Needfully lavishing praise on someone is unlikely to get you into their heart. When you’re not enough for yourself, you’ll seek a union to offer you the reassurance you desperately need. No person depended upon to be the center of your universe will remain comfortable in such a confining role. We all need a deep connection with another, but by depending on it needy individuals minimize its possibility. Non-assertive, needy people with poor self-esteem can, paradoxically, be unusually demanding, even abusive. Fiercely Trying to Cajole Another into Loving You In the context of a romantic relationship , if you’re not enough for yourself, you’ll likely be driven to depend on your partner for validation. Or, in your emotional quandary, pursue a partner who, given their own neediness, may be just as desperate as you are. As in: If you’ll let me depend on you, I’ll let you depend on me. Regrettably, that’s not a good solution for overcoming deficits in your self-image. Yet if you are unable to generate a loving relationship with yourself, this pseudo-solution is certainly understandable—maybe, inevitable. After all, if you’re to have steadfast self-esteem, it’s crucial to view yourself as self-reliant and complete within yourself. Otherwise, you can’t stand steady and balanced on your own two feet. Rather, harboring lingering deficits in your sense of self, you’ll be reduced to depending on another to soften (if only temporarily) the personal doubts tormenting you. Ultimately—vs. immediately—what’s the price of such neediness? The short answer here is A Lot. Pressuring—indeed, harassing—someone to fill the troubling void inside you typically boomerangs, quite possibly leaving you worse off than you were before. So what are the reasons that this anxiety -induced tactic is rarely effective? Why Needy, Clinging Behavior Ends Up Not Endearing You to Another But Alienates Them I’ll enumerate the different, though intimately related, reasons that neediness fails to get from the depended-upon individual what the needful person craves. And all these explanations can be seen as variations on a theme. This theme is based on the well-established finding that to be happy all of us (in this instance, both the needed and the needy) must create, and maintain, a balance between personal autonomy and social dependency. 1. Initially, the willingness to say or do almost anything to endear yourself to the one you’re attracted to may be effective. But over time it’s far more likely that your excessive dependency will make that put-upon individual experience you as burdensome. If you text them 10 times an hour, call them after they’ve gone to bed, or push them to spend more time with you than they’d want, they’ll probably feel more used than loved. But even though your bids for attention may be too much for them, they’re no more than what you feel you need to feel cared about in the relationship. Moreover, unless their attachment style is avoidantly disturbed (i.e., they were purposely raised by emotionally distant caregivers to be super self-reliant and independent), the problem isn’t theirs but your own. However unconscious, your goal may have been to flatter them into loving you. Eventually, though, your efforts are apt to leave them feeling flustered and frustrated, overwhelmed by the vast amount of loneliness-ameliorating togetherness you’re strenuously aiming to achieve. And how can that help but constitute a dire threat to their indispensable need for personal autonomy? In idealizing them, you’re also objectifying them. You’re compromising something critical to them by lessening their sense of relational equality. 2. “Smother love” reeks of negative connotations since being smothered is tantamount to being choked, suffocated, or locked in a stranglehold—hardly an experience anyone would find nurturing. Most of us would probably be disposed to call it something other than love—as a contrivance bordering on fulsome, scheming manipulation. Therapists, too, would generally concur that such love can’t reasonably be characterized as authentic. As opposed to obsequiously subordinating yourself to the one depended upon, here you’re subordinating their needs to your own. 3. If the receiver of this suspect loving feels trespassed upon, it can be inferred that they’re experiencing an irksome violation of their boundaries. Another way of accounting for their pained reaction is that they’re feeling disrespectfully “crowded” by you. From deep within, they’ll be distrustful and disapproving of your exaggerated admiration for them. And whether or not they conceptualize it as such, vicariously your anxiety about the connection will be felt by them. In fact, as the extraordinarily needful one in the relationship, you’ll be broadcasting it to them. They won’t feel loved for who they are but rather what they can do for you. Your insecurity and hyper-dependency will be veritably transparent to them. Here is where the distinction between neediness and love rears its repellent head. However often you profess your love and dedication, it won’t be seen as true caring but, surreptitiously, as controlling. And in too many ways that’s the exact opposite of caring. 4. Successful unions—unions that demonstrate mental, emotional, and physical intimacy—are marked by reciprocity. But the nature of this needfully impaired relationship is such that neither party can experience it as complementary. The one depended upon is prone to feeling preyed upon, whereas the dependent party is disposed to feel that their ostensible givingness isn’t being adequately returned. That’s a perfect recipe for disappointment—and as much for one side as the other. 5. As the neediness or clinginess, comes to feel never-ending, the too heavily depended-on party increasingly experiences the relationship as burning them out. Although their initial attraction to the needy individual may have made them willing to provide the reassurance requested of them, after a while that person’s dependencies come to feel insatiable. And they end up exasperated by the responsibilities which, unceremoniously, have been laid on them. Moreover, explicitly setting limits on what the dependent individual can expect from them probably won’t be heeded because the dependee’s needs are simply too weighty to be assuaged by anything short of the effort already made to appease them. And, as in the impossibility of appeasing a dictator (or would-be dictator), the dependee’s inability to internalize the positive messages received by the one depended-upon makes it exceedingly difficult for them to accept as adequate what their (hoped-for) savior has before willingly offered them. 6. From afar, the dependee might well be seen as the supplicant in the relationship, imploring the one depended upon to meet their past unmet needs. Yet there’s a certain demandingness about the needy individual. They can be aggressively critical of the one depended upon when that person fails to sufficiently furnish what they cannot provide for themselves. In these instances, they’re the disapproving ones and can make their now adversary feel selfish or guilty. Still, as mentioned earlier, because of the insatiability of their demands, the one depended upon can’t ever be successful in whatever conscientious endeavor they may make to pacify such neediness. The ultimate remedy for this unfortunate, even toxic, dependency is self-validation. And that’s a topic I’ll take up in my next post. Leon F. Seltzer, Ph.D.

