, spooning, masturbating solo or beside each other—these are just a few ideas for a 30-day challenge.

This exercise works best for couples who are feeling generally good in their relationship. If you or your partner are navigating sexual pain, past trauma, postpartum changes, big differences in desire, or other challenges, take it slow, and don’t hesitate to check in with a sex therapist before diving in.

Bonus idea straight from a sex therapist’s office: One of my clients’ favorite ideas for being sexual that doesn’t require much of anything is a “walk down memory lane.” This approach draws on the therapeutic power of reminiscence, which research shows can create positive emotional connections and enhance wellbeing. Reminisce together about the hottest sex you’ve had together, fire up your memory by indulging in a description of what your senses experienced, maybe even come up with a title for this memory as if it were its own sexy movie. Perhaps take the memory a little further by embellishing, elaborating, or peppering some components of fantasy by sprinkling in spicy details you would add if you could go back in time.

The “walk down memory lane” exercise is most enjoyable when your shared sexual history feels positive and consensual. If you and your partner have experienced trauma, coercion, or infidelity, revisiting sexual memories might feel upsetting instead of connecting. In that case, it’s perfectly okay to skip this one, or try it with guidance from a therapist.

Find a Therapist

This isn’t necessarily a go-big-or-go-home challenge, mind you. Take on something you can be successful doing. The goal is to form a new habit, enrich intimacy, and add pleasure to your relationship.

Enjoy!

References:

1. Singh, B., Murphy, A., Maher, C., & Smith, A. E. (2024). Time to form a habit: A systematic review and meta-analysis of health behaviour habit formation and its determinants. Healthcare, 12(23), 2488. https://doi.org/10.3390/healthcare12232488
2. Healthline. (2025, October 16). Habit formation: How long it takes and how to start now. Healthline. https://www.healthline.com/health/how-long-does-it-take-to-form-a-habit
3. Psychology Today. (2026, January). One powerful habit that couples should never underestimate. Psychology Today. https://www.psychologytoday.com/us/blog/social-instincts/202601/one-powerful-habit-that-couples-should-never-underestimate
4. Johnson, S. (2008). Hold me tight: Seven conversations for a lifetime of love. Little, Brown and Company.
5. International Centre for Excellence in Emotionally Focused Therapy. (2024). Dr Johnson books. ICEEFT. https://iceeft.com/dr-johnson-books-2/
6. Gottman Institute. (2017). The magic relationship ratio, according to science. The Gottman Institute. https://www.gottman.com/blog/the-magic-relationship-ratio-according-science/
7. Psychology Today. (2022). The Gottman ratio for happy relationships at work. Psychology Today. https://www.psychologytoday.com/us/blog/curating-your-life/202206/the-gottman-ratio-happy-relationships-work
8. Australian Institute of Family Studies. (2023). Relationships and sexual activity: Trends in Australia. https://aifs.gov.au/research/reports/relationships-and-sexual-activity-trends
9. Positive Psychology. (2025). Reminiscence therapy vs. life review therapy: A quick guide. PositivePsychology.com. https://positivepsychology.com/reminiscence-therapy-life-review-therapy/

The personality traits of neuroticism, agreeableness, openness, extraversion, and conscientiousness, known as the “big five,” have been studied at length in relation to nearly every psychological condition. Several of the big five traits have been linked to suicide, but only in the presence of other comorbid conditions or only when viewed through a limited lens.

To get a more comprehensive picture of how these personality traits affect the risk of suicide in the general population, Victor Bluml of the Department of Psychoanalysis and Psychotherapy at the Medical University of Vienna in Austria recently conducted a study involving community participants. Bluml assessed 2,555 adults for measures of past, present, and potential suicidality as well as for the big five. He controlled for other risk factors such as anxiety, depression, PTSD, and socioeconomic status.

The results revealed that specific big five traits influenced risk for suicide for men differently than for women. For women, Bluml discovered that high levels of openness and neuroticism increased suicide risk. For men, low levels of conscientiousness and extraversion elevated the risk of suicide.

Bluml believes that neuroticism, which is a risk factor for depression, could increase depressive symptoms in women, making them more vulnerable to maladaptive coping and impulsivity. This could explain the link between neuroticism and suicidality in women. However, women are more likely to have nonfatal suicide attempts than men.

