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Understanding our family through the multigenerational transmission process. Families pass on behaviors, emotions, and relationship patterns from generation to generation. The family is the first social system to which an individual is exposed. Becoming aware of our inherited patterns, we can choose which to continue and which to change. Imagine navigating through a forest, where each tree represents a family , and its roots represent its members that span back many generations. The roots, entwined and deep, hold the shared experiences, values, and emotional undercurrents that bind the family together. Just as these roots draw nutrients from the soil to sustain the tree, so too do our ancestors' emotional and behavioral patterns influence and nurture our ways of being in the world. This natural framework sets the stage for understanding the multigenerational transmission process, which explores how the hidden roots of our family's past shape our present and future landscape. The multigenerational transmission process is a concept developed by psychiatrist Murray Bowen. It posits that families pass on behaviors, emotions, and relationship patterns from generation to generation. These inherited traits can influence how we view relationships, manage stress, and approach life's challenges. Many find themselves replicating family behaviors without fully understanding why, and this concept helps explain why patterns repeat. Consider the family as the first social system to which an individual is exposed. Within this system, children absorb not just love and care but also ways of handling emotions, conflict, and relationships. For example, a family where open communication about feelings is encouraged might foster generations of individuals comfortable with emotional expression. Conversely, in families where emotions are suppressed, or conflict is avoided, children may learn to internalize their feelings, leading to potential emotional disconnects in their future relationships. Additionally, the multigenerational transmission process explains the slight differences in how independent or differentiated individuals are from their parents and how this can lead to significant differences in independence among extended family members over many generations. Over time, some family members become more independent or "self-differentiated," while others become less so, based on the dynamics in their immediate family. People tend to choose partners who are as independent as they are, which can lead to families where these traits become more pronounced over generations. One family line might become more independent and stable while another becomes less so. How independent or differentiated someone is can significantly influence their life, affecting things like health , marriage stability, success in school, and career achievements. Families with highly independent individuals tend to be more stable and contribute more to society, while those with less independent members might struggle more and rely more on others. This concept tells us that the most profound human issues and strengths are often inherited from many generations back. It also shows how these inherited traits influence how we see ourselves, interact with others, and choose our partners. For instance, someone who's been taught to be overly dependent and indecisive is likely to select a partner who complements these traits by being overly controlling and decisive. Understanding the impact of our family legacy begins with tracing family relationships back through generations. Here's a guide to help you start exploring your family patterns: 1. Start With Conversations: Talk to older family members about their lives, values, and the lessons they've learned. These stories can provide invaluable insights into recurring family patterns. 2. Map the Family Tree: A visual representation of your family tree, a genogram, can help you identify relationships and patterns more clearly. Pay special attention to any repeated events or behaviors (e.g., instances of divorce , mental health issues, or career paths). 3. Recognize Emotional Patterns: Reflect on your family's emotional climate. Are there prevailing moods or attitudes toward certain life events? How do family members interact during conflicts? 4. Seek Common Themes: Look for themes that recur over generations. These could range from positive traits like resilience and strong work ethic to more challenging patterns like avoidance of conflict or difficulty in maintaining relationships. 5. Acknowledge Individual Differences: While recognizing patterns, it's crucial to remember that each family member has their own agency. People can and do change, influenced by factors outside the family system. Understanding our family legacy doesn't mean resigning ourselves to fate. Instead, it offers a powerful opportunity for growth and healing. By becoming aware of these inherited patterns, we can choose which to continue and which to replace with new, healthier patterns. This process isn't always easy and may require support from mental health professionals, especially those familiar with Bowen Family Therapy or similar modalities. In essence, the multigenerational transmission process teaches us that while our family history influences who we are, we hold the power to create new patterns for future generations. It reminds us that amidst the complexities of our family legacies lies the potential for profound personal transformation and healing. By exploring the depths of our family stories, we gain insights into our past and empower ourselves to create a legacy of mindfulness, resilience, and emotional health for future generations. Ilene S. Cohen, Ph.D. - Website - Blog - Book - References Bowen, M. (1978). Family therapy in clinical practice . Jason Aronson.

Depression can cloud the mind, but we can improve our ability to think clearly. One mechanism of depression's effects on memory may involve neuroinflammation. Neuroinflammation appears to disrupt functions of the hippocampus, an area of the brain key in memory. Adaptive strategies and treatment may improve cognition in people experiencing depression. What was her name? I could vividly picture her. I could remember all kinds of stories and times we shared. Why couldn't I think of her name? I put my head down, trying to figure out how I could find it. There it was, written in a book. I took a breath and moved on. I know what this is. No shame spirals today. Depression Thinking Most people are aware that depression can incite negative thinking. We become more pessimistic and self-critical when we are depressed. Yet, something less known is that depression can also affect your ability to think clearly. If you feel like you are thinking more slowly and struggling to get things done while depressed, you are probably right. A systemic review found that individuals experiencing major depression consistently showed slower processing speed. They also had difficulties with executive functioning or engaging in the tasks necessary to plan or complete another task (Nuño and colleagues, 2021). Other research has identified depression-related difficulties in cognitive domains as diverse as attention and long-term memory (Hammar and colleagues, 2022). Yet, positively, many of these deficits appear to improve when a person reaches recovery from their depression (Kriesche and colleagues, 2023). It's Not in Your Head, It's in Your Brain Why does this happen? My undergraduate professors taught me that much of this relates to motivation. When we feel down, it is difficult to wrangle the energy to best engage our brain resources. Although such demoralization may play a role, more current research suggests there may be neurological reasons as well. Research investigating how and why depression affects our ability to remember things and concentrate has suggested neuroinflammation as a possible mechanism. Specifically, neuroinflammation affecting the hippocampus, a brain region believed to be key in memory, appears to disrupt an important process. The hippocampus is one section of the brain capable of a fantastic process called neurogenesis, which creates new neurons and connections. Neuroinflammation linked to depression seems to inhibit this process (Wu and Zhang, 2023). What Can You Do? If you are struggling with cognitive symptoms of depression, you are not alone. Here are a few simple steps to tackle these frustrating challenges. Self-Compassion Difficulties with memory, attention, and processing speed set us up for self-criticism. Remember that these symptoms are part of depression. They aren't your fault. Give yourself the kindness you would give a friend. If you make a mistake, show grace. If you notice your mind spouting off unkind self-talk, respond to yourself with compassion. 2. Adaptive Strategies During times of depression, utilizing all available tools can be helpful. Simple strategies like writing things down, setting phone alarms to remind you about important tasks, and giving yourself more breaks with high-demand cognitive tasks are ways you can work around depression's effects. 3. Ask for Help Cognitive symptoms can be like an alarm signaling a need for help. Receiving support for your depression is vital. Many depression treatments, including transcranial magnetic stimulation (Luber and colleagues, 2014) and some medications (McIntyre and colleagues, 2014), have been demonstrated to address this class of symptoms. Jennifer Gerlach, LCSW, - Website - Blog - Book - References Hammar, Å., Ronold, E. H., & Rekkedal, G. Å. (2022). Cognitive impairment and neurocognitive profiles in major depression—a clinical perspective. Frontiers in Psychiatry, 13, 764374. Kriesche, D., Woll, C. F., Tschentscher, N., Engel, R. R., & Karch, S. (2023). Neurocognitive deficits in depression: a systematic review of cognitive impairment in the acute and remitted state. European Archives of Psychiatry and Clinical Neuroscience, 273(5), 1105-1128. McIntyre, R. S., Lophaven, S., & Olsen, C. K. (2014). A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults. International Journal of Neuropsychopharmacology, 17(10), 1557-1567. Luber, B., & Lisanby, S. H. (2014). Enhancement of human cognitive performance using transcranial magnetic stimulation (TMS). Neuroimage, 85, 961-970. Nuño, L., Gómez-Benito, J., Carmona, V. R., & Pino, O. (2021). A systematic review of executive function and information processing speed in major depression disorder. Brain Sciences, 11(2), 147. Wu, A., & Zhang, J. (2023). Neuroinflammation, memory, and depression: new approaches to hippocampal neurogenesis. Journal of Neuroinflammation, 20(1), 283.