The peers children associate with say a lot about their identity and security. The stability of your kids’ friends often reflects the stability of their own self-esteem. Every kid benefits from three important friendships in their circle. Your child will usually reflect the median of their five closest friends socially and emotionally. Elle is a longtime friend whom I’ve known since elementary school. On the surface, Elle seemed like any other girl, making average grades, and blending with the rest of her class. Upon closer examination, however, it became clear she needed more affirmation than anyone else I knew. She attracted friends who were also needy and often in trouble. They were socially awkward and weren’t sure how to talk about anything but themselves. She drew boyfriends who needed rescuing. Observing these male friends over the years, it was apparent Elle felt better about herself as she rescued them from their problems. She flitted from one activity and commitment to another, not sticking with anything for very long. It’s as though she was afraid of being found out as a fraud or a poser. Your Relationships Are Rarely Healthier Than Your Self-Esteem Herein lies the sobering truth about all of us. Our relationships reflect what we think about ourselves. They’re seldom healthier than our self-esteem. This means our relationships reflect how we feel about ourselves: Like attracts like. It also means the stability of those relationships tends to be about as stable as our self-esteem: Unstable attracts unstable. We migrate toward the people with whom we feel most comfortable—which can be good news and bad news. When Lacy’s mom and dad talked her into dating and marrying a solid, successful young man, things looked great at first. In time, they had three children, a nice home, and two new cars in the garage. Then, about eight years into the marriage, Lacy began exhibiting self- sabotaging behaviors, forming a drug habit, and hiding extramarital affairs. Her parenting grew volatile, swinging from lackadaisical to strict. It was as if Lacy was conveying: “I don’t deserve this life.” Within a year, Lacy divorced her husband, only to rebound into an unstable relationship with a man in prison, incarcerated for selling illegal drugs. She got pregnant, and the rest is history. Lacy began living below her potential, unstretched and stagnant. How could she do this? Our relationships will rarely be healthier than our self-esteem. Questions to Ask About Your Kids If you’re concerned your kids may reflect this dilemma, try asking yourself these questions: Are their friends insecure or fearful? Do they lie, cheat, or steal anything from anyone? Are they a rescuer who hangs around others who need help? Do they attract needy friends who make them feel better about themselves? Motivational speaker Jim Rohn says that we are the average of the five people with whom we spend the most time. This is based on the law of averages, a theory suggesting the result of any given situation will be the average of all outcomes. Consider this in light of your kid’s friends. 3 Ingredients That Boost Your Kid’s Self-Esteem Our generation of parents is consumed with our children’s self-esteem. While I admire this, too often we create a synthetic self-image for our kids, built on exaggerated praise and trophies. It frequently backfires, creating young adults with high arrogance and low self-esteem. As our two children grew up, I concluded their sense of identity was fed by three elements: Their achievement: When they accomplished something, it fed their self-image. Their affirmation: When we or others affirmed their conduct, it fed their self-image. Their association: Spending time with those who stretched them fed their self-image. While we can’t force any of these, parents, teachers, coaches, and youth workers can position their kids to enjoy these elements and create environments where they happen naturally. It must be a balance between organic and organized. We must be intentional and laissez-faire. Each of these elements must feel real, not artificial or contrived. How You Can Encourage Them My wife and I watched these realities firsthand when our kids grew up. We discovered a lot about how our kids viewed themselves by observing their friends. We attempted to play a natural and positive role in deepening their own sense of identity. Let me suggest a rule of thumb I tried to practice as they grew up: Encourage your kids to find at least one: Stretch friend: These are sharp, confident, and positive friends who stretch them. Safe friend: These are easy friends—peers whose influence is equal and comfortable. Support friend: These are friends whom your kids influence, mentor and inspire to grow. We usually live better lives and continue to grow when we spend time with those who are ahead of us in their growth, those who are next to us in our growth, and those who are behind us that we can help to grow. In the end, our circle of friends nudges us to stoop or to stretch to our potential, which eventually creates our reputation. And this creates a mold for our lives. James Clear said, "Your reputation is your most important asset. It precedes you before you walk into the room and lingers long after your presence is gone." Let’s guide this process for the next generation. Tim Elmore - Book -

Understanding pain and volatility. Individuals with borderline personality disorder are particularly sensitive to feeling shamed. Feelings of shame make people with BPD feel flawed and undesirable, raising fears of abandonment. Individuals with symptoms of BPD often respond to feeling shamed by lashing out at others. Most individuals with symptoms of borderline personality disorder (BPD) struggle with an underlying sense of self-loathing that makes them particularly vulnerable feeling flawed . The fear of being seen by others as flawed drives a strong fear of abandonment. Their propensity to be easily shamed makes it very difficult for them to take responsibility for undesirable outcomes. Efforts to resolve conflicts with individuals suffering from symptoms of BPD can be facilitated by approaches that minimize their experience of shame. For many with BPD, the sensitivity to being shamed is so high that they routinely hear others as slighting, defaming, humiliating, and exploiting them. This can take the form of paranoid thinking, where they feel targeted by others or groups. This may be associated with lashing out at others or shunning others, which are efforts to protect themselves from people they think are likely to expose their flaws. These reactions inhibit intimacy and cooperation. Following are some examples* of how individuals suffering from symptoms of BPD react to their sense of being shamed. Lila met her friend Sue, who has symptoms of BPD, for lunch. When they arrived at the restaurant, they were told that there would be a 45-minute wait for a table. They got onto the waiting list and had this conversation. Lila: Sue, did you make a reservation? Sue: How was I supposed to know this place would be mobbed? Lila: I never heard of this place. You picked the restaurant. Sue: So, I should have known a reservation was needed, and I am stupid for not making one. Lila: I didn’t say that. Sue: Next time you make the reservation. Or better yet, next time, go eat by yourself. Lila thought she was innocently asking Sue about the reservation. If Sue had said yes, she would have pointed this out to the maître d' in the hope of being seated sooner. Sue heard this as blame and criticism and immediately reacted defensively. Lila attempted to respond to Sue’s remark, but Sue then lashed out and threatened abandonment. Had Lila understood her friend’s sensitivity to shame, she could have started the conversation by suggesting a cooperative approach. It might have sounded like this: Lila: Sue, do you want to wait to be seated, or should we look for a less crowded place? If Sue had made a reservation, she would say so. For some individuals, any questions about performance, in this case, making a reservation, are seen as threatening with regard to shame. The sensitivity to being shamed can even be activated without direct contact. This is illustrated in the following*: Eric and Ken just returned from a cocktail party and had the following conversation. Ken suffers from symptoms of BPD. Eric: Wasn’t that a great party? Ken: Not for me. Eric: What do you mean? Ken: I can’t believe you talked about sports with our friends. Eric: What’s wrong with that? Ken: You know I don’t know anything about sports. I felt like an idiot. Eric: Nobody thought that. Ken: How do you know? I just stood there saying nothing. Maybe they think I am mute. Eric: You should have brought up something you were interested i Ken: Now you are blame-shifting. Forget it. Understanding that Eric is sensitive to feeling shamed in social situations, he might respond to Ken as follows: Eric: I am sorry you felt embarrassed. Next time we go to a party together, I will make sure to bring up some topics that I know you are interested in. The suggestions made in this post are meant to help people who have loved ones with symptoms of BPD minimize their experience of shame and, as a result, reduce conflict. It is a transactional solution. More permanent healing and growth require individuals with BPD to recognize their sensitivity to shame and their associated tendency to project shame into situations where it may not exist. Accepting this, individuals sensitive to change can ask others to clarify what they are saying before assuming they are being shamed. For example, Sue might have responded to Lila’s question about the reservation by saying: Sue: No, did you expect me to? If Ken accepts that he is sensitive to shame in social situations, he can prepare to bring up topics other than sports that will be of mutual interest to his friends rather than relying on others to ensure he does not feel shame. Daniel S. Lobel, Ph.D.