When Bluml looked at the big five scores for the male participants, he found that there was no direct association between openness or neuroticism and suicide. But extraversion, which is associated with positive affect, was found to be linked to suicide risk when scores were low. Likewise, low scores on conscientiousness, which directly impacts hopefulness, were also shown to be predictive of suicidality for males. Bluml also found that these trends persisted even when other factors such as anxiety, unemployment and stress were considered.

These results clearly show how specific personality factors impact suicide uniquely for each gender. Bluml also added, “Different personality dimensions are significantly associated with suicide-related behaviors even when adjusting for other known risk factors of suicidality.”

Reference:
Blüml, V., Kapusta, N.D., Doering, S., Brähler, E., Wagner, B., et al. (2013). Personality factors and suicide risk in a representative sample of the German general population. PLoS ONE 8(10): e76646. doi:10.1371/journal.pone.0076646

The most common way to assess the outcome of therapy is to gather information relating to well-being, functionality, and problems that brought someone to therapy, and to do this both at the beginning of therapy and again at the conclusion of therapy. This allows a therapist, and the person attending therapy, to see the progress they have made and determine what areas may still need to be addressed in the future. Unfortunately, this outcome measure is rarely accurate, because a large number of people who receive cognitive therapy or talk therapies drop out prior to therapy conclusion.

Therefore, Slawomir Czachowski of the College of Medicine at the Nicolaus Copernicus University in Poland recently led a study utilizing a revised outcome tool. Czachowski altered the Psychological Outcome Profiles (PSYCHLOPS) tool to include questions pertaining to problems that could arise during therapy, not just those that were present when therapy began. Further, Czachowski repeatedly administered the revised PSYCHLOPS throughout the therapy process to gauge progress along the way.

Using a sample of 238 clients, Czachowski administered pre-therapy, during therapy, and post-therapy surveys. A total of 135 people completed all three assessments. The results revealed that those who experienced valid change increased from 56% to 81%. This suggests that the revised PSYCHLOPS method captured more accurate data than the traditional delivery method, or more change occurred because PSYCHLOPS was repeatedly administered.

Czachowski also discovered that 60% of the completers reported new problems during therapy. However, these problems were not more severe than any that they presented with and the level of change that occurred with respect to these new problems was equal to that that occurred for the prior existing problems.  In fact, completers were more likely to have new problems arise during therapy, or at least admit them, than those who did not complete therapy.

Another interesting finding was that during therapy PSYCHLOPS allowed Czachowski to recognize that non-completers had the lowest PSYCHLOPS scores before and during. This could help therapists identify and take steps to help those most at risk for early drop out. In sum, these results support intermittent PSYCHLOPS to measure therapeutic outcome. “A large proportion of outcome data is lost when outcome measures depend upon completed end of therapy questionnaires,” said Czachowski. “The use of a during-therapy measure increases data capture.”

Reference:
Czachowski, S., Seed, P., Schofield, P., Ashworth, M. (2011). Measuring psychological change during cognitive behaviour therapy in primary care: A Polish study using ‘PSYCHLOPS’ (Psychological Outcome Profiles). PLoS ONE 6(12): e27378. doi:10.1371/journal.pone.0027378

The term “enabler” has gained widespread recognition and use in popular culture and media over the past several decades. It is a label that can result in a great deal of anxiety and guilt for anyone who has been accused of being, or suspects that they may be, an enabler.

In its original context, enabling refers to a pattern within the families of people addicted to alcohol and drugs, wherein the family members excuse, justify, ignore, deny, and smooth over the addiction. This notoriously allows the addicted person to avoid facing the full consequences of his or her addiction, and the addiction is able to continue.

In a wider sense, enabling can describe a pattern of behavior that becomes organized among the family and friends of not just an addicted person, but any person who is exhibiting poor choices that harm themselves or others and for which they are not being held responsible.

[fat_widget_right]

Who are enablers? Enablers can be romantic partners, ex-partners, parents, adult children, siblings, or friends. The one thing that all enablers have in common is this: they love someone who is out of control, and they find themselves taking more responsibility for the actions of that person than the person is taking for themselves.