Seeing dating and relationships as exciting opportunities vs. stressful threats. Anxiety is a bad feeling (negative valence) of urgency (high arousal) from situations we see as threatening. Calming down is hard because we must change both our valence (think positive) and arousal (relax) to do so. With only positive refocusing, however, anxious social situations can become exciting opportunities instead. When we experience situations that are new, uncertain, or not under our control, we can feel anxious. As a result, we might even start imagining the worst, making it hard to think, focus, and perform. Unfortunately, social situations are often new and uncertain. Such situations are also circumstances where we’d like to think, focus, and perform at our best. So, what can we do? To start, we need to understand that anxiety raises our energy (called high arousal) but also makes us feel bad (called negative valence). When we try to calm down, we attempt to change both of those things at the same time. We’re trying to relax (lower our arousal) and see things more positively (improve our valence). Doing both of those things at once can be a challenge, especially when we’re stressed in the first place. Given that, what if we tried to just change one thing instead? Specifically, what if we got excited—keeping arousal high, but making our emotional valence more positive? Would that work? Let’s see what the research has to say… Reappraising Anxiety as Excitement A series of studies by Brooks (2014) tested this very idea. The author reasoned that both anxiety and excitement were very similar emotional states, helping to raise our energy level and anticipate future events in uncertain situations. Nevertheless, they differed in their valence (negative vs. positive), which changed how people thought about those uncertain situations (as threats vs. opportunities). Given the similar arousal level and motivation toward anticipating events, however, would it be possible to just switch the valence and reappraise anxiety as excitement instead? Brooks (2014) explored that question in two experiments, by putting participants in surprise social situations, where they had to sing karaoke or give a speech in front of a stranger. Before performing, they were told to make self-statements of “I am excited” or “I am calm” out loud. Follow-up questions found that all performers were still somewhat anxious, but those who said they were excited out loud felt better and performed better. Singers sang better and felt more successful, while speakers were seen as more persuasive, competent, confident, and persistent, too. Brooks (2014) conducted two more experiments to look for the underlying reason why this reappraisal of anxiety as excitement worked. This time, however, participants were instructed to “get excited” or “try and remain calm,” as they took what was labeled as a “difficult IQ test” of math problems. Here again, those who focused on getting excited performed better and felt more efficacious. In addition, the study results indicated that getting excited also helped participants adopt an opportunity mindset (as opposed to a threat mindset). Put simply, getting excited helped participants identify the positive possibilities and options in the situation, rather than getting bogged down on the negative risks and hazards. Getting Excited for Opportunities Given those results, it appears that getting excited can help make anxiety provoking situations feel less threatening and intimidating. In turn, the positive focus that comes from excitement can improve confidence, performance, and even persuasiveness. Taken together, those factors can put us in an opportunity mindset, where we can better enjoy social interactions and intellectual challenges too. Overall, we feel, think, and perform better when we’re excited, because it changes our perspective. Much of the time, however, negative thinking and worrying about risks is our default human mindset (known as loss aversion). Thus, we can improve our decision-making by including other perspectives. Getting excited gives us that new perspective—a positive one. So, we can see the opportunities and benefits, rather than just the risks and costs. With a date or mate, that means we can focus on mutual attraction, compatibility, and fun! Other research supports this type of positive refocusing as well. For example, in my book Attraction Psychology (Nicholson, 2022), I discuss how focusing on being curious can help reduce anxiety in dating and social situations, too. Much like excitement, curiosity also improves our perspective, opening us up to see more opportunities and possibilities. So, putting those two mindsets together might be particularly helpful in romantic and social interactions. In fact, much of the fun of dating and relating comes from being curious and excited, enjoying the positive opportunities and experiences that social interactions bring into your life. Beyond that, exciting and arousing activities can create attraction between yourself and your date or mate as well. So, get excited, stay curious about the positive possibilities, and enjoy your social life. If you do, then you might find you’re more attractive, arousing, and persuasive than you think, too! Jeremy Nicholson, M.S.W., Ph.D. - Website - Blog - References Nicholson, J. S. (2022). Attraction Psychology: Solutions for Successful Dating and Relationships. Brooks, A. W. (2014). Get excited: Reappraising pre-performance anxiety as excitement. Journal of Experimental Psychology: General, 143(3), 1144–1158.