Yet it is at the core of successful human relationships. There are dire consequences in nature for being vulnerable. Yet vulnerability is essential for creating thriving relationships. Social anxiety results from the inability to tolerate the risk of rejection. Tolerating anxiety is the first step in reaching out to others. Humans want to feel safe. Feeling or being safe reflects profound shifts in your body’s chemistry, ushering in the capacity to “rest and digest.” Not only do you feel a deep sense of contentment, openness, and play, your body refuels and regenerates. Your safety needs are not met, however, if you don’t feel heard, validated, and nurtured; your body shifts to a fight-or-fight state. You may seek to achieve safety by using power and control or, further, by deploying anger , a last-ditch survival effort that, while being protective for you, is destructive to those around you. There is no reward for vulnerability for any species of life, from one-celled organisms to Homo sapiens. Consequences for being vulnerable are severe and often swift. It is never safe to be off-guard, and different species create ways to be safe in order regenerate. Dolphin sleep with one eye open. Many species form protective groups. Other creatures hide or camouflage. Many species simply have thousands of offspring so that a few will survive. When such strategies fail, organisms resort to whatever aggressive response they have available to them. The more strength and power, the better. Humans have language, which creates another level of issues around seeking safety. It enables us to possess abstract thinking, which allows us to engage in the arts, create coordinated societal actions, and have complex relationships with others. We rose to the top of the food chain because of our capacity to cooperate with each other. We have a strong evolutionary need for close connections and relationships: Being socially isolated or lonely has the same effect on health as smoking 15 cigarettes a day.1 Notice how much effort we put into seeing close friends and family during the holidays. We want to be with each other, and the closer the better. But one of the most perverse aspects of being human is that successful, thriving relationships require vulnerability and trust. These traits are the antithesis of feeling safe. “You hurt my feelings” and “you broke my heart” reflect the fact that emotional /mental pain is processed in a similar manner as physical pain.2 We don’t like pain in any form, yet we have to become vulnerable in order to have deep and satisfying relationships. It is a huge problem, and it is not playing out well for the human race. By definition, every interaction with another person requires taking a risk of being rejected or hurt. Even check-out at the grocery store involves trusting the person at the register to accurately document your purchases and help you with your bags. It's nice if they're in a good mood and are friendly, but what if they are having a bad day? Then there are deeper relationships—being part of a team, engaging in a project together, starting up any type of relationship, and living together. Being rejected at some level of interaction is not only common but also the rule. As you become more and more trusting, a tipping point of vulnerability may be reached, and one person will pull back or even reject the relationship. Your options At this point, your choices are to 1) quit taking risks associated with interacting with others, 2) engage but experience social anxiety, 3) use whatever power you possess to control others, 4) learn to be vulnerable. Since we don’t inherently possess the ability to feel vulnerable, the other strategies are more commonly utilized. Some form of anger is universal. Why? It keeps you safe. It protects you from both emotional and physical pain. Even if you don’t actually have the power to change the situation, you may feel like you do. Raw anxiety is intolerable and why we hold onto anger. Why let go of anger? You simply cannot heal or thrive when you remain angry. The essence of healing is normalizing your body’s neurochemical state to that of safety, which is profoundly restorative. If your whole system remains fired up, it can’t and won’t happen. Anger is destructive, as it is meant to be. It's your body’s last-ditch effort to escape threat. It is destructive in every direction, including self-destructive. It is a reason why many people completely neglect every aspect of their health. It is tantamount to slow suicide. Anger is abusive and destroys relationships. The key element of successful human interactions is awareness of your needs and others’ needs. How else can you constructively interact with those close to you? Anger completely blocks awareness. Anger destroys families. Human consciousness evolved through language and social interactions. The ability to cooperate took Homo sapiens to the top of the food chain. The need for human connection is deep. Unfortunately, close connections also provide the strongest emotional triggers. Why would you ever be unkind to someone you care for so much? Why is the incidence of domestic abuse so high? That may be the most disturbing paradox of human existence. Anger, as the manifestation of the fight mode of the survival response, affects all organ systems. The blood supply to your gut, bladder, and frontal lobes of your brain diminishes and is shunted to your heart, lungs, and skeletal muscles. You can’t think clearly, although it might feel like you can. It is critical to “take no action in a reaction. Interacting with others involves taking the risk of being rejected or even hurt. There are material risks, such as trusting a business partner who might run off with your money. What about when a partner or spouse takes off with another person? Simply reaching out to another person in friendship creates some level of anxiety. Train your brain You can use avoidance, suffer from chronic social anxiety, or resort to power and control to feel safe. The healthiest and most satisfying option is learning to be vulnerable and process rejection. In other words, being with anxiety. Being or feeling rejected is inherent to relationships, and unless you understand this, your world will become progressively smaller. Training yourself to lower your physiologic response to threat (anxiety) instead of fighting it allows you to navigate life more easily. It also matters that social connections are anti-inflammatory and lower your level of anxiety.3 Addressing social anxiety is a bi-directional process. You can nurture joy, more easily interact with others, create the life you desire, and feel safer. David Hanscom MD - Website - Resources - References Cigna US Loneliness Index. Cigna: 2018. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42

It's more important than ever to use this terminology correctly. Representative Marjorie Taylor Greene hung a sign outside her Capitol office door that said “There are TWO genders: MALE & FEMALE. ‘Trust the Science!’” There are many reasons to question hanging such a sign but given that Rep. Taylor Greene invoked science in making her assertion, I thought it might be helpful to clarify by citing some actual science. Put simply, from a scientific standpoint, Rep. Taylor Greene’s statement is patently wrong. It perpetuates a common error by conflating gender with sex. Allow me to explain how psychologists scientifically operationalize these terms. According to the American Psychological Association (APA, 2012), sex is rooted in biology. A person’s sex is determined using observable biological criteria such as sex chromosomes, gonads, internal reproductive organs, and external genitalia (APA, 2012). Most people are classified as being either biologically male or female, although the term intersex is reserved for those with atypical combinations of biological features (APA, 2012). Gender is related to but distinctly different from sex; it is rooted in culture, not biology. The APA (2012) defines gender as “the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex” (p. 11). Gender conformity occurs when people abide by culturally derived gender roles (APA, 2012). Resisting gender roles (i.e., gender nonconformity) can have significant social consequences—pro and con, depending on circumstances. Gender identity refers to how one understands and experiences one’s own gender. It involves a person’s psychological sense of being male, female, or neither (APA, 2012). Those who identify as transgender feel that their gender identity doesn’t match their biological sex or the gender they were assigned at birth; in some cases they don’t feel they fit into into either the male or female gender categories (APA, 2012; Moleiro & Pinto, 2015). How people live out their gender identities in everyday life (in terms of how they dress, behave, and express themselves) constitutes their gender expression (APA, 2012; Drescher, 2014). “Male” and “female” are the most common gender identities in Western culture; they form a dualistic way of thinking about gender that often informs the identity options that people feel are available to them (Prentice & Carranza, 2002). Anyone, regardless of biological sex, can closely adhere to culturally-constructed notions of “maleness” or “femaleness” by dressing, talking, and taking interest in activities stereotypically associated with traditional male or female gender identities. However, many people think “outside the box” when it comes to gender, constructing identities for themselves that move beyond the male-female binary. For examples, explore lists of famous “gender benders” from Oxygen, Vogue, More, and The Cut (not to mention Mr. and Mrs. Potato Head, whose evolving gender identities made headlines this week). Whether society approves of these identities or not, the science on whether there are more than two genders is clear; there are as many possible gender identities as there are people psychologically forming identities. Rep. Taylor Greene’s insistence that there are just two genders merely reflects Western culture’s longstanding tradition of only recognizing “male” and “female” gender identities as “normal.” However, if we are to “trust the science” (as Rep. Taylor Greene’s recommends), then the first thing we need to do is stop mixing up biological sex and gender identity. The former may be constrained by biology, but the latter is only constrained by our imaginations. Jonathan D. Raskin, Ph.D., - Website - Book - References American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10-42. Drescher, J. (2014). Treatment of lesbian, gay, bisexual, and transgender patients. In R. E. Hales, S. C. Yudofsky, & L. W. Roberts (Eds.), The American Psychiatric Publishing textbook of psychiatry (6th ed., pp. 1293-1318). American Psychiatric Publishing. Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: Review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6. Prentice, D. A., & Carranza, E. (2002). What women should be, shouldn't be, are allowed to be, and don't have to be: The contents of prescriptive gender stereotypes. Psychology of Women Quarterly, 26(4), 269-281.