The one thing that all enablers have in common is this: they love someone who is out of control, and they find themselves taking more responsibility for the actions of that person than the person is taking for themselves.

Who is enabled? The enabled person may be one who is refusing to take on responsibilities he or she would otherwise be expected to take on in the course of age- and stage-appropriate development. The enabled person may be exhibiting a range of poor choices with alcohol and drugs, ranging from abuse to addiction. This may also encompass poor choices around so-called “soft addictions” such as gambling, pornography, or excessive video gaming. He or she may refuse, or appear unable, to fulfill normative roles of adulthood. If a parent, he or she may underperform or disregard the responsibilities of parenthood. He or she may frequently disrupt romantic partnerships. The enabled person often displays poor money management, as well as disorganized academic and/or career-planning choices. He or she may quit or be fired from a series of promising jobs and educational or training programs. The enabled person often describes himself/herself as a victim of circumstances or of other people.

The enabled person’s behavior elicits a great deal of anxiety within the people who love him or her. This creates a dysfunctional system into which people who are close to, love, or care for the person can become enmeshed: compelled to organize their own behavior around the needs and choices of the enabled person.

Some who use the term “enabler” do so with a heavily negative judgment against the person who fulfills the role. It is commonly believed that enablers are knowingly, even willingly, complicit in the actions of the person they are enabling; that enablers support and condone the negative choices of the person they are enabling.

This is far from true. Enablers do not like or feel OK with what the enabled person is doing. To the contrary, enablers are often the ones most affected by, and most disturbed by, the negative behaviors of the enabled person. They feel extremely anxious about the destructive consequences that the enabled person could face.

Consider the following quotes from self-described enablers in therapy:

• “If I kicked him out, he would be homeless. He’s so irresponsible with money, he could never make it on his own. What else am I supposed to do?”
• “Every time I’ve tried to talk to her about her addiction to those pills, she’s gone on an even worse binge, and I’m afraid she will overdose.”
• “I know I shouldn’t have paid for his lawyer after the third DUI, but if he went to jail, he would lose his job.”
• “Every time she and her boyfriend fight, she crashes here. I let her because I know he can be violent, and I don’t want her to be hurt. I wish she would leave him for good.”

In other words, enablers detest the behaviors of the enabled, but they fear the consequences of those behaviors even more. They are locked into a lose-lose position in the family. Setting boundaries feels like a punishment, a rejection, or an abandonment of the person they love. Enablers may struggle with the guilt they would feel if the person they’re enabling were “left alone” to be hurt and damaged by the real consequences of their actions. In some instances, enablers are also protecting themselves and/or children from those consequences.

Enabling, therefore, is a distorted attempt to solve problems. Enablers desperately desire to find a solution to the issues at hand, but their attempts to do so are severely limited by the dysfunctional family system.

Enablers frequently find themselves thinking things like:

• “If only I can keep this person going through their current crisis, it will buy us another day.”
• “If I can’t change what they’ve done, at least I can help limit the damage of that choice.”
• “Maybe my loved one will wake up and come to his or her senses. Maybe a real solution is waiting right around the next corner.”

Enabling has the effect of releasing the enabled person from having to take responsibility for his or her behavior. Enabling means that someone else will always fix, solve, or make the consequences go away. When someone is in the throes of an addiction or other grossly dysfunctional behavior pattern, he or she begins to rely on the resources available. Enabled persons will come to expect that their behaviors are disconnected from consequences or negative outcomes. Enabled persons may even begin to hold their enabling family members in “emotional hostage” in order to keep this pattern going. They may learn to manipulate their enablers in order to ensure that the help and support keep coming.

In this kind of a system, everybody loses by inches. The enabler is desperate to prevent one enormous crisis, but winds up experiencing a constant state of stress as he or she attempts to manage each smaller daily crisis. Enablers generally are aware that they are being taken advantage of in some way; they often report feeling frustrated, unappreciated, and resentful.

The enabled person becomes stuck in a role in which he or she feels incompetent, incapable, disempowered, dependent, and ineffectual. He or she may gradually accept a self-concept that includes these negative traits, destroying self-esteem.

