Tag Archives: Emotion Regulation

When Intense Emotions Take Over My Mind

Okay, this year’s #AtoZChallenge didn’t work out. I knew it would be tough writing about autism and related disorders when myself undergoing re-assessment for autism. It didn’t help that, from the E-mail I received on the day I posted my theme reveal, it became clear that I will not have an answer before the end of April. That wasn’t the reason I haven’t written at all since April 1 though. The real reason was my mental health.

Like I mentioned, I have been rather anxious and depressed lately. It however got extreme over the past two weeks. This likely isn’t a worsening of my depression as much as it is emotional dysregulation. That doesn’t make it less real though.

About two weeks ago, I started being more irritable and having more dark, death-related and suicidal thoughts than I had before. I had had almost-daily dark thoughts for a few months, but now they became more than daily. I also started making more concrete plans for a final step. Before then, there had been bizarre images in my head of how I’d die by crucifying myself over the staircase at home and such. These had appeared a bit laughable even to my twisted mind. Now, I started making plans and the before then bizarre-sounding thoughts didn’t seem that ridiculous anymore.

I wandered out of the house at home last week Saturday. Thankfully, my husband came back from where he’d been within aobut fifteen minutes and I was fine. Then on Sunday I had a very bad argument with my named nurse that ended in me melting down.

On Monday, I decided I’d stop taking my medication. I didn’t take my morning meds other than birth conrol and vitamin D (because I wanted to take birth control and couldn’t tell the two apart) on Tuesday. I spiraled out of control that same afternoon. This, for your information, can’t have been from withdrawal yet.

The reason I quit taking my medication was that I’d been having these dark thoughts for a while already and yet I felt I was too drugged up to express them. I don’t mean that I wanted to tell the world, like I’m doing now, but I wanted to be able to cry. And cry I did. I also felt like maybe, if I stopped taking my meds, I’d feel some kind of motivation again. I take a high dose of an antipsychotic, which admittedly the psychiatrist says can’t cause flat affect. I also take an antidepressant, but I’d forgotten why I’d been prescribed it (in 2010!) and it had never been reviewed.

Admittedly, there was also a part in me that wanted to signal to my staff that I wasn’t coping. That didn’t really work. My psychologist said that, if I wanted to be taken seriously about my mood, I needed to take my meds. Not that she’s ever taken me seriously about my mood, unless writing depression NOS into my diagnosis counts, which I don’t feel it does. She also told me that I sabotage the independent assessment if I don’t take my meds. I don’t like to admit it but that was one reason I started taking them again on Saturday. I hate to admit I give in to authoritarian manipulation, but I do.

on Wednesday, I started experiencing what I believe are brain zaps – a kind of weird dizzy spell caused by antidepressant withdrawal. I at first thought they were a side effect of a failed attempt at an overdose. They weren’t. By Friday, they occurred about every minute. I was then ready to start my antidepressant again, but wasn’t sure I could safely go back on it after five days. The nurses had to ask the on-duty doctor or some kind of head nurse or whoever and I didn’t get an answer till Saturday afternoon. Now I feel so stupid for havng bothered the nurses with this question on a week-end. I am glad for no more brain zaps though. I did also start back on the anitpsychotic. Not because I want to be on it, but because it seems I need to.

Since late Thursday evening, I’ve felt relatively well. I still experience anxiety and depression, but my emotions aren’t as out-of-control as they were before. Some things that helped were one nurse taking me on walks and allowing me to use her boxing equipment to blow off some steam. It sucks that I can’t do this at home.

Describing My Limitations

Many years ago, an online friend of mine was part of a disabled people’s ministry that explored what it meant to be disabled. She wanted to get me involved too, but at that point, the ministry was closing down, so she started her own discussion group. The first question we got was to introduce ourselves without mentioning our disabilities. I don’t know whether I did this with my last post, but I don’t want to do things over again. The second question was to describe your limitations. We could mention diagnoses, but the focus was on how disability limited us. I am now trying to answer this question in this post.