Unpacking anxiety and OCD can make a huge difference for moms. Intrusive thoughts in motherhood are incredibly common, especially after having a baby. Intrusive thoughts that occur rather frequently and cause distress and impairment may be a sign of anxiety. Postpartum OCD is characterized by intense worry, checking behaviors, and avoidance of feared situations. Therapy, especially cognitive-behavioral therapy, is highly effective and can help you get your life back. This post is co-authored with Tatyana Mestechinka, Ph.D., Founder and Director of CBT For Better Living Becoming a mother is often portrayed as a magical and fully joyful experience. Yet, for many women, it can be overwhelming, anxiety -provoking, stressful, and lonely. An often misunderstood, yet common experience of postpartum mental health is anxiety, particularly the presence of intrusive thoughts—unwanted, distressing, irrational thoughts or images (e.g., “What if I hurt my baby?” “What if I die in the next three months?” “What if something terrible happens to my baby?”). This experience is usually accompanied by a false sense of urgency and anxiety. If you are a mom experiencing these thoughts, it can understandably feel bewildering, disturbing, and upsetting — yet nothing is wrong with you! Many moms question whether having these thoughts means they are a danger to their child or are a “terrible mother.” Here’s the truth: intrusive thoughts are incredibly common. Studies indicate that about 90% of people experience intrusive thoughts at some point in their lives, and new mothers are no exception. If anything, moms can be even more vulnerable to this experience, due to the often-startling transition into motherhood. What Is Postpartum Anxiety and OCD? How do we distinguish the remarkably common occurrence of intrusive thoughts after having a baby from the type that might be more problematic? If intrusive thoughts occur rather frequently and cause significant distress and impairment, they may be part of Postpartum Obsessive-Compulsive Disorder (OCD) or Generalized Anxiety Disorder (GAD). Unfortunately, as many new moms are unfamiliar with this and fear speaking about it, it can feel incredibly isolating and shameful. Understanding, unpacking, and treating these symptoms can help you get through that “fourth trimester” and beyond without being tormented by anxiety. What Might Postpartum Anxiety Look Like? Imagining scenarios in which harm could come to your child Checking multiple times that your child is safe Asking others for reassurance that your child is safe and/or that you wouldn’t harm them Avoiding certain situations due to fear Rumination, checking and avoidance behaviors, while understandable in the moment, only serve to fuel and reinforce the anxiety and unnecessarily validate the relevance of the intrusive thoughts. These behaviors reinforce the false alarm signal that the thought itself is important, meaningful, or should be attended to immediately. Treating intrusive thoughts as relevant may inadvertently lead to their increased frequency and intensity. This cycle not only exhausts an already sleep-deprived new mom, it can also begin to disrupt her overall well-being at a time when she is already vulnerable. Instead: Recognize that an intrusive thought is just a thought (we all get nonsensical thoughts from time to time) and should be dismissed as such, especially when danger is in fact unlikely (it is extremely unlikely a new mom will harm her baby). Why Don’t More Moms Talk About This? Despite their commonality, the experience of postpartum anxiety and OCD is rarely openly talked about, partly due to the pervasive myth of the “perfect mother.” Society often expects moms to be entirely selfless, fully attuned to their baby’s needs, and endlessly positive about their role. Yet, for many, the reality is much messier, and moms can be left feeling isolated in their struggles, believing they’re the only ones who are experiencing them. Furthermore, many moms fear being judged or misunderstood, and they may even worry that seeking help will result in unwanted interventions or social services. This can prevent them from discussing their distress openly with friends and loved ones, and they can even be wary of sharing their symptoms with mental health professionals. However, a mental health providers who specializes in this area can offer a supportive, helpful, and judgment-free space. The truth is postpartum OCD and anxiety are treatable! Sharing with trusted people is the first step in overcoming this challenge. When to Seek Help: It’s time to reach out when: These thoughts start to interfere with daily life (i.e., take up undue attention and energy) They affect your mood and well-being You’re avoiding things or engaging in excessive checking or reassurance-seeking Talking to a therapist, especially one who specializes in postpartum care, can be incredibly helpful. Cognitive Behavioral Therapy (CBT), particularly a subset of CBT called Exposure and Response Prevention (ERP) as well as Acceptance and Commitment Therapy (ACT), are highly effective in helping individuals manage intrusive thoughts and feelings. In fact, research shows that 50–60% of people see significant improvement with ERP—and those improvements often last long-term. What Treatment May Look Like Through CBT and ERP, moms can reduce the impact of obsessive thoughts, breaking free from the hold these worries can have. The first aspect of therapy will involve openly sharing your experience with your provider. The therapist will assess if your symptoms are a part of a postpartum anxiety, OCD, or a mood disorder (PMAD) and offer you information to help you understand your diagnosis. CBT therapy, particularly ERP and ACT, will help you develop specific tools to manage this distress. You can learn to recognize intrusive thoughts as merely “thoughts” and to refrain from engaging in behaviors that might fuel these thoughts. For example, excessively reviewing the thoughts and engaging in excessive checking (e.g., checking over and over that your baby has not swallowed something) and avoidance behaviors (e.g., refusing to leave the house or leave your baby with a responsible caregiver due to fear of harm) can all reinforce the unwanted anxiety. In exposure therapy, the clinician will encourage a new mom to gradually reduce checking behaviors (e.g., check once, not seven times) and to gradually approach feared situations (e.g., take your baby for a five minute walk around the block, hire a babysitter for 30 minutes while you remain at home). These exercises are a way to teach your brain that you are no longer responding to these anxiety signals with any relevance. The exposure exercises may be done in the therapist’s office or may be assigned to the mom as “homework” to practice. Exposures are always offered at a pace the mom is willing to do, and therapy can take place in person or via telehealth. To find a CBT therapist who offers ERP, consider asking your internist or searching online. In Conclusion Many moms experience postpartum anxiety after having a baby. This can be incredibly isolating if you have no idea what the symptoms are and keep them to yourself. Yet there is good news — effective treatment is available! Portions of this post have been excerpted from my book, Goodbye, Anxiety: A Guided Journal for Overcoming Worry. Terri Bacow, Ph.D - Website - Blog -