How, then, does the enabled person also “lose”? The enabled person may wish he or she felt in control of themselves, particularly with regard to addiction; but lacking the life experience and lessons that facing consequences brings, they may not know how to break those patterns. They may not have had the benefit of true self-reflection and self-evaluation of their behaviors. The enabled person becomes stuck in a role in which he or she feels incompetent, incapable, disempowered, dependent, and ineffectual. He or she may gradually accept a self-concept that includes these negative traits, destroying self-esteem and rendering the person even less likely to suddenly do a 180 and become responsible and self-sufficient in the future. The enabled person may essentially be prevented from building the skills and motivation he or she needs in order to practice responsibility and reach his or her full potential. Because the enabler(s) will always solve problems for them, the enabled person does not learn how to solve their problems themselves.

By this point, you may be thinking, “I can see some of the ways I have been enabling my loved one. What now?”

You must accept that while your enabling behaviors come from a place of love, enabling is an ineffective way of solving problems at best; debilitating to all involved at worst. You may buy another day or prevent another emergency, but in the end, you are only postponing the real solution.

The key to breaking the pattern of enabling is to return responsibility to the person it belongs to. This involves setting boundaries between yourself and your loved one. You can no longer attempt to take on responsibility for anyone else’s actions but your own. Your loved one’s choices are (and have always been) his or hers. Your loved one’s outcomes and consequences, as well, belong to him or her alone.

The enabled person lives in the same world, with the same rules, as everybody else. Managing their world for them means that they don’t learn to manage themselves within the world. He or she is very likely to have untapped internal and external resources which have not been utilized because the enabling pattern has short-circuited their growth.

When you set boundaries, you release your need to control the outcomes that your loved one experiences. You allow your loved one the chance to connect his or her own choices to the positive and negative experiences that naturally follow. Their choices, their consequences, and what they do or don’t learn from them are all on their side of the boundary.

On your side of the boundary, this means that you must learn to cope with, and internally manage, the anxiety of not being in control of your loved one. Many recovering enablers find that they must rely on their own sources of support to help them overcome the urge to control and enable. The fear of your loved one being hurt can be so overwhelming that setting boundaries and stepping back can be panic-inducing. Receiving counseling for further insight and support in this area is highly recommended.

When you stop enabling, this does not mean that you stop loving the person. It does not even mean that you cannot help him or her.

When you stop enabling, this does not mean that you stop loving the person. It does not even mean that you cannot help him or her. There is a difference between healthy help and enabling. Healthy help involves providing information, encouragement, and coaching to your loved one. You may give your loved one contact information for doctors, counselors, lawyers, or rehabilitation programs, without feeling the need to force him or her to accept this help. You may discuss with your loved one what the possible consequences of actions might be, without feeling as if you must make sure they make the choice you want them to make. Healthy help puts your loved one in control and allows you to take a secondary role.

Enabling is essentially love turned to fear, and help turned to control. The effects of enabling are toxic to all involved. With a solid understanding of what enabling is, and what it is not, there is hope for families who are acting out this pattern. An experienced individual and/or family counselor can be a valuable source of support for anyone who is looking to break enabling patterns.

Attention deficit hyperactivity (ADHD) is characterized by cognitive disorganization, low attention, and impaired focus. Among the many symptoms and behaviors associated with ADHD are excess energy and externalizing behavior. Research has shown that as children with ADHD mature, their symptoms often decrease.

However, some children also exhibit signs of conduct disorder and personality problems, which exacerbate and perpetuate symptoms. This combination of psychological conditions can lead to violent behavior in some individuals. But does ADHD itself cause violent behavior?

That was the question posed by Rafael A. Gonzalez of the Forensic Psychiatry Research Unit at the University of London as the subject of a recent study. Gonzalez and his colleagues wanted to determine if ADHD by itself was linked directly to violent behavior in adults. And if so, what aspects of ADHD were most influential on violence?

To answer this question, Gonzalez reviewed responses from over 7,300 adults in the general population, using the Adult Self-Report Scale for ADHD. He also asked about violence, recurrence of violence acts, level of violence, and other comorbid issues. Gonzalez found that ADHD alone was only slightly predictive of violence. More specifically, the hyperactive behavior linked with ADHD, not the inattentive aspect, was the impetus for violence.