My first disability is blindness from retinopathy of prematurity. My vision is measured as light perception only. Technically, this means i can see the eye doctor’s flashlight when it’s brought into my visual field but I cannot tell what direction it comes from. This commonly leads to the misconception that people whose vision is measured as light perception only, are essentially completely blind. In truth, I can orient to light – just not the eye doctor’s flashlight. I can visually locate windows and see whether a light is on or off. With that last one, I do often need to check twice to be sure and I often find it easier to memorize the position of the switch than to depend on my vision.

Then it gets hard. I used to have a diagnosis of autism, but since that was removed, I now have to describe my limitations without depending on a catch-all label. Let me try. I have sensory processing difficulties. I am oversensitive to sounds and textures. With regards to taste, I am a sensory seeker, in that I crave spicy food. I can also be a seeker in the vestibular sense. I used to love to swing and when the movement therapist at my old institution had a trampoline set up, I was over the moon.

I may also have auditory processing issues. I have trouble understanding speech sometimes, especially in a crowded place. I haven’t had a hearing test in forever, so can’t be sure that it’s processing and not my hearing itself. Sometimes though, I do hear something, ask the other person to repeat it and then before they repeat themselves, I process what was said.

I also have social difficulties. I can keep a reasonably normal-sounding conversation but it takes me a lot of energy. I have trouble with reciprocity, in that soetimes all I do is listen and sometimes all I do is talk. I can’t do group conversations, because I get overwhelmed.

I have mild communication issues too. Sometimes, when anxious or overwhelmed, I go mute or stutter or have trouble finding the right words. I remember going mute in high school too, but not sure whether I had these issues before that. It could be anxiety, since I also have that. My psychologist is considering diagnosing me with generalized anxiety disorder, which basically means you worry to an extreme degree about all sorts of things. There are also additional symptoms, like difficulty concentrating, physical tension, etc.

I have cognitive issues too. This may sound stupid, because I have a high IQ. Maybe executive dysfunction is a better word. I appear lazy sometimes, because I get easily overwhelmed by relatively complex tasks and then end up not doing them at all. I also feel anxiety when people ask me to do things, but when I take the initiative, I feel more confident. I wrote earlier that this could be pathological demand avoidance. However, when for instance my husband asks me to do something, i’m fine with it unless it’s a complex task.

Then I have emotion regulation difficulties. I used to have a diagnosis of borderline personalty disorder, but that can’t co-exist with the brain injury I suffered from a brain bleed and hydrocephalus. I don’t have the relational instability that many people with BPD have. Mostly, my emotions are extreme. In this sense, I relate more to the profile for multiple complex developmental disorder (McDD) than to that for BPD. I have never been psychotic, but I do have some delusion-like thoughts.

Lastly, I have motor difficulties. I saw a physiatrist till I was about eight, but was too young to remember the diagnosis. I have a much weaker left side than right, although I recently found out that my grip strength is equal in both hands. The fact that I use my left hand much less could indicate mild hemineglect (lessened attention to one side of the body, usually left). I also have and have always had a lot weaker muscles than most people. I have however learned to live with that. I mean, what do you need to reach your toes for when in sitting position? I do have significant balance and coordination issues. MY gait is very wobbly. I recently learned that healthy people can climb stairs without even holding onto the railing. In my home, where the staircase has only one railing, I need to hold onto the railing with both hands and wobble sideways.

These are the limitations I can think of now. I have some others, but this post has been long enough. When I feel like it, I will answer the next question I remember, which was about adaptations for coping with your limitations.

Mental Health Goal: Move In with My Husband #Write31Days

31 Days of Mental Health

Welcome to day 26 in the #Write31Days challenge on mental health. Today, my husband and I accepted the house to the right side of Arnhem we were offered on Thursday. I am therefore cheating a bit with the 30-day mental illness awareness challenge and choosing the question from day 29. Actually, it isn’t cheating at all since I never followed the challenge to a T. Anyway, for day 29, the question is about some of your goals with regard to your mental health.