A Personal Perspective: Knowing which one can help you flourish with bipolar. Are you a rocking chair or swivel chair? Play along with me. Imagine you’re a chair. But what kind of chair? You need to know because it determines what you can and cannot do. No one chair is better than the other. They’re just different, with different abilities. This rocking versus swivel metaphor has helped me to be gentle with myself and realize I’m not broken just because I can’t do certain things due to the bipolar disorder and anxiety I live with. Understanding which chair, I have allowed me to flourish despite, or maybe in spite of, my mental illnesses. The chair comparison was born out of my frustration when I first experienced the limits bipolar disorder, anxiety, and my propensity to psychosis placed upon me. Things I took for granted I could no longer. Such as staying up late a couple of nights in a row if I happen to, say be reading a great book, or binging on a Netflix series. Enjoying drinks with friends over dinner or having one in the evening while I make a meal. Forgoing my regular exercise for two or three weeks because I just don't feel like it. A consistent sleep routine, no alcohol (or keeping it to the minimum, which for me is around one drink per month if any at all), and consistent exercise (I’m a runner—well a jogger, let’s be honest) are essential to maintaining a stable mood and, as a result, a stable life. If I don’t adhere to these, I either do a nosedive into a murky quicksand of depression /anxiety combo or take the escalator up to a mania. When I faithfully follow them, I'm at my best, and I stay there for the most part. Any drawbacks of having to honor these pales in comparison to the benefits I reap. Back to the furniture: I needed to realize (and accept) whether I was a swivel office chair or a rocking chair. Why? Because if I tried to spin around while a rocking chair, I just exasperated myself and felt defeated. As a swivel chair, if I pushed back and forth in an attempt to rock, well, not only would it be fruitless, but I'd also likely hurt myself. Wheeled pedestals have a habit of toppling when trying to move in that way. I would never expect either kind of chair, or any other piece of furniture for that matter, to be something that it’s not. When I realized I was a rocking chair (OK—this isn’t when I’m in a psychosis), I knew what I could and couldn’t do. It meant I could stop fighting myself. When I finally understood that I wasn't a swivel chair, it meant I could celebrate my unique aptitudes and skills and manage my bipolar more easily. As someone who lives with mental health conditions, I have an acute empathy for others’ struggles. I have a stick-to-it-iveness to stay the healing course and to master things that are difficult. I’ve learned to be honest with myself and others. And I've learned to be vulnerable in healthy and safe ways. My nervous system is a delicate eco-system, which means I need to respect that I can’t stay up until all hours; I can’t let myself get overstimulated by large crowds; I need to pace myself and not take on too much. Early in my recovery, I blamed myself for being so "sensitive" and for not being able to push myself in a society that prizes work and productivity. But now I see it’s my constitution. It’s what I was born with. Like hazel eyes. Not bad or better. It just is. Once I embraced that, my life opened up and so did my self-compassion. Accepting my limits, paradoxically gave me my freedom. When you need something to hang onto in order to hang in there, I hope this lends a helping hand. Victoria Maxwell - Website -

Learn how this “Universal Rule” can instantly decrease anxiety. The stronger your emotion, the harder it is to think logically. Emotion can hijack your brain. Learn a new secret weapon in the fight to not let fear, anxiety, or worry take over your brain. The "Universal Rule" test helps you sort realistic fears from false alarms. Learn how. You learned how to create a fear vs. facts dialogue table in my past three blogs Listening to Worries Can Actually Make You Less Anxious, Practical Tips on Changing Anxious Thoughts, and How to Effectively Talk Back to Worries and Fears. Creating a dialogue table is a way to challenge anxiety -provoking thoughts and strengthen your thinking brain in its struggle with your emotional , reacting brain. Emotions make it hard to think The more your primitive, emotional, reacting brain is activated, the harder it is to activate and listen to your smarter, logical, thinking brain. A fear vs. facts dialogue table helps you to question the thoughts making you anxious, stressed, fearful, worried, or upset and replace them with more factual, logical, and helpful thoughts. Practice makes you better The more you write and review your dialogue tables, the more you believe and act using facts and logic. Creating and rereading the tables helps you access your thinking brain even while you are flooded with emotion. Fears vs. facts A fear vs. facts table has two columns and multiple rows. The left column is “Worries, Fears, Distressing Thoughts”; the right column is “Facts, Evidence, Logic, Perspective”. Write anxiety-triggering thoughts in the left column, one thought per row. Simply putting fears into writing may activate your thinking brain Some worries lose their power as soon as you see them in writing. You literally view those fears from a different perspective. You gain emotional distance. Read the three earlier blogs on how to create a fears vs. facts table. What if you think, “My thought is true”? When the anxiety-provoking thought seems true, pull out your new secret weapon: the “Universal Rule”. Test the thought’s credibility by restating it as a universally applicable rule or law that holds true for everyone. Realistic thoughts pass the test Take the thought, “I’m scared to walk on highways. Walking on highways is dangerous.” When you restate it as a "Universal Rule": “People agree that walking on highways is dangerous” the original thought passes the test. Here are some more examples: Fear: “I am embezzling at work. There’s going to be an audit. I am afraid I’ll be fired and prosecuted.” Restated as a Universal Rule: “Audits are likely to reveal embezzlement. Embezzlers are fired and prosecuted.” Fear: “Driving is dangerous because I have uncontrolled seizures.” Restated as a Universal Rule: “It is dangerous for anyone with uncontrolled seizures to drive.” Unrealistic thoughts flunk Some scary thoughts seem convincing but fall apart when restated as a “Universal Rule”. Here are some examples: Fear: “I made a mistake. My boss will think I can’t do my job and I’ll be fired.” Restated as a Universal Rule: “Everyone who makes a mistake is fired.” Restated, the original fear is pretty obviously not true. It’s good to minimize mistakes and learn from them, but everyone makes mistakes. What about these examples? Fear: “It is not safe for me to drive because panic will make me crash the car." Restated as a Universal Rule: “Everyone who has panic symptoms crashes.” Or “Panic symptoms make every driver crash.” Or “No one drives safely when scared.” Fear: “There’s turbulence! The plane is going to crash!” Restated as a Universal Rule: “Every plane that hit turbulence has crashed.” Or “No plane has landed safety after experiencing turbulence.” Or “Every flight that encounters turbulence crashes.” Fear: “The person I was dating broke up with me. No one will ever love me.” Restated as a Universal Rule: “Everyone who ever had a breakup is alone.” Or “No one has found love after a breakup.” Fear: “My parents do not accept my sexual orientation or gender identity. No one will accept me.” Restated as a Universal Rule: “Everyone thinks like my parents on gender issues.” Try it right now Write down an upsetting thought. It will only take a minute. Go ahead. Now, restate that thought as if it is universally true, as if it applies not just to you but to everyone. Notice what happens. Did the thought suddenly seem less credible? The next blog in this series discusses what to do when your fear is realistic. Thanks for reading and best wishes for a happier, less anxious life. Elizabeth McMahon, Ph.D., - Website - References For more information on Fears vs. Facts Dialogue Tables, see McMahon, E. (2019). Overcoming Anxiety and Panic interactive guide. San Francisco, CA: Hands-on-Guide.