When Gonzalez examined levels of ADHD in relation to levels of violence, he discovered that the mild and moderate symptoms of ADHD were most closely related to repeated violent perpetration. However, severe ADHD was only associated with violence in the context of comorbidity. The most common conditions that appeared to be responsible for violent behavior in the adults with severe ADHD were personality problems, anxiety, and substance abuse.

“We thereby conclude that repetitive violence among persons with severe ADHD is associated with multiple forms of coexisting psychopathology but not ADHD,” said Gonzalez. Therefore, it is imperative that people with ADHD and co-existing psychological problems address the issues that could make them more susceptible to violent behavior. Future research should address the most effective ways to accomplish this.

Reference:
González, R.A., Kallis, C., Coid, J.W. (2013). Adult attention deficit hyperactivity disorder and violence in the population of England: Does comorbidity matter? PLoS ONE 8(9): e75575. doi:10.1371/journal.pone.0075575

Trauma brings with it flashbacks of memory and strong emotions, which are often uncomfortable and difficult to cope with. Typically these symptoms are followed by the fight-or-flight response. This is natural, as instinct tells us to do everything we can to avoid pain and discomfort. Unfortunately, avoiding trauma symptoms can be detrimental instead of helpful. Resisting and avoiding trauma symptoms often brings on more intense emotions as well as increased frustration, anger, and panic.

I often use this analogy to explain why this happens: Imagine you are out in the ocean, far from shore. Giant waves are coming, very intimidating and scary. The first instinct is to fight, to swim as hard as you can back to shore. However, unless you are a physical anomaly, you only end up exhausting yourself and don’t get closer to your goal of safety. When exhausted, you are at higher risk of drowning. Thus, survival experts advise that the best thing you can do in this type of situation is to allow your body to relax to conserve energy, floating instead of fighting. This gives you a better chance of getting through the ordeal and allows time to calm yourself so you can think clearly about what to do to in order to survive.

I advise clients to do the same thing when they are experiencing trauma symptoms. On many occasions, I have seen shock and confusion on their faces when I tell them to stop fighting their symptoms and to just go with them—not making them worse, but also not fighting or avoiding. It sounds absurd, I know, to advise against fighting panic, awful memories, intense emotion, and flashbacks. After all, don’t we want relief from those symptoms? Of course we do. It is natural to want to be without pain. I ask people to take a risk and try just riding the waves of their symptoms, experiencing and observing them without feeding into them and making them worse—all the while not trying to make them better, either.

[fat_widget_trauma_ptsd_right]

When we try to make our symptoms better by fighting or avoiding, we are often fighting a losing battle. The body and brain are amazing. They know what they need to do to work through trauma, and we often get in the way of that process because it is uncomfortable and sometimes downright painful. Healing often involves pain. Think about a time you had an injury of some sort (a broken bone, a sunburn, a cut, or any other physical ailment). Think about the healing process and how it wasn’t always comfortable. Often there are uncomfortable or painful sensations that come as a result of the body trying to heal itself. The same is true when we have experienced a traumatic event. Our brains need the chance to process what has happened. When we fight or avoid the discomfort, not only do the symptoms last longer and become more intense, but we become frustrated because we were not successful in getting rid of the symptoms as soon as we wanted to.The good news is this: I have seen the awe on the faces of people when they allow themselves to experience and observe their symptoms, and find that it does indeed work to decrease the intensity and duration of their emotions, flashbacks, and panic. They find that their symptoms have far less power over them and they are able to increase their ability to function in their lives. This is what riding the waves is all about. The goal is to decrease the suffering in a way that is conducive to healing.

To learn to do this, I would advise that someone experiencing trauma reach out for professional help for a few reasons. First, this process can be scary, and a professional can give you the support and monitoring necessary while you are developing this technique. Also, additional coping skills are helpful and necessary when one is learning to ride the waves of their symptoms. Lastly, a professional can help you to develop a comprehensive treatment plan for trauma that will be tailored to your individual needs so you can get the best outcome possible.