My main goal that I’ve been working on for the past nine months now is to eventually be able to move in with my husband. Since we’re moving to the right side of Arnhem in probably less than a month, you may think there’ll be a bit of a delay in finding me care, but things never went that fast anyway. I hadn’t had an intake interview with supported housing on this side yet. Neither had a definite decision about allocated care hours been made. Remember, we’ve been working on this goal for nine months. Things go that slowly.

One factor in this slow-going process was the fact that my treatment team and I were waiting for the consultation with the autism center we didn’t have till the middle of May. Looking back, there’s not a single thing this center has been helpful with. Another factor, however, was the fact that my husband and I had been planning on moving for months. Even though my psychologist said she’d make arrangements as if we weren’t going to move, I at least have a bit of hope (or illusion) that now that the elephant is out of the room, we can actually start making arrangements for my care.

Apart from preparing for living with my husband, I don’t have any real goals for my mental health treatment right now. However, living with my husband requires a greater level of emotional self-control than living in an institution with 24-hour care. My husband works irregular hours and may be working long days. I won’t have support available when I need it right then during my husband’s work hours. If a support worker will be able to come out to the tiny village on call at all, it’ll take at least fifteen minutes if they can leave right away. Fortunately, I am relatively good now at spending time without care if I know at what times I’ll be abe to enlist a support worker or my husband will be home. I still need to work on improving this ability, because my husband cannot always tell when he’ll be home.

When I do live with my husband, additional goals for my mental health will have to do with other aspects of emotion regulation. I want to finally learn to kick the binge eating beast, for example. There are undoubteldy other negative coping skills I need to learn to replace, but I can’t think of them right now. In short, I hope to eventually be able to participate in day activities and live with my husband without too much emotional turmoil or behavioral outbursts.

Supporting Someone Who Self-Injures

I have a diagnosis of borderline personality disorder (known in the UK as emotionally unstable personality disorder). BPD is sometimes known in the Netherlands as emotion regulation disorder, because it causes people to be unable to deal with intense and rapidly shifting emotions. BPD sufferers get stressed much more easily than those without mental health problems. They also tend to cope with stress ineffectively. One destructive coping mechanism that is common in BPD is self-harm.

Self-injury is not unique to people with BPD. In fact, starting with DSM-5, non-suicidal self-injury is its own diagnosis in the psychiatrist’s manual. Before then, if a person self-harmed, they were often incorrectly diagnosed with BPD, which has many more symptoms than just self-injury.

Self-injury is also common in people with autism, which is my other diagnosis. It is thought that people with autism, particularly those with a co-occurring intellectual disability, self-harm as a way of self-stimulatory behavior (to regulate sensory input) or as a way to communicate. For example, they might start to self-harm when they are overloaded sensorially or cognitively, or when they are in pain.

People with BPD are thought to self-harem to regulate their emotions. For instance, they may feel intense hopelessness or rage, or they may conversely feel numb and self-harm to have any sensation at all.

Self-harm is commonly thought of as a way of manipulating or attracting attention. This may be true, but isn’t necessairly. Many people feel a lot of shame about their self-harm. I, for one, don’t tend to self-injure to garner attention of others. I self-harm for many reasons, one of them being expressing emoitons to myself.

It is important to realize that people who self-injure, no matter their diagnosis, are in distress, be it physical, sensory, cognitive or emotional. It is important to find out what precedes the self-injury and what follows it. Don’t make judgments about what goes on inside the self-injurer’s mind. For example, I commonly start self-harming when I get frustrated trying to communicate my needs to my staff. It may then be easy to assume I do it “for attention”, because the staff give me more one-on-one attention when I self-injure. However, if I am able to communicate my needs effectively, I don’t self-injure to get attention. Behvior is communication, but bad behavior is not always intended to be malicious.

There are different ways of supporting self-injurers. Prevention is the first step. Some people, particularly those with emotion regulation disorders, may benefit from mindfulness and other skills training in a form such as dialectical behavior therapy. Others may benefit from augmentative or alternative communication methods to signal they’re in pain or overloaded. I need a little of both. I practise emotion regulation skills and mindfulness, but sometimes I also need support in the area of communication. For example, I cannot always communicate when I need a staff member to help me with something, be it emotional support or a practical task. Signaling cards, gestures or other alternative or augmentative communication may help in this situation.