What you see is not always what you get. Partners may not be who we thought they were. Partners may not look closely enough at each other. Partners must empathize and be more authentic with each other. In all my years of treating couples , one of the most common complaints has been that one partner has changed in some significant way immediately after marriage. Of course, the partner who complains is the one who feels betrayed, tricked, ripped off, or made a fool of. He or she might say something to me like: “I think my partner put on a show for me just to close the deal or get me to the altar. Now I find I have married a different person.” I see this most often in the context of: Affection - “Before marriage, my husband treated me like a princess. Nothing was too good for me. Since marriage, however, he has treated me as if I am a burden to him. I am totally confused. Even my friends cannot believe his sudden shift in attitude and behavior.” Children – “Before marriage, my wife told me that she wanted at least three children. After marriage and our first child, she changed her mind.” Sex - “My wife used to be kinky and suddenly she has become a prude.” Travel - “Before we married, my husband was adventurous and spontaneous. Now he says he is bored with traveling and wants to stay at home and work on his hobbies.” Work - “Before we married, my wife was career-oriented with a nice salary. But as soon as we married, she told me that she was tired and wanted to retire. She knew how important a two-income marriage was to me, but decided to make a unilateral decision.” The partner who breaks the spoken or unspoken marital contract usually presents as feeling justified in their position. They even resent being challenged by their shocked and confused counterpart. It is easy to understand why the bewildered spouse is upset. After all, “what they saw, they did not get.” But it is much harder to understand their counterpart’s resentment. After seeing hundreds of these couples, I have come to two conclusions: 1. The spouse who made a seemingly sudden shift was never happy or satisfied with the role they were playing prior to their marriage. They were in conflict about their identity, or what they wanted out of life. Winnicott (1960) might say they were not being their true selves. There could be many reasons for this, but the one I find most often is that they were never allowed to be themselves and so they adopted a pleaser identity. “Whatever I have to be or do to please others in the moment, I can be;” and 2. The spouse who feels tricked is not as fooled as they think they are. Because of their own needs, these individuals may not look closely enough at their potential mates, and in a sense, do not get to know who their partners truly are. This mistake could serve to unconsciously replicate their history of not getting their needs met. For couples to work through a dynamic such as this, both partners will first need to empathize with each other and decide if they still want each other as they truly are. This will usually take some compromise and the willingness to accept some loss. If they can do this, they will then have to re-contract, but this time it should be based on authenticity. Stephen J. Betchen, D.S.W. - Blog - References Winnicott, D. W. (1960). Ego distortion in terms of the true and false self. In L. Caldwell & H. T. Robinson (Eds.), The collected works of D. W. Winnicott (Vol. 6, pp. 159-171). Oxford.

Neuroscience can transform stress into joy and support weight loss. The chemicals that drive obesity are activated by stress. Treating a root cause of obesity, physiologic stress, is a natural alternative to drugs and diets. Research has shown that treating the stress response is associated with lasting weight loss. Physiological stress is the root cause of obesity Despite the popularity of weight loss drugs, in most cases, obesity is not caused by a deficiency of GLP-1, the biochemical that these drugs mimic, and they have adverse side effects. Rather, boosting GLP-1 through prescription drugs results in changes in the symptoms of increased appetite and weight gain. In contrast, stress is a root cause of obesity, so treating the brain's stress response is a natural alternative to these drugs. You can use tools to rewire the stress response, which is associated with continued weight loss after treatment ends. The strategy of rewiring the brain's stress response is rooted in two pieces of scientific literature. One is biochemical. All eight chemicals associated with obesity increase appetite or promote weight gain in stress. These chemicals are: cortisol, dopamine, serotonin, insulin, ghrelin, PYY, leptin, and GLP-1. The other rationale for treating stress in obesity care is based on evolutionary biology. For 99 percent of evolution, food availability was scarce and unpredictable; stress was associated with starvation. The brain interprets psychological stress as a signal of starvation, dysregulating these eight chemicals and biochemically promoting weight gain. Stress is associated with the eight chemicals that drive obesity The approach holds promise because the techniques have shown long-term effectiveness after treatment ends, whereas weight is regained after weight loss drugs are discontinued. There is a new emphasis nationally on preventive and natural therapeutic methods that do not involve pharmaceuticals. A person can address the stress response based on neuroscience, learn how to process negative emotions into positive ones, and change the expectation embedded in the stress circuits to support positive neuroplasticity. The goal is for the brain to naturally activate reward and provide "comfort" biochemically to decrease the psychological need to overeat. The neural pathways of the stress response are emotional. The brain can deactivate the stress response by using specific emotional techniques that turn stress into positive, joyful emotions. Cognitive methods may be ineffective in shutting off the stress chemical cascade, a possible rationale for the ineffectiveness of mindfulness and cognitive strategies in producing lasting weight loss. Treat stress as a natural strategy for obesity care As most patients stop taking weight loss drugs within one year of starting them, use of these drugs may not be suitable for many individuals. Access to alternatives, such as addressing the stress response, can offer an alternative to food restriction. The dietary approach has been shown to fail after one year of use, and as lasting weight loss is the goal, it is not a solution. As obesity is associated with adverse childhood experiences and stress, treatments that address psychological stress may have beneficial effects on these factors and the underlying causes of eating disorders and obesity. The psychological challenges faced by the obese are significant. Innovations in obesity treatment that decrease the risk of weight regain and promote positive emotional health outcomes are needed. Laurel Mellin, Ph.D., - Website - Blog - References Tomiyama AJ. Stress and Obesity. 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Front Public Health. 2022 Oct 20;10:996179. doi: 10.3389/fpubh.2022.996179. PMID: 36339230; PMCID: PMC9631444.