The diagnosis of “borderline personality disorder” carries profound stigma for many people. Even some mental health professionals use the term pejoratively, which is not difficult considering that the diagnosis itself implies that someone’s personality is flawed. In reality, the flaw lies within the diagnosis—not to mention all the painful and agitating symptoms that come with it.

I will go into more depth about these challenges, but first a definition is in order.

What Is ‘Borderline Personality Disorder’?

People who are diagnosed with borderline personality tend to have problems with unstable self-image, moods, and relationships. They may experience suicidal thoughts, self-harming behaviors, displays of anger or irritability, and periods of intense sadness or despair called “dysphoria” (the opposite of euphoria).

To receive a diagnosis of borderline personality, a person must meet at least five of the nine characteristics below. Keep in mind while reading the list that, in order to qualify for the diagnosis, the person’s symptoms must be longstanding and inflexible, not just occasional ways of relating to life:

1. “Frantic” attempts to avoid abandonment
2. Intense and turbulent relationships, with a tendency to alternate between seeing the other person as all good or all bad
3. Unstable sense of self, which could lead to radical changes in major aspects of identity such as career, religion, or sexual orientation
4. Frequent suicidal thoughts or self-harming behaviors, such as cutting
5. Impulsive behaviors in at least two other areas, such as substance abuse or binge eating
6. Wild mood swings with extremes of anxiety, irritability, or dysphoria
7. Persistent feelings of emptiness
8. Intense anger or rage that is often close to the surface
9. Brief periods of paranoia or dissociation when under stress

I have seen more than one writer refer to borderline personality as the equivalent of emotional hemophilia: when a person with borderline personality experiences a hurt, even a small one, the emotional bleeding is profuse. The suicide rate for people with borderline personality is about 10%. Most people—up to 90%, by some estimates—with borderline experienced neglect or abuse, particularly sexual abuse, during childhood. Individuals with borderline personality commonly view themselves as inherently defective, bad, or broken.

For many years, borderline personality disorder was considered untreatable. Now, decades of research and treatments have illuminated the errors in such thinking. For one thing, we know that many people “grow out” of the disorder as they age. For another, a great many people with the diagnosis respond positively to treatments such as dialectical behavior therapy.

Stigma and Borderline Personality

All personality disorder diagnoses are controversial. The mere phrase “personality disorder” situates the problem in the person’s personality, rather than neurology or life stressors (including trauma). GoodTherapy.org’s founder, Noah Rubinstein, LMFT, has even explained why he views personality disorder diagnoses to be flawed:

“I believe that by labeling a person as personality disordered or, in its more gentle form, stating that a person has a personality disorder, we are essentially claiming one’s personality, their person-hood, their essence, is fundamentally flawed. What else are we, other than our personality? Such a diagnosis is very, if not absolutely, likely to produce more shame, worthlessness, and rejection in a person who probably has enough of it already.”

I agree with his analysis. In some ways, the situation is even worse for people diagnosed with borderline personality. Any mental health diagnosis can engender feelings of shame, or of being “fundamentally flawed.” On top of that, feelings of shame and badness are both symptoms and consequences of borderline personality. This can create a vicious cycle, as if the diagnostic label alone confirms the feelings of defectiveness that came well before the diagnosis.

Too often, some mental health professionals add to the stigma. It is well known that some clinicians have applied the label “borderline” merely because they do not see an individual improving, or the individual poses challenges such as expressing overt anger toward the therapist. For some therapists, it is easier to blame the client for treatment’s lack of success than it is to look at the clinician’s own inability to help.

Another source of stigma concerns others’ tendencies to judge the person, rather than the person’s behaviors. Some, though certainly not all, people with borderline personality may cope or express their pain in ways that hurt those around them. They may yell or even be physically violent, make unrealistic demands, display intense sadness or anger at what seems a disproportionately small provocation, or even attempt suicide or hurt themselves in ways that make another person feel manipulated.

It helps to keep in mind the fundamental, excruciating pain that often underlies borderline personality disorder. Marsha Linehan, the psychologist who created dialectical behavior therapy, compares the behaviors of people with borderline personality disorder to those of people with painful cancer who will do anything to reduce their pain. The cancer patients may cry, scream, or attempt to “manipulate” others in order to get their pain medication. But we seldom view their efforts negatively, because we understand their abject suffering. Their behaviors make sense.