When someone self-harms, it is of course important that their physical wounds be taken care of if they cannot do this themself. I find it helps most when someone doesn’t make a big deal out of my self-injuring when taking care of my wounds. Some professionals advocate limiting contact for a day or more after a person has self-injured, reasoning that in that case they have solved their problem already, albeit in a destructive way. Though I find that a bit of distance is good shortly after I self-harm, it is still important to make sure the person is safe from further harm. I do also find that I want to discuss the situation later when I’m calm, so that I can learn what better strategies will help me in the future.

Everyday Gyaan

Unusual Fascinations and Fears in Autism #AtoZChallenge

Welcome to the A to Z Challenge on autism, day 21. Today for the letter U, I will focus on unusual fascinations and fears in autistic people. This is mostly a personal post.

Many autistic people have one or more special interests that they obsess over. In the previous edition of the psychiatrist’s handbook, the DSM-IV, these interests were said to be abnormal either in intensity or focus. I discussed intensity when I talked about obsessive and compulsive behaviors. Focus refers to an interest in an abnormally narrow aspect of a topic. For example, I used to be interested in public transportation, but only insofar as I could memorize bus and metro routes.

Another DSM-IV criterion of autism was an unusual fixation on (parts of) objects. This could include collecting a specific object, as I discussed before. It can however also refer to fixation on parts of objects rather than the whole. A classic example of this is a child who spins the wheels of a toy car compulsively rather than playing with the toy.

Unusual fears are also common in autistic people, particularly those with emotion regulation problems (such as people with McDD). A person with autism or a similar condition often creates illogical relations and jumps to irrational conclusions. For example, Gunilla Gerland wrote in her book A Real Person that she thought that her sister would come home if the newspaper lay in a certain position on the table, so when someone moved the newspaper, she thought her sister would never come home again. In a Dutch book on autism, I read about a boy who heard a grey wolf had been seen somewhere. He was afraid that the wolf would come into his home, even though it had been seen nowhere near his city.

I draw similar conclusions which lead to fear. For example, in our apartment, my husband and i have a taxus on the balcony. Since I know taxuses to be poisonous, I don’t want to go on the balcony, fearing that somehow this taxus thing will kill me.

Fear-inducing things or situations can also be a person’s special interest or fascination. For example, I used to be fascinated by the Brazilian wandering spider, even though I was also fearful of it.

Of course, magical thinking and related fears are common in typically developing children too, but in autistics, they last much longer. Autistic people may also benefit from a different approach to reassurance. The boy in the Dutch book, for example, was reassured when he’d read an encyclopedia article on wolves, even though the article had quite gruesome details in it.

Borderline Personality Disorder and Anger

As you may’ve noticed, I like to pick my topics for my blog posts in the “mental health” category from recovery or awareness challenges. I don’t usually finish the challenge or answer the questions exactly as they’re asked, but I like to get them to zap me out of writer’s block. One such challenge is the “31 days of BPD” challenge. It asks 31 questions – one for each day – about life with borderline personality disorder. The first one asks you to describe why you were last very angry.

Now the thing about anger in my case is that I don’t usually remember why I get angry, or even what happened. Another thing is that I tend to get angry over the slightest things but then get to make my anger about lots of big and only partly related issues.

For example, a litle over a month ago, I got angry because the staff were decorating the unit for Christmas. I don’t even remember what exactly preceded my blow-up. I ended up running off the ward, wandering, and eventually taking some of my cltohes off so that I froze. When security got me back to the ward, I went into seclusion (voluntarily). I was determined I wasn’t going to go back to my ward. I was angry at the staff on my ward in general for there not being enough support for me or structure to guide me through the day. I eventually even said I wanted to be discharged if my only options were to stay in seclusion or go back to my ward (which indeed were my only options). Eventually, I did go back to my ward.