A good night's rest improves our mental health. So how do we get it? Sleep cleans the brain, clearing out waste and byproducts. When we don't get sleep, it becomes harder to focus and we experience more intrusive thoughts. Taking a hot bath and focusing on your body can help you get good quality sleep. Sleep on it. Things will look better in the morning. These tropes stand the test of time because we all know the feeling of waking up in the morning and things seeming less harsh than they did the night before. What gives? How does sleep change how we think and feel about ourselves and our lives? And how do we get better sleep so we can feel better? Researchers nicknamed sleep ‘the brain’s garbage disposal system’ because it clears away the cellular trash that accumulates from a day of use. During sleep, the fluid that bathes your brain is increased by 60%. It clears the byproducts of all the firing you did in the day, rebalances the neurotransmitter levels between synapses, and flushes out the old fluid. In fact, one of the byproducts that gets cleared is beta-amyloid metabolite, a key driver of neurodegenerative diseases like Alzheimer’s and dementia . When you wake up from a good night’s sleep and things don’t seem quite as bad, or new ideas immediately pop into your head, it’s due to this massive cleaning making your brain run effectively. When you don’t get adequate sleep, you disrupt this process. Your brain is essentially dirty, affecting the efficiency of your thought processes. When we are sleep-deprived, a thought network called the Central Executive Network (CEN) doesn't work as well. It becomes harder to focus, and it also becomes harder to turn off the judgmental, catastrophic thinking of your other thought network — the default mode network (DMN). This is why our thoughts get nastier and more intrusive when we’re sleep deprived. We can’t stop them. Yet, one of the primary drivers of nighttime insomnia? Intrusive thoughts. Research shows that the ‘stronger’ the DMN network, the more likely people are to suffer from insomnia and night waking. So how do we stop this nasty rinse-wash-repeat cycle of negativity? Try these hacks: Take a hot bath. Our bodies naturally go through changes in body temperature over a 24-hour cycle. In the hours leading up to sleep, it drops between 2 to 3 degrees Fahrenheit to initiate quality sleep. When we take a hot bath or shower, we draw out the heat from the core of the body by bringing it to the surface of our skin. When our hands and feet expel this extra heat, it cools off the core and brings us back in line with normal body temperature cycling. Studies show that people who take a hot bath or shower for 10 minutes or more can experience improved sleep duration and quality. In fact, a hot bath or shower helps people fall asleep almost as fast as the common pharmaceutical sleep aid Ambien. Whereas Ambien users fell asleep 16 minutes faster than the control group, people who took a hot bath or shower fell asleep 7 minutes faster. If it is too much effort or you worry that you will wake everyone else up, try using a heating pad to warm your hands and feet. It most likely isn’t as powerful as a hot bath or shower, but could trigger an attenuated version of the same cooling process. Get into your body. When sleep deprivation makes it feel impossible to focus on a work presentation or school project, we have to look for simpler, easier ways to direct our attention. Start by focusing your attention on your heart. How does it feel? Does it feel tight? Is it beating quickly? Do you feel any emotions come up as you do this? Feel into those as well. Sit with the feelings without trying to change them. Take some deep breaths. You can stay focused on the heart if it feels good, or go to other parts of your body. Think to yourself, “I’m sending love to my heart (or back, or arms),” and pay attention to how it feels. Switch gears. Sometimes our nervous systems are too wired to fall asleep, and we need an activity to occupy us while our bodies wind down. In that case, try reading. It is far better to have your mind engaged with a story than your own, automatic, critical thoughts. If blue light is a worry, try turning your phone onto night mode, or using an electronic reader that does not have blue light. It is frustrating to be up when you wish you were sleeping, but at least, you can direct your thoughts away from negative self-talk towards something else. Struggling to get quality sleep can make anyone feel frustrated and hopeless. The most important thing you can do is to treat yourself with kindness and compassion. You may not get as much done the next day. You may want to crawl into bed early. Taking care of yourself can help it feel a little less hard. Copyright Betsy Holmberg Betsy Holmberg, Ph.D., - Website - Blog - References Eugene, A.R., & Masiak, J. (2015). The neuroprotective aspects of sleep. Medtube Science, 3(1), 35-40.

How to manage your anger, and the anger of everyone else. Anger is an emotion designed to change things. There is nothing wrong with anger. It's what you do with it that matters. You can manage someone's anger by unleashing the power of respect. We all want the same thing: to feel valued by someone else. This ancient survival truth has an enormous influence on everything we do. When we feel valued, we feel safer. Respect leads to value. Value leads to trust. And trust is based on the neurohormone oxytocin, the cuddle chemical. [1] It is that feeling you get when you know that someone else sees you as amazing. But when we feel devalued, our survival response can activate instantaneously. This primordial fight-flight-freeze response is housed in the ancient part of our brain called the limbic system. Anger is the fight branch of fight-flight-freeze. Of all the emotions like happiness, sadness, envy, or anxiety , our brains are designed to recognize anger the fastest, within 39 milliseconds, or less than the blink of an eye! [2] This makes sense from an evolutionary perspective. It was much more important to know if you were looking at me as lunch than if you were hungry. If someone else is angry, I could be in danger, because aggression is the enactment of anger. Anger happens. We can devalue another on purpose, but more often unwittingly. And if you are doing it, your partner is doing it. They, too, may sometimes devalue you on purpose, but even in the best relationships we can unwittingly devalue our partner and get them angry. There is nothing wrong with anger: it’s what you do with it that matters. Here are 7 steps to manage your anger, and anyone else’s anger with whom you have a relationship. It is as applicable to romantic relationships as the workplace, and even when waiting in a long and annoying grocery line. 1. RECOGNIZE RAGE Anger is an emotion designed to change things. We get angry when we want someone to do something different; start doing something or stop doing something. When you or your partner is angry, the first thing to wonder about is what do you or they want to see happen differently. Think about this every time you feel angry, or if someone else feels angry. Take a pause, put your hand on your forehead (right behind which is your pre-frontal cortex or PFC, and wonder, what do I want to see happen differently? 2. ENVISION ENVY stems from the idea that you don’t have enough and that someone else has more, placing you at a potential survival disadvantage. Sounds simple, right? But at its root, envy stems from one's own self-image—the lower the self-esteem, the more envy. In a relationship, you may think someone has more than you: more money, a better job, a more rewarding relationship, and other things. If they have more, they could have an advantage. That advantage gives them more value, and the perception of more control in the relationship. If they have more value, then we have less. And if we have less value it puts us at risk. Envy can be used as a motivator: if you think someone else has more than you, what steps can you take to reach that new level? You don’t need to bring someone down to do it. Instead, you can reach those new heights on your own road to success. 