Veteran suicides increase 10-fold from 2006 to 2020. Veterans suffer from high rates of mental health conditions, including PTSD, depression, and substance use. Suicides among veterans increased 10-fold from 2006 to 2020. New treatment strategies are desperately needed. Addressing mental and metabolic health simultaneously may lead to better outcomes. Every year on Veterans Day, we celebrate the brave individuals who have served our country. The mental health challenges that veterans face is both unique and profound. As they transition from service to civilian life, many carry the weight of experiences that significantly impact their well-being. Conventional treatment approaches for conditions such as PTSD , anxiety , depression , and substance abuse are invaluable, yet some veterans continue to struggle with symptoms. A recent research study published in JAMA Neurology has unearthed a deeply troubling trend: a greater than 10-fold increase in suicide rates among U.S. veterans from 2006 to 2020. Clearly, our current treatment strategies are failing far too many veterans. This is where innovative perspectives, such as the brain energy theory of mental illness, offer fresh hope and understanding. The brain energy theory, as outlined in this post, posits that mental health conditions are intricately linked with the brain's energy dynamics. A brain with balanced and optimal energy is crucial for mental wellness. For veterans, whose brains are often taxed by the rigors of service and the scars of trauma , ensuring adequate brain energy could be particularly transformative. Brain energy is, in essence, the currency that powers every thought, emotion, and reaction. This energy stems from the complex interplay of nutrients, hormones, neurotransmitters, and mitochondrial function. For veterans, exposure to stressful environments, trauma, sleep disruption, and physical exertion can lead to a mismatch in energy supply and demand within the brain, potentially exacerbating mental health symptoms. Research has demonstrated that PTSD, for example, is not just a manifestation of psychological distress but may also be linked to altered metabolism. This can affect the way the brain processes information and responds to stress. By targeting these metabolic processes, we might be able to offer veterans more effective interventions. How, then, can the brain energy theory guide novel treatment strategies? Nutritional Interventions: Tailored nutritional counseling aimed at optimizing brain energy production can be a powerful addition to veterans' treatment plans. Exercise and Stress Reduction: Interventions such as targeted exercise regimens may not only enhance overall energy but also improve brain plasticity, resilience, and the regulation of stress hormones. Mind-body practices like yoga and meditation could further aid in rebalancing the brain's energy utilization and emotion regulation mechanisms. Specialized Brain Energy Interventions: One promising area is the exploration of supplements, medications, and even light therapy that specifically support mitochondrial function and, consequently, brain energy. While still in the early stages of research, these interventions may offer relief for veterans whose mental health symptoms have been resistant to other treatments. One example is the application of red or near-infrared light to the scalp (transcranial photo biomodulation). In a pilot trial, this intervention was found to improve brain metabolism and reduce symptoms of traumatic brain injury and PTSD. Enhanced Psychotherapy: Integrating brain energy optimization into behavioral therapies could amplify their effectiveness. By ensuring the brain is energetically equipped to engage with and benefit from therapy, we can enhance learning, neural growth, and the consolidation of therapeutic gains. Comprehensive Care Teams: Coordinated care teams can ensure that veterans receive holistic support, addressing both mental and metabolic health. The journey toward healing and mental wellness for veterans is both a collective and individual endeavor. By harnessing the principles of brain energy, we can open new avenues for treatment that honor the complexity of the brain and the diversity of experiences among veterans. With continued research and clinical application, this perspective holds the promise of not only alleviating symptoms but also restoring a sense of vitality and hope to those who have served. As we move forward, it is essential to continue advocating for and investing in research that elucidates the intricate connections between metabolism and mental health. By doing so, we not only pay homage to the sacrifices of our veterans but also elevate our approach to mental health care for all. Christopher M. Palmer, M.D. - Website -

Choosing not to know reveals a lack of self-respect. Adultery damages your relationship whether or not you find out about it right away. Choosing not to know about your cheating partner is deceiving yourself. Healthy self-respect demands that you know whether your partner is cheating, no matter who tells you. Anywhere you go in the real world or on the internet, adultery is a constant topic of discussion. Although people mostly agree that it’s wrong in general, they disagree on whether you should tell your partner if you’ve cheated on them or whether you should tell a friend that their partner has cheated on them. (This, of course, assumes that fidelity is an important aspect of your relationship, no matter how you and your partner define it.) The view from the other side is discussed less often, though. Although there are a lot of opinions about what to do after you find out your partner has cheated on you, I see much less written about the question of whether you should want someone to tell you if you've been cheated on (regardless of who tells you, your partner or a friend). On the simplest level, of course, it is up to every person to decide for themselves whether they want to know if they’ve been cheated on. This is based on the basic concept of autonomy that says we all have the right to conduct our lives as we choose, given that our choices do not infringe on the equal rights of others to do the same. Even though you have the right to determine for yourself if you want to know if you’ve been cheated on, several ethical and practical considerations suggest that you should want to know. 1. What you don’t know can hurt you. This obviously contradicts the common belief that “what you don’t know can’t hurt you.” This is true if we're only considering the feeling or experience of being hurt, which is certainly prevented as long as you're unaware of the hurtful event. But the injury still occurs, just like if your house is damaged or broken into while you’re on vacation: Your interests are still set back even if you don’t learn about it for some time. In the case of adultery, your relationship is damaged from the moment it happens, whether or not you’re aware of it—and given enough time, it is likely you will be, at which point the pain may be much worse for all time you didn't know. 2. You deserve to know what’s going on. If you don’t know you’ve been cheated on, your relationship will have continued under false pretenses. It is no different than if your partner lies to you about cheating, even though in this case it was your choice not to know—either way, the result is deception. Of course, we can never know everything about our partners, nor should we want or demand to. But there are some things you should want to know, things that are directly relevant to your relationship—and if you value fidelity in your relationship, violations of that are definitely relevant. 