When I’m angry, I don’t really pick fights or become particularly angry at a specific person. Even when I do direct my anger at someone in particular, I usually don’t mean to single them out for my rage. I don’t ever become physically aggressive towands people, but I do usually shout obscenities and may direct my aggression towards objects.

For me, anger is usually accompanied by a fight-or-flight response. I usually flee in anger indeed, as was the case with the rage over the Christmas decorating I experienced last month. It seems in a way anger for me is close to other emotions, such as anxiety.

It is also closely related to sadness. I usually can’t cry unless I’ve been angry first. Often, also, when I’ve been depressed for a while, it tends to turn into irritability and may even turn into rage. The same occasionally happens with excitement, where I get so excited it turns into rage. In fact, any strong emotion in my case can turn into anger. It’s probably because, with BPD, my emotions tend to shift so rapidly. Maybe even anger is the only “bad” emotion I know.

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Things People Don’t Tell You (or Even Know) about Borderline Personality Disorder

Having borderline personality disorder, I have severe and rapid mood swings. Usually, people with BPD experience chronic, low-grade depression, but it can worsen or spiral down into anxiety, paranoia or anger at the drop of a hat. I have experienced that during severe mood episodes, I have similar experiences that are listed as those common in mood or anxiety episodes for people with depression, bipolar or anxiety disorders. The difference is the episodes are usually more severe but last shorter.

Today, I came across a list of things people don’t tell you (or even know) about depression. I can relate to many of these and could add a few that apply to my BPD moods specifically.

1. Most of the things people tell you, are not going to register with you and/or aren’t helpful at the time. “Just accept that you feel like crap”, “just act happier”, or “it will get better”. When I’m in a BPD mood episode, I usually can’t see beyond this episode and am utterly overcome with emotion. Telling me to “just” accept it or “just” act ahppier will seem totally unhelpful, even though it is particularly the “just” bit that is making it unhelpful. It’s not easy, but acting opposite to emotions and acceptance of one’s emotional state do help.

2. It physically hurts. Particularly depression and anxiety can cause physical symptoms. I often experience a heavy weight on my body when in a depressed state. Intense fatigue is another symptom. Anxiety can come with a lot of physical symptoms, such as a racing heartbeat, chest pains, lightheadedness, etc. When you experience these symptoms for the first time, do see your doctor to make sure it’s indeed anxiety and not a physical health condition.

3. Your relationship with food changes to “it’s complicated”. Many people with BPD also experience eating disorders, usually of the not otherwise specified type, where they alternate between anorexic and bulimic or binge eating episodes. Mood episodes can, as the author of the article I linked to says, also cause you to overeat or forget to eat.

4. Some “friends” will let you down, and that’s okay. Being BPD, we often tend to cling to people and have severe fears of abandonment. However, those friends who let us down during a mood episode, probably aren’t worth our frantic efforts to keep them. Friendships are generally hard for borderlines, so especially when not in a severe mood episode, it may be helfpul to invest in interpersonal skills.

5. You feel like you’re absolutely losing your mind. When in a severe mood episode, I can’t see beyond this episode and usually think it is worse than it is. Even if I do recognize that my symptoms are mood symptoms and I’m not going to die of a physical health condition, I often do feel like I’m going crazy. I could’ve been fine hours or even minutes before, but in such a severe emotional state, all there is, is depression, anxiety or paranoia.

6. Everything will start to annoy you. Even you will start to annoy you. My sensory overreactivity gets a lot worse when I’m in a mood episode. So does my general irritabilty. Unfortunately, irritability in BPD is commonly seen as a behavior problem rather than a mood problem./P>

7. Everyday tasks will feel overwhelming. As I said, most people with BPD experience chronic, low-grade depression. For this reason, everyday tasks feeling overwhelming is not just a symptomom of a severe mood episode for me. It could also be related to autism in my case. However, it is true that, when in a severe mood episode, I find everyday tasks even mroe overwhelming than usual. It is important to keep some level of activity even when in an episode.

8. It’s nearly impossible to tell when it’s “just your BPD talking”. With BPD being a chronic mental health condition, we often get used to our irrational beliefs. They however do become worse when in a dysregulated state. At the same time, it is extremely hard to see beyond this mood to our (still distorted) everyday sense of reality.