3. SENSE SUSPICION The flip side of envy is suspicion, and it is every bit as primal. Suspicion originates with the fear that someone will take what’s yours—or what should be yours—and leave you out in the cold. If you have ever felt your anxiety rising when waiting for your partner to show up, and wondering why they are late, you are sensing suspicion. Are they late because they are interested in someone else, with more value? We fear we will be seen as less valuable. When you think someone is trying to bring you down, the reframe is to recognize that they do see you as valuable. You can use this shift to help that other person to achieve. We don’t need to have a society of competition when cooperation can do so much more for all of us. Every human being gets angry at some point. We all get angry when we feel envy or suspicion. These first three steps are how to manage your anger. But it is not always your anger that gets in the way of your success. Very often, it is someone else’s anger that gets in the way of your success: their rage, their envy, or their suspicion. These next four steps are how to manage someone else’s anger. 4. PROJECT PEACE Our brains have evolved the ability to mirror other people’s emotions. These mirror neurons can activate your anger when someone else is angry. But you can also use your mirror neurons to calm the angry brain of the other person. By projecting peace, you communicate that you are not a threat, and the other person does not need to be envious or suspicious. 5. ENGAGE EMPATHY Empathy is based on our ability to wonder what someone else is thinking or feeling. As soon as you engage empathy, you send a message that the other person’s anger is important, and you want to know more. Empathy increases the other person’s value. And whenever you remind someone of their value, you increase your own value. 6. COMMUNICATE CLEARLY Language is the most amazing and important invention we have ever created. With language and communication, we have the opportunity to learn from someone why they are angry. What do they want to see happen differently? 7. TRADE THANKS Most of the time in our culture when someone says “Thank you,” the other person says “You’re welcome.” This means you are now part of my group, I am not envious of you, nor suspicious. Instead, you have reminded me of my value, which makes me feel safer. I like acronyms. The acronym of the seven steps is: RESPECT. Being respected feels great. When was the last time you got angry at someone treating you with respect? Respect helps to reduce anger. And even though respect is a two-way street, don’t give respect only when you feel respected: Just give respect. It is the key to defusing our most dangerous emotion. There is nothing wrong with anger: it’s what you do with it that matters. Joseph Shrand, M.D., - Website - Blog - References Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. Oxytocin increases trust in humans. Nature. 2005 Jun 2;435(7042):673-6. doi: 10.1038/nature03701. PMID: 15931222. Bar M, Neta M, Linz H. Very first impressions. Emotion. 2006 May;6(2):269-78. doi: 10.1037/1528-3542.6.2.269. PMID: 16768559. Outsmarting Anger: 7 Strategies to Defuse Our Most Dangerous Emotion. Shrand J., Devine L. ‎ Books Fluent; 2nd ed. edition (February 16, 2021) ISBN-10 ‏ : ‎ 1953865186

A guide for parents on seeking mental health support for their children. Knowing when to seek help can be key to preventing long-term struggles for both your child and yourself. Mental health support is a tool for growth, not just crisis. Parental well-being matters, too. As a parent, it’s natural to focus your energy on your child’s growth, development, and overall well-being. But when your child has learning differences, attention-deficit/hyperactivity disorder (ADHD) , anxiety , or other challenges, your role becomes even more demanding. You may begin to notice shifts in your child’s behavior, mood , or ability to function and wonder if it's time to seek mental health support. Whether your child has a diagnosed disability or you're still in the process of figuring things out, knowing when to reach out for help can be the key to preventing long-term struggles for both your child and you. Below are some important signs that it might be time to seek therapy for your child, coaching for yourself, or both. Your Child Is Struggling Emotionally or Behaviorally Children often show distress in ways that don’t look like typical sadness or anxiety. Look for: Frequent meltdowns or tearful responses to schoolwork Withdrawal from friends or activities that were once fun Persistent worries, fears, or physical complaints (e.g., stomachaches, headaches) Irritability, anger , or impulsivity that seems out of proportion Avoidance of school or learning-related tasks These may indicate underlying anxiety, depression , ADHD, or a combination of concerns. You’re Seeing a Pattern Across Settings It’s normal for kids to have bad days. But if you’re noticing the same emotional, behavioral, or learning challenges: At school and at home Across subjects or activities Over weeks or months …it may be time for a deeper evaluation by a child psychologist or licensed therapist. Your Child Has a Hard Time Focusing, Remembering, or Following Through Many children with ADHD or learning differences struggle with: Short attention spans Difficulty following multistep directions Poor memory and recall Trouble organizing thoughts or completing tasks If these patterns persist despite your best efforts, professional support can help uncover what’s underneath—and what strategies may help. School Is Becoming a Source of Stress or Conflict Is homework time filled with tension? Are school days emotionally exhausting for your child or for you? Signs it’s time to seek help: Frequent tears, shutdowns, or outbursts A refusal to go to school A drop in grades or motivation Emotional exhaustion at the end of the school day Therapy and parent coaching can support both your child and your parenting strategies. You, the Parent, Are Running on Empty When you’re caring for a child with additional needs, your own mental and emotional health can take a hit. Ask yourself: Are you constantly exhausted, even after rest? Do you feel irritable, unmotivated, or sad most days? Are you losing interest in friendships or hobbies? Are your eating or sleeping habits off track? If your emotional tank is empty, it becomes harder to support your child. Parent support groups, individual therapy, and coaching can give you tools and a safe space to regroup. Support Isn’t Just for Crisis—It’s for Growth Mental health support isn’t just for when things are falling apart. Therapy can help children: Build confidence and resilience Develop coping skills Understand and manage big emotions Learn strategies for focus, organization, and problem-solving It can also help parents: Learn how to support without over-accommodating Gain services and supports for their child in school Set boundaries to decrease stress at home Engage in needed self-care Next Steps: How to Get Support If you’ve recognized signs in your child or in yourself: Start with your pediatrician or school counselor. They can refer you to child psychologists, licensed therapists, or parent coaches. Consider a psycho-educational evaluation. If learning differences or ADHD are suspected, this can offer clarity and direction. Explore therapy options. Look for licensed professionals with experience in child development, learning challenges, and family dynamics. Join a parent support group. Sharing your journey with others can help you feel less alone and more empowered. You Don’t Have to Do This Alone Parenting a child with extra needs is rewarding, but it’s also demanding. Seeking help doesn’t mean you’ve failed—it means you care deeply about getting the right support for your family. This Mental Health Awareness Month, let this be your reminder: Support is available, and healing is possible. Whether it’s for your child, for yourself, or for both of you—you deserve care, too. Liz Nissim-Matheis, Ph.D., - Website - Blog -