So, Should the Diagnosis Be Abolished?

I agree with other critics that the label “borderline personality disorder” can compound an already painful situation for people, especially the newly diagnosed. But I also find value in the diagnosis—not the name, but the concept.

Before diagnosis, people with borderline personality often feel bewildered. They may deeply experience their internal chaos yet find that few people understand. I have worked clinically with many people who felt soothed when they learned their problems fell into a distinct category that millions of other people shared. These people felt they were no longer alone.

Once people have a name for a condition, they can more easily find information about challenges and ways to heal. They can find other likeminded people in online support groups. Also, diagnoses enable clinicians to better treat people. Clinicians can draw from a large body of research on borderline personality to identify the best treatment options for individual clients.

The diagnostic label deserves to be changed, but the construct itself should remain, as long as it is supported by continued research. Some researchers, like the psychologist Judith Herman, think that borderline personality actually is a type of posttraumatic stress, and should be reclassified as such. But the idea has not gained much momentum in the field of psychiatric diagnosis.

Changing the name, too, is a pipe dream for now. The American Psychiatric Association only months ago released its first overhaul in almost 20 years of the Diagnostic and Statistical Manual of Mental Disorders, and the group never seriously considered altering the name. That is a shame. The name of a diagnosis should describe the problem—in this case, problems regulating emotions—not the personality. Others have proposed alternate names. My preferred label is one proposed by Dr. Linehan, “Emotion Dysregulation Disorder.”

What Can We Do to Diminish the Stigma?

Use the word “borderline” appropriately. Do not use the word “borderline” as an insult. This especially applies to mental health professionals. I have worked in the mental health field for almost 20 years, and it is disheartening how many times I have heard a professional say “She is so borderline,” or “What a borderline.” Borderline is an adjective to describe a series of symptoms, not a person. And it certainly is not a noun.

Be clear that stigma is undeserved. When we discuss how stigmatizing the diagnosis of borderline personality can be, it is necessary to make clear that the stigma is unfounded. Despite appearances or assumptions, the label does not truly mean that somebody’s personality is flawed. We need not buy into the pejorative meaning.

Exercise compassion. Whether you know somebody with borderline personality or have the symptoms yourself, always keep in mind the underlying pain and anger that can drive behaviors. This is not to say that people with borderline personality are not responsible for their behaviors and cannot make changes. Rather, a compassionate stance helps diminish shame. It also emphasizes the possibility that people can learn more constructive ways to manage their emotions.

Avoid stereotypes. The diagnosis of borderline personality captures a very heterogeneous group. Only five of the nine diagnostic criteria are required for a diagnosis. Two people with the diagnosis could have only one symptom in common. In fact, there are 256 different possible symptom combinations for borderline issues, and every person who has been diagnosed with borderline personality has his or her own unique stories.

Maintain hope. As I noted above, borderline personality need not be a lifelong struggle. The symptoms of borderline personality often mellow with age. Borderline personality disorder, as a diagnosis, also has the advantage of garnering significant attention among researchers, clinicians, and grant funders. New discoveries continue to be made.

More and more, we learn about effective ways to treat people who are diagnosed with borderline personality. These gains in knowledge lead to more hope: hope for people to heal, and hope for the condition, by whatever name, to elicit less stigma and more understanding.

References:

1. American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders – 5. Washington, DC: Author.
2. Gunderson, J. G., Stout, R. L., McGlasham, T. H., Shea, T., Morey, L., Grilo, C. M., Zanarini, M. C. et al. (2011). Ten-year course of borderline personality disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders Study. Archives of General Psychiatry, 68, 827 – 837.
3. Leichsenring, F., Leibling, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 9759, 1 – 7.
4. Lilienfeld, S. O., & Arkowitz, H. (2012). Diagnosis of borderline personality disorder is often flawed. Scientific American. http://www.scientificamerican.com/article.cfm?id=the-truth-about-borderline
5. Linehan, M. M. (1993). Cognitive behavioral treatment for borderline personality disorder. New York: Guilford.