9. Moods will wreak havoc on your sleep schedule. When depressed, people often experience disrupted sleep. They may sleep more during the day and less at night. On the other hand, borderlines can have periods of hyperactivity similar to bipolar (hypo)mania, when they seem to need less sleep. Sleeping pills may have opposite effects in BPD, causing agitaton and even aggression.

10. Sometimes, you will not feel anything at all. Feeling nothign at all may be a sign of depression, but it is also common in BPD (“chronic feelings of emptiness” is one of the criteria). I personally don’t feel empty or numb that often, but when I do, it’s often the “calm before the storm” and I run an increased risk of falling into a dysregulated mood episode.

11. Your dreams get weird. Both changing moods and the medications many borderlines take can cause you to start having weird, intense or scary dreams. I felt a wave of recognition when I read this in the article I linked to. When I was admitted to the psychiatric hospital in 2007, the psychiatrist asked whether I had scary dreams. I said “No”, but I did say I had these really weird, intense dreams. They quieted for a while and then came back when I went on an anitpsychotic. PTSD is also common among those with BPD, and one of the symptoms of this is recurrent nightmares about the trauma you endured.

12. Your mood will seem totally “logical”. As I said, it is hard when in a severe mood state to look beyond this state. Your mood will also make you feel like it’s the most normal, or even the only state to be in. Some research shows that depressed people lack healthy but unrealistic optimism. Therefore, your thoughts may seem or even be close to reality, but they aren’t helpful.

13. You won’t be able to think clearly about your future. When I was in my worst mood epsiode, even looking a day ahead seemed impossible. I not only had no hope, but no image of even the short-term future whatsoever.

14. Mood episodes distort your view of the past, too. When I am in a severe mood episode, I can not only not see that it will ever get better, but I exaggerate how long I’ve been in this state. This doesn’t happen consciously or with a purpose, but it’s impossible to look not only beyond this state, but also to the past before this state started.

15. BPD makes you feel like you’re alone. You’re not. I often feel like no-one has similar experiences to mine. Of course, it is true that no-one is in my head so no-one has the same expeirneces, but many people do have similar experiences. You are not alone with BPD.

Multiple Complex Developmental Disorder (McDD)

Multiple Comlex Developmental Disorder (McDD) is recognized as a subtype of PDD-NOS in the Netherlands. It is an autism spectrum disorder in which people also suffer from emotion regulation problems and thought disorders. Its proposed criteria according to the Yale Child Study Center are as follows:

  1. Impaired social behavior/sensitivity, similar to that seen in autism, such as:

    • Social disinterest

    • Detachment, avoidance of others, or withdrawal

    • Impaired peer relations

    • Highly ambivalent attachments

    • Limited capacity for empathy or understanding what others are thinking or feeling

  2. Affective symptoms, including:

    • Impaired regulation of feelings

    • Intense, inappropriate anxiety

    • Recurrent panic

    • Emotional lability, without obvious cause

  3. Thought disorder symptoms, such as:

    • Sudden, irrational intrusions on normal thoughts

    • Magical thinking

    • Confusion between reality and fantasy

    • Delusions such as paranoid thoughts or fantasies of special power

In The Netherlands, slightly different criteria are used. For example, social disinhibition is proposed as a possible symptom in the social impairments category.

In the Dutch Wikipedia, McDD is referred to alternatively as juvenile schizophrenia and juvenile BPD. However, most parent-directed sources highlight the intense anxiety which is at the core of McDD. Psrenting, therefore, needs to be aimed at providing structure and boundaries and helping the child reduce their anxiety and emotional lability. Parents need to refrain from showing too much emotion to prevent the child from absorbing the parent’s emotions.

Children with McDD often experience psychotic symptons or full-blown psychosis in adolescence. The emotion regulation problems become less pronounced as individuals with McDD grow into adults, but social problems an thought diosorders often remain significant. Antipsychotic medications can be used to help reduce psychotic symptoms. Even so, most McDD individuals will need lifelong support.