A survey of LGBTQ+ youth quantifies fears of family shunning. Nearly half of LGBTQ+ young adults are estranged from at least one family member. LGBTQ+ adults are twice as likely as non-LGBTQ+ adults to say they are not close to immediate family members. When trying to sustain a "family myth" or identity, relatives often cast out those who are different. I first realized how common and devastating estrangement is in the LGBTQ+ community while conducting a survey for my book, Brothers, Sisters, Strangers. A startling number of respondents reported experiencing cutoffs from family members after revealing their sexual orientation. Here are some of their comments: I’m trans and my family has nothing to do with me. Estrangement is something many LGBTQ people face. I’m gay and my sister does not believe in homosexuality because of her alt-right fundamentalist Christian beliefs. I don’t know why my sisters have distanced themselves, but I think it's because I identify as bisexual and polyamorous while they are “married homemakers with mortgages.” Now, new research from Just Like Us, a UK charitable organization serving LGBTQ+ young people, quantifies this LGBTQ+ experience. It found that nearly half of LGBTQ+ young adults are estranged from at least one family member, and one-third are “not confident” that their parent/guardian would accept them if they came out. “As LGBT+ people, many of us know the anguish that the breakdown of family relationships causes us when we’re not accepted for who we are,” says Amy Ashenden, director of communications at Just Like Us. “It is heartbreaking to see so many LGBT+ young adults spending their formative years in fear that their parents won’t love them because they’re lesbian, gay, bisexual or trans.” Ashenden points out the fallacy of the common notion — presumably based on increased visibility of LGBTQ+ individuals in today’s media — that being LGBTQ+ has become easier. To the contrary, the Just Like Us survey of 3,695 adults, ranging in age from 18 to 25, shows how widespread both the fear and the reality of rejection are throughout the community. It also reveals how often family members repudiate even their “nearest and dearest” relatives on the basis of their LGBTQ+ identities. Respondents were twice as likely as non-LGBTQ+ young adults to report that they are not close to an immediate family member. The family myth Some families simply won’t tolerate behaviors that resist, defy, or “stray from” the family identity. “The ‘family myth’ is the presumption that every family member is compatible, possesses the same goals, and loves one another,” explains psychologist Mark Sichel, director of the Addiction Recovery Unit at Hebrew Union College, New York, and author of Healing from Family Rifts. Sichel says that the family myth, characterized by “we” statements, implicitly discourages individual differences by asserting shared values and norms. Often, families perceive their collective identity to be threatened by one member’s significant difference. If the family feels a choice must be made between accepting deviation or keeping the family identity intact, members who challenge the myth — whether through sexual orientation, interracial marriage, religious conversion, political philosophies, or unconventional career or lifestyle choices — may be cast out. In a moving essay for “Auto straddle,” a digital publication and community for multiple generations of LGBTQIA+ people and sympathizers, Whitney (Whit) Pow, a media historian and assistant professor at New York University, writes of the pain and devastation of being cast out. When I came out to my parents, the rejection hit me so badly I could barely get out of bed most mornings in college. I ended up going to an emergency therapist one day because I needed to talk to somebody. When I sat down in the therapist’s office, I sobbed the entire time, and the therapist, who had a tiny rainbow flag hanging in her office, told me softly that things would be okay, that I wasn’t the only person. There were others, she said, who came into her office with the same story. Her eyes were filled with tears. Other consequences of family estrangement for LGBTQ+ students A recent survey from the Trevor Project/Human Rights Commission, which works to prevent suicide among LGBTQ+ youth, found that its population named parental or family lack of acceptance as the most difficult problem in their lives. Family rejection often results in other, perhaps desperate, life challenges. Those in the LGBTQ+ community are 120 percent more likely to face homelessness than their peers, according to data compiled by Chapin Hall at the University of Chicago, a research organization supporting services and systems for young people and families. LGBTQ+ youth often are disowned and/or kicked out of their homes, posing acute challenges to their living arrangements and, often, longer-term trouble in securing financial aid for college. Parents are legally required to sign the Free Application for Federal Student Aid (FAFSA) forms, but applicants whose parents won’t speak to them are stuck without the most basic cooperation. Eluned Parrott, former director of the United Foundation, a UK charity that provides scholarships for estranged youth, suggests some ways to mitigate the consequences of estrangement in the LGBTQ+ community: Provide safe, secure living quarters for LGBTQ+ youth. Young people who find themselves suddenly homeless are extremely vulnerable to violence, intimidation and worse. Treat youth homelessness as an emergency to prevent long-term harm. Don’t require estranged young people to relive their trauma every time they for apply for assistance, such as housing benefits or student support. Public bodies should only need to ask once for proof of circumstances. Adequate record-keeping and inter-agency communication would eliminate repeat requests. Make sure that the loss of parental support doesn’t mean the loss of life goals. Obviously, Parrot says, losing parental support should not automatically mean homelessness for a LGBTQ+ young person. Nor should it limit prospects for pursuing higher education, obtaining an apprenticeship, or finding a safe home. Ashenden asserts that LGBTQ+ young people should know that their identities are valid — deserving of acceptance and celebration. “When there is silence,” she says, “there is shame, so we must talk about these topics in school and at home to ensure LGBT+ young people no longer live in fear of rejection." Fern Schumer Chapman - Website - Blog - References Neus, Nora, Teen Vogue, "LGBTQ Students Face Barriers to Getting Student Loans Without Parents’ Participation," May 16, 2023 Federal Student Aid, Dependency Status

Decreasing use of victim-blaming language for survivors of abuse. The language we use to refer to victims of abuse often fails to account for the trauma they have experienced. Many survivors of abuse develop certain coping strategies to survive and navigate their environment. Reframing can create a more compassionate approach to supporting those who have been through trauma and abuse. “Attention-seeking.” “Daddy issues.” “Abandonment issues.” “Codependent.” These are just a few of the labels casually thrown around to refer to survivors of abuse —especially women and gender-diverse people. On the surface, they may seem like personality traits or pop-psychology diagnoses. But in reality, the language we use to refer to victims of abuse often fails to account for the trauma survivors may have experienced trauma that led to the development of these behaviors that were, at one time, necessary for their survival. Labeling can be blaming Trauma from abuse in families and relationships can impact one's ability to self-regulate or cope in healthy ways. Many survivors of violent and abusive homes were not given examples of healthy relational interactions. Therefore, many of these behaviors are developed as learned survival mechanisms: as coping strategies that help them feel safe. When we label these individuals negatively, we reinforce harmful stereotypes and miss the opportunity to support and understand what led to them in the first place. Instead of using labels that pathologize and victim-blame, it's more constructive to understand these behaviors as responses to trauma. Many trauma responses are learned survival responses Many survivors of abuse develop certain coping strategies to survive and navigate their environment. These survival responses are developed as a means of seeking safety or emotional support. Some of the common terms used are actually survival mechanisms