3. Choosing not to know shows a lack of self-respect. Intentionally remaining ignorant of your partner’s infidelity and continuing in a deceptive relationship is a sign you don’t respect yourself enough. It’s saying to your partner, your friends, and—worst of all—yourself that you aren’t important or valuable enough to be told the truth about your partner’s behavior. In practical terms, you are effectively giving them permission to cheat (and keep it from you), and if you do this you will always wonder if they have. This constant state of uncertainty may be just as bad as finding out they actually did cheat, and much worse than knowing they have not. Why do you feel you don't deserve to know? All three of these reasons argue against telling people that you don’t want to know if your partner cheats on you. It may seem like it is saving you pain, but if your partner does cheat on you, you have been hurt even if you don’t realize it at the time—and chances are you will find out, at which point it may hurt even more. In the meantime, you are deceiving yourself by closing your eyes to what’s going on, and your relationship will be a lie. Most importantly, by saying you don’t need to know about things that are relevant to your life, relationship, and happiness, you are denying yourself the respect you deserve. Again, you are free to do that, but before you do, ask yourself why you feel you don’t deserve the truth from the person you have dedicated an important part of your life to. Has your partner said or done something to make you feel this way? (Then consider if this is the right person for you.) Are you worried you'll lose them if you don't look the other way? (Then you need to ask if you feel like you're less worthy than your partner, or what shortcoming you feel you need to make up for—and why.) Have you been hurt by infidelity in the past, and you think that not knowing will prevent you from feeling that pain again? (Then you need to consider the chances that you will find out eventually, and whether you're actually saving yourself from anything.) In the end, all of this point back to how you perceive your own self-worth, both as a person and as a partner—and none of them justify treating yourself as anything less than a person who deserves to know what's going on in your relationship. Mark D. White, Ph.D., - Website -

Why toddlers get aggressive, how to respond, and ideas for keeping things calm. Toddlers throw tantrums because they don't have the language skills or emotional habits to communicate more effectively. Getting angry or impatient with a child in a tantrum just makes things worse, exacerbating the frustration that led to the child’s bad behavior. Peaceful co-existence with a toddler starts with responding attentively so they don't have to escalate in order to get attention. Most toddlers get aggressive sometimes. Tantrums and aggressive behaviors—hitting, kicking, scratching, and biting—don’t mean you’re a bad parent, but they are a call to action. Why Little Kids Get Nasty An aggressive young child, at least up to the age of three, is not being "bad" or disobedient. They are trying to tell you something and haven’t yet developed the language skills or emotional habits to communicate more effectively. Either that, or they don’t feel you’re listening to them, and violence is the only way to get your attention. Toddler aggression usually happens when a little one is not getting what they want, whether that want is reasonable (food, attention, a cuddle), or not (candy, someone else’s toy, something dangerous). And context matters. Quite predictably, toddlers are more likely to be aggressive when they’re tired, worried, not feeling well, hungry, or otherwise stressed. Looked at from a child’s eye view, lashing out at someone is a reasonable reaction to the powerlessness of being a toddler. What else can they do? How to Respond to a Young Child Who Has Lost Control To begin with, punishment doesn’t help. In fact, you are getting angry or impatient just makes things worse, exacerbating the frustration that led to your child’s bad behavior, as well as demonstrating that anger and impatience are okay. When your child gets violent, you have a great opportunity to fine-tune your parenting, and to help your child understand and communicate what they’re thinking and feeling. If you can find a way to welcome your young child’s act of aggression as a great teachable moment, you’re more likely to retain your sense of humor and perspective, and to act wisely and well in that moment. Here are four simple steps for stopping toddler aggression, and teaching some important new skills in the process: Stop the Aggression Do what you need to do—gently, but seriously—to stop your child from being physically aggressive. If they’re hitting you, for example, or trying to hit, hold their hands firmly enough—with kindness—to ensure they won’t be effective. If your child was brandishing a loaded gun, you wouldn’t hesitate to take that weapon away. Hitting, scratching, kicking, and biting are no different. Hands, nails, teeth, and feet are the weapons available to the toddler. It’s your job to ensure they learn they cannot use their weapons on others. Go Somewhere Private If there are other people around, remove your child (yes, that might mean picking them up and carrying them, kicking and screaming) to a private place. That can be a quiet corner of a store or parking lot, or a separate room in a home. This serves three purposes: It gives your child a chance to calm down away from the situation where they were hitting (or scratching, or whatever), and it gives you a chance to deal with it away from the eyes of others. It also allows your child to maintain their dignity. Even for a toddler, it’s embarrassing to have a problem addressed in public. Help Your Child Use Their Words (and Not Their Hands, Nails, Feet, or Teeth) Once you’ve found a quiet spot, and are still restraining your child, or they’re no longer hitting, etc., look them in the eye, and tell them firmly and calmly—no anger or impatience or annoyance in your voice—something like, “In our family, we do not hit.” Model patient adult self-control. That is, be kind, matter-of-fact, and strong. No matter how you are feeling—angry, worried, embarrassed, whatever—this is a time to act like a good parent. Debrief Once your child has calmed down, and before too much time has passed (within the first half-hour, if at all possible), have a short chat about what happened. You might say, “Hitting is never okay. When you notice you’re about to hit (or scratch, etc.), try to use your words to tell me how you feel. Instead of hitting, maybe you can say, ‘I’m tired, Mommy’ or ‘My tummy is rumbling,’ or ‘I really need you to listen to me, right now.’” Prevention: 10 Pathways to Peaceful Co-Existence with a Toddler Give your child your full attention. As much as possible, avoid using electronic devices when you are with your child. Respond attentively when they say or do something, so they don’t have to escalate their communications into tantrums and aggression in order to get your attention. Snuggle your child frequently . Provide warm close cuddle time throughout the day. Show your love actively and often. Maintain a schedule for playing, sleeping, and eating. A dependable schedule helps a child feel the world is safe and predictable. It also increases the likelihood their physical needs are being met. Provide reasonable small choices. Give your child as much control and as many choices as you reasonably can. For example, you can say, “It’s time to put your shoes on. Do you want to do it yourself, or do you want help?” “Would you like peanut butter on your banana slices?” “You choose a book, and I’ll read it to you.” Look for different kinds of stimulation. Sometimes toddler aggression reflects boredom. Make sure your child gets enough different kinds of stimulation—musical, physical, intellectual, social, and visual. Ensure ample time for active play. two-year-old needs three hours of active physical exercise every day. Ideally, a good portion of that is outdoors. Toddler aggression sometimes reflects a need for more physical activity. Create a harmonious environment. Children mimic what’s happening around them. Are there other kids they spend time with who use hitting to get what they want? Are there worries or tensions at home or daycare they might be reacting to? Role-play different possibilities. In a calm easy moment, and in a lighthearted