developed for protection. Here are some common examples: Codependency : Often misunderstood as unhealthy dependence, codependent behaviors usually form in environments where emotional needs were consistently dismissed or punished. In such situations, the child may learn that their role is to take care of others emotionally—especially caregivers—to avoid conflict, gain approval, or maintain some semblance of stability. As a form of survival and protection, Tiffany learned to anticipate her mother's moods. If she could anticipate her moods and therefore act to meet her needs, she could avoid conflict as a way to stay safe and prevent further trauma or abuse. In adulthood, she still acts in these ways, constantly worrying about her partner's moods and needs as a way to keep the peace. Attention seeking: Similar to codependency, "attention-seeking" behaviors may be an attempt to connect with others, especially for children who did not experience a safe relationship with adults in their home. This label is frequently used to shame children and adults for expressing distress or trying to get their needs met, especially in school environments. If caregivers were emotionally unavailable, inconsistent, or neglectful, seeking attention becomes a way to ensure someone notices them. Human beings need attention and support to survive. This is why many mental health professionals refer to this behavior as "connection seeking." Ben grew up in an emotionally unavailable or neglectful home and quickly learned that dramatic and negative behavior was the only way to be seen or heard. As a result, he acted out in school, frequently getting in trouble. As an adult, his nervous system still associates attention from others as positive, and reports feeling anxious when he is ignored or feels unseen. Abandonment issues: Sometimes referred to as "daddy issues," "abandonment issues" usually stem from real experiences of emotional or physical neglect. A child who is repeatedly left—either literally or emotionally—may develop a deep fear that anyone they grow close to will eventually leave them, too. This can come out in the survivor's relationships with others, where being hyper-aware of others’ behaviors and actions becomes a way to protect themselves against real or perceived abandonment. Sean was abandoned as a young adolescent after coming out to his parents. As a result, he often clings to relationships in a desperate attempt to avoid the pain of being alone and abandoned again. Using more trauma-informed language can help We should shift the language we use to one that is empathetic and trauma-informed, acknowledging that victims of trauma may exhibit certain behaviors as part of their coping mechanisms, rather than viewing them as personality flaws. Moving away from pathologizing language can help challenge stigma and promote better care and support systems for survivors. Kaytee Gillis, LCSW, - Website - Blog - References Irwin HJ. (1995). Codependence, narcissism, and childhood trauma. J Clin Psychol. 151(5):658–665. Załuska, M., Kossowska-Lubowicka, A., Traczewska, Z., Kszczotek, M., Zaniewska-Chłopik, U., & Poświata, E. (2011). Codependency, traumatic experiences and the symptoms of posttraumatic stress disorder (PTSD) in hospitalized and non hospitalized women from alcoholic families. European Psychiatry, 26(S2), 130. doi:10.1016/S0924-9338(11)71841-7

Borderline personality disorder is often confused with other disorders. BPD is frequently misdiagnosed and confused with other mental health conditions. The various labels for this disorder are often misleading. It's vital to be evaluated by a qualified therapist to get an accurate diagnosis and appropriate treatment. Borderline Personality Disorder (BPD) is a challenging mental health condition that is characterized by a collection of symptoms, including emotional dysregulation , fear of abandonment, self-harm, impulsivity , unstable moods, unstable relationships, and an unstable self-image. Stereotypical symptoms include suicidality and self-mutilation, although the clinical presentation of BPD varies widely across all individuals. According to research, BPD affects around one to two percent of the adult population, however, it is thought to be underdiagnosed, especially in men. (Leichsenring, et al., 2024) Part of the reason for this is that BPD is often misunderstood and frequently misdiagnosed, or it is conflated and confused with other mental health conditions. “Borderline” The disorder was first identified by psychoanalyst Adolph Stern in 1938, who used the term “borderline” to describe patients who were “on the border” of psychosis and neurosis (Stern, 1938). For decades, these people were classified as “borderline schizophrenic” or “borderline neurotic.” In 1975, John Gunderson defined and re-named the disorder to the name we’re familiar with today (Gunderson and Singer, 1975). It wasn’t until 1980 that BPD was formally recognized as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Nowadays, it is sometimes called emotionally unstable personality disorder (EUPD). However, these various labels have often been misleading. “Borderline schizophrenic” was a misnomer, because BPD and schizophrenia are distinct mental health conditions. Its current name, however, associates the condition with more serious personality disorders. As a result, BPD is often stigmatized and lumped in with narcissism, sociopathy, and psychopathy. (The latter two are technically called antisocial personality disorders or ASPD.) In light of these misclassifications of BPD, some prefer to call it emotional intensity disorder (EID) to better reflect the nature of the condition and differentiate it from others. Distinguishing BPD from other conditions BPD is often conflated with other mental health conditions (Saunders, et al., 2015). Part of the reason for this is that it has some overlap with other disorders. For instance, BPD commonly includes post-traumatic stress disorder (PTSD) , depression , and anxiety , although being diagnosed with these alone can mask the bigger issue. BPD is also frequently misdiagnosed. In particular, it is misdiagnosed as schizophrenia. While both have delusions in common, there are considerable differences between the two, notably the auditory and visual hallucinations that characterize the latter. BPD is also commonly conflated with bipolar disorder (BD). The two have similar names, which may cause some confusion. They also share the symptoms of reckless behaviors and mood swings, although BD is characterized by alternating episodes of mania and depression. BPD is also confused with other disorders, such as attention-deficit/hyperactivity disorder (ADHD) , obsessive-compulsive disorder (OCD) , and other personality disorders. BPD can also share symptoms with these conditions or be comorbid with them. In particular, addictions and eating disorders co-occur with BPD. It can be difficult to tease apart these similar conditions. The similarities to other conditions and the general confusion around BPD add to the misconception that it is untreatable. While there is no cure for the condition, it can be successfully managed, usually with medication in conjunction with therapy. In particular, evidence-based dialectical behavior therapy (DBT) has proven to be successful for those with BPD. The takeaway message is that BPD is a misunderstood and often misdiagnosed condition. For these reasons, it is vital to seek out an evaluation from a qualified therapist so that individuals receive an accurate diagnosis and appropriate treatment. Karen Stollznow, Ph.D., - Website - Blog - References Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. 2024. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry. Feb;23(1):4-25. doi: 10.1002/wps.21156. Stern, A., 1938. Psychoanalytic investigation of and therapy in the border line group of neuroses. The Psychoanalytic Quarterly, 7(4), pp.467-489. Gunderson, J.G. and Singer, M.T., 1975. Defining borderline patients: an overview. The American Journal of Psychiatry, 132(1), pp.1-10. Saunders, K.E.A., Bilderbeck, A.C., Price, J. and Goodwin, G.M., 2015. Distinguishing bipolar disorder from borderline personality disorder: A study of current clinical practice. European Psychiatry, 30(8), pp.965-974.