manner, re-enact a recent violent episode. Think together about possibilities other than violence, aggression, or tantrums. These could involve finding words, using a punching-pillow, one of the other options listed below, or something else entirely. Then reverse the roles, so you’re playing the aggressive child, and your child plays the parent role. I’ve seen even very young children come up with delightfully inventive alternatives that adults would never have thought about. Create a checklist of good alternatives to bad behavior . Print a list of some good brief alternatives to violence. Ask your child for suggestions. You can illustrate it if you like or paste on a photo of an angry bird or a violent child (crossed out with a big X) as well as a happy photo. Here are a few ideas to get you started: Use your words. Help your child learn to use words instead of hitting. Walk away. Teach your child to walk away when they feel someone is treating them badly. You don’t want them walking away from you, but that’s almost always better than scratching you. Go to your quiet corner . Make a special corner where your child can choose to go when they’re feeling like they need to hit. Let them keep books, toys, or stuffed animals there. If they have a special blanket or other object, let them take it to the quiet corner. You can ask if they want to go to the quiet corner when they’re aggressive, but don’t send them there as punishment. You want them to experience it as a good place to collect their thoughts and gain control of their emotions. Get physical. Some toddlers benefit from physical alternatives to aggression. In a calm moment, work out some options your child likes. That might include hitting a hitting pillow, stomping their feet while punching the sky, doing an angry dance, or touching their toes. Breathe out the nasties. Have your child breathe in to the count of five, hold their breath to the count of five, then breathe out like a dragon to the count of five. “Breathe out all your fire,” you can say, or “Breathe out the nasties and the angries, and then we can talk.” Ask for help . Help your toddler translate their aggressive urge into a request for help. Develop a code so they can let you know they want to get violent, and want your help preventing that. It can be “I need a hug,” or “Please help me,” or “I’ve got the angries again.” And then whenever the child uses the code, be sure to be available to hug them and listen to what’s going on. 10. Take good care of yourself. The best way to teach a child about regulating their own emotions and behavior is to be a good model of emotional self-regulation yourself. Do what you need to do to keep yourself happy, healthy, and optimistic. Find ways of managing your own emotions so you can be a model of calm, thoughtful, respectful behaviour. Remember that anger and shouting are also forms of aggression, tantamount to bullying when a (large) parent shouts at a small child. Get help. If these ideas for coping with a young child's aggression and preventing it don't work, or the level of violence is disturbing you, or your child is three or older and still going out of control, it is time to consult a professional. Some problems with anger and violence need professional help. Dona Matthews, Ph.D., - Website - Book -

Fear of intimacy, along with a fear of rejection. Borderline personality disorder (BPD) is characterized by marked instability. People with BPD greatly fear abandonment, yet they paradoxically act in ways that ensure they'll be abandoned. BPD may be considered fundamentally a disorder of self-contradiction. Borderline personality disorder (BPD) is classified as a severe and persistent mental disorder that causes considerable morbidity and mortality. Roughly 10 percent of people with BPD will die by suicide (Paris, 2019). The economic costs associated with BPD are roughly double those associated with major depression (Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008). The birth of the concept of borderline personality stems from the 1950s and 60s when authors such as Knight (1953), Main (1957), Frosch (1964), and Grinker and colleagues (Grinker, Werble, & Drye, 1968) began documenting patients whose problems appeared to exist between the border of the neuroses and the psychoses. Because they rarely reported hallucinations or delusions, these patients could not be considered psychotic, but they also lacked the consistency of neurotic patients; as McWilliams (2011) puts it, the only stable thing about them was their marked instability. Borrowing from the work of Cleckley (1941), Bradley and Westen (2005) describe borderline patients as having only a “mask of sanity.” It was John Gunderson and colleagues (e.g., Gunderson & Singer, 1975) at Harvard who operationalized the diagnosis of borderline personality disorder , and the disorder was listed for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Kernberg's contributions to the broader concept of borderline personality organization (e.g., Kernberg, 1984) have been instrumental in understanding the psychodynamics of these patients. While much has been written about borderline patients and their treatment, relatively little attention is given in the modern literature to one of the hallmark features of the disorder: the patient’s characteristic engagement in self-contradictory, paradoxical, and self-defeating behavior. I have said previously that the great paradox of BPD is that while the patient's greatest fear is abandonment, they will act in ways that virtually ensure they will be abandoned (Ruffalo, 2023). Thus, I submit that BPD is fundamentally a disorder of self-contradiction. Understanding these dynamics will likely yield benefits in conceptualization and treatment. Cyclical Psychodynamics A number of psychodynamic theories of the nature, pathogenesis, and treatment of BPD have been advanced since the 1970s. Object relations perspectives, for instance, emphasize how borderline patients internalize relationship patterns from their interactions with their primary caregivers (e.g., Masterson, 1972). Kernberg's focus on transference issues has revolutionized treatment. In 1977, psychologist Paul Wachtel described a process he called "cyclical psychodynamics," by which borderline patients often inadvertently elicit precisely what they most fear. The brief vignette below depicts this phenomenon. Anna has been dating her boyfriend for eight months. After a period of intense infatuation, she becomes increasingly suspicious of his intentions. If he doesn't text her back within a short period of time, she accuses him of cheating on her. She begins to attribute malevolence to benign interactions. Every few days, a fight occurs. Often, when her boyfriend expresses love for her and a desire to further their relationship, she responds by pushing him away. The relationship is marked by a chaotic pattern. When some semblance of stability is reached, Anna inevitably "stirs something up" by criticizing her boyfriend or pointing out his flaws. Sometimes she withdraws completely. Ultimately, her boyfriend cannot stand the chaos any longer and breaks up with her. Despite his love for her, he cannot fathom a life of such instability. Anna is left heartbroken, wondering why her boyfriend would do such a thing to her. The vignette above depicts the self-contradiction inherent in borderline pathology. So fearful of losing her boyfriend, Anna behaves in ways that serve only to drive him away. Although she expresses a desire for true love, her conduct in essence makes this an impossibility, for no healthy person is likely to endure the ongoing assaults on their character and psyche at the hands of someone who, at times, sees them only as a bad actor. Furthermore, it depicts a psychodynamic process known as identification with the aggressor. While Anna's behavior contributed to the downfall of her relationship with her boyfriend, she ultimately ends up blaming him for leaving. This reversal of victim-victimizer roles, first identified by the psychoanalyst Sándor Ferenczi, is a common defense in borderline disorders. Making Sense of Self-Contradiction Why do patients with BPD behave in such paradoxical ways? We must remember that borderline patients are driven by not one, but two, intense anxieties. While it is rejection or abandonment anxiety ("fear of abandonment") that receives the most clinical attention—since it is usually what the patient most frequently complains of—a second anxiety, enmeshment anxiety, fuels much of the chaotic push-pull patterning that characterizes the borderline's interpersonal life. The borderline patient is, in essence, caught in a dilemma. When they feel close to another person, their fears of intimacy kick in; when there is too much distance, they feel traumatically abandoned and rejected. This central conflict between intimacy and rejection results in their going back and forth in relationships, in which neither closeness nor distance is comfortable (McWilliams, 2011). Because love for these patients is intricately tied to pain, no stable middle ground exists. As a result, the patient's loved ones—and especially their romantic partners—are placed into an untenable situation; either they attempt to reassure the patient of their love and commitment and are met with coldness, distance, or hostility, or they take a step back and are told that they are being insensitive and rejecting. That is to say that the patient has placed the partner into a double bind, a lose-lose situation. As Bateson and colleagues (Bateson, Jackson, Haley, & Weakland, 1956) described, the consequences of double bind scenarios for the recipient of such communications include frustration, confusion, and a sense that one is "losing one’s mind." Ultimately and inevitably, via the process of cyclical psychodynamics, the person with BPD brings about the outcome they so desperately seek to avoid; despite their proclamations of needing and desiring closeness in a relationship, they destroy any such chance. The partner leaves, and if the psychological conflicts remain unresolved, the cycle repeats in aeternum. Conclusion A hallmark feature of the borderline syndrome is a pattern of self-defeating, paradoxical behavior attributable to the patient's enduring conflict between intimacy and abandonment. It is as if these people continually shoot themselves in the foot without realizing that they, themselves, are holding the gun. It is therefore suggested that BPD be considered fundamentally a disorder of self-contradiction. Mark L. Ruffalo, M.S.W., D.Psa., - Website - References Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. (1956). Toward a theory of schizophrenia. Behavioral Science, 1(4), 251–264 Bradley, R., & Westen, D. (2005). The psychodynamics of borderline personality disorder: a view from developmental psychopathology. Development and psychopathology, 17(4), 927–957. Cleckley, H. (1941). The mask of sanity: An attempt to clarify some issues about the so-called psychopathic personality. Mosby. Frosch, J. (1964). The psychotic character: Clinical psychiatric considerations. Psychoanalytic Quarterly, 38, 91-96. Grinker, R. R., Werble, B., & Drye, R. C. (1968). The borderline syndrome: A behavioral study of ego functions. Basic Books. Gunderson, J. G., & Singer, M. T. (1975). Defining borderline patients: an overview. The American journal of psychiatry, 132(1), 1–10. Kernberg, O. F. (1975). Borderline conditions and pathological narcissism. Aronson. Knight, R. P. (1953). Borderline states. Bulletin of the Menninger Clinic, 17(1), 1–12. Main, T. F. (1957). The ailment. British Journal of Medical Psychology, 30, 129–145. McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford. Masterson, J. F. (1972). Treatment of the borderline adolescent: A developmental approach. Wiley-Interscience. Ruffalo, M. L. (2023). Understanding borderline personality disorder: A closer look at psychodynamic approaches. The Carlat Psychotherapy Report. Paris J. (2019). Suicidality in borderline personality disorder. Medicina (Kaunas, Lithuania), 55(6), 223. Soeteman, D. I., Hakkaart-van Roijen, L., Verheul, R., & Busschbach, J. J. (2008). The economic burden of personality disorders in mental health care. The Journal of Clinical Psychiatry, 69(2), 259–265. Wachtel, P. (1977). Psychoanalysis and behavior therapy. Basic Books.

Reducing anxiety is not as simple as "flipping a switch." Positive thinking can be invalidating to some people's experience of anxiety. Throwing an overly simplistic positive thought at anxiety is like telling a physical injury to “just heal.” There is no "one-size-fits-all" fix for anxiety. You have probably heard these before: “Look on the bright side”; “Focus on the positive”; “It could be worse.” These are the types of things people often say to those who are anxious, worried, or overwhelmed. While the intention is good, the result is not always productive. At times, these types of statements can feel invalidating and minimizing rather than helpful or supportive. They imply that a simple attitude change will rid us of our feelings of worry. Stopping or changing an anxious mindset is not as simple as flipping a switch or telling ourselves something positive. If it were this easy, there would be very few anxious people. According to the National Institute of Mental Health, more than 30 percent of adults struggle with a diagnosable anxiety disorder at some point in their lives—and that’s just those that are officially diagnosed. Countless others experience anxiety and worry, often on a daily basis. The numbers simply do not support the idea that thinking positive is the antidote to anxiety. Throwing an overly simplistic positive thought at anxiety is similar to telling a physical injury to “just heal.” The wound can only truly heal in its own time, with the correct treatment and proper attention, based on our unique physicality. Anxiety is no different. There is not an exact prescription for treating anxiety, and this is part of the problem with positive thinking as a “one-size-fits-all” intervention. It may be helpful to some, but not necessarily to all those who experience anxiety. When we assume that a single treatment or intervention can be broadly applied, we fail to understand the uniqueness of each individual’s experience, and this can result in feeling invalidated. In knowing ourselves, it is important to ask what we need (and what we don’t need) when our anxiety is flaring up. These two simple questions can help: What helps me when I am anxious? What does not help me when I am anxious? For myself, what I need when I am anxious is to tell a loved one that I am feeling anxious. I need them to just listen. I do not need them to try to “solve” my anxiety or offer me solutions. I do not need simplistic statements reminding me to “Think positive.” I feel great relief in the simple act of speaking how I am feeling. Often, I experience a sense of calming almost instantly. This is not to say that my anxiety vanishes on the spot but, rather, that I feel I no longer need to carry it all by myself. This is my personal experience with what helps me during anxious moments. Yours may be different, but knowing what helps you can allow you to find the right type of support when you are feeling anxious. You can even tell a loved one that you don’t need solutions right now—that you just need to be heard. The point is that once you know what helps, you can actively attain the right kind of support for you. In our effort to be understanding of anxiety relief as unique to each individual and their experience, here are some reminders for supporting ourselves and others when anxiety is interfering with our lives: Don’t assume that there is a “right” thing to say. Ask what would help right now and what would not help. Remember that, unlike a physical injury, anxiety does not have a single or broadly applicable “prescription” or intervention. Remember that each individual’s experience with anxiety is unique and, therefore, so is what they need to feel comforted. Phil Lane, MSW, LCSW, - Website - References Any anxiety disorder. (n.d.). National Institute of Mental Health (NIMH).