I do not have a diagnosis of McDD, although I think I may meet its criteria. I remember my parents were asked about thought disorder symptoms and unprovoked emotional outbursts at my first autism assessment, but they said I didn’t have them. In reality, I had a lot of bizarre thoughts as a child and still do have them sometimes, and my parents were confused about the questions on unprovoked outbursts. I have, interestingly, foudn that antipsychotics help more with the emotion regulation problems than with the thought disorder symptoms. This does mean that I suffer in silence soometimes, because I do have strange fears and bizarre thoughts, but am too drugged up to act on them.

Emotion Regulation Skills for BPD Sufferers

In the Netherlands, borderline persoanlity disorder is sometimes also called emotion regulation disorder. There were in fact psychiatrists advocating for this name change in DSM-5, but it didn’t happen. Indeed, I myself notice that emotioon regulation problems are, besides having little sense of self, the most prominent symptom of my BPD. Tonight, I noticed how being told that I had to ask a fellow patient to help me with something minor rather than a staff member, set into motion a train of emotions and behaviors that I now realize, at least to some extent, was uncalled for.

Learning to regulate emotions does not mean stuffing them. Rather, it means observing and describing your emotions, decreasing your vulnerability to negative emotions and increasing positive emotions. Identifying what emotion you are feeling is usually the first step, and it can be especially hard. Many people, even those without mental illness, learn that certain emotions are not allowed, so they convert them into others. I for one often act angry when I’m sad or overwhelmed. However, all emotions have value.

Changing emotions requires first observing them without judgment, then letting go of them through for example mindfulness. Mindfulness allows you to experience the coming and going of emotions like a wave. In mindfulness, you shouldn’t try to block or suppress an emotion or try to keep it around. Rather, let emotion run its natural course.

This does not mean acting on emotions the moment they come up. We are not our emotions. Therefore, another step in emotion regulation is choosing whether to act upon your emotion. This seems impossible at first – at least, it does for me -, which is why mindfulness is important. When you have chosen to challenge an emotion, some therapies, like dialectical behavior therapy (DBT), explicitly teach acting opposite from the emotion. The most useful example of this I’ve heard is from a woman who suffered from bipolar disorder. When she was sliding into depression, she was encouraged to become active, while she was encouraged to take it slow when she was climbing towards mania. Other therapies, like rational emotive therapy, emphasize the fact that an emotion doesn’t come out of the blue, and encourage sufferers to challenge the thoughts that lead to their emotions. I believe that challenging cognitions may be best done when emotions are not overflowing you.

Autistic Processing Difference vs. Cognitive Distortion

Today, I experienced a combination of emotional turmoil and sensory overload. Which came first is hard to tell, as I was having oversensitivities already for an hour or so, but the actual reaction, which is either a meltdown or an emotional breakdown, was caused by frustration. Given that both autism and borderline personality disorder come with distress tolerance issues, it is hard knowing which is to blame. It doesn’t really matter, except that the two require different approaches. BPD treatment involves skills training in distress tolerance, learning to shift your idea that you can’t handle frustration to the idea that you prefer not to get furstrated. Autistic distress tolerance issues involve an increased need for routine and time to adapt to a sudden change in that routine.

When sensory overreactivity comes into the equation, it gets more complicated. If this is assumed to be an emotion regulation or distress tolerance issue, people need to learn to accept that sometimes there’s noise they don’t like. When people still didn’t acknowledge my autism, I was often told that it’s other people’s right to make noise, as if I was depriving them of that right with my reaction to overload. In autism, however, noise can be painful, and the right approach is to allow the autistic quiet time away from the overloading stimuli.

Now that I write this, I notice that I’m connoting that the treatment I assuem is perceived to be right tfor BPD is really not that right at all. In fact, I believe that you cannot assume that a problem with distress tolerance is ever true unwillingness to accept that things can’t happen on your terms all the time, which is what is assumed in personality disorders. There are some people who are truly unwilling to take others’ feelings into account, but this si much rarer than the assumption that people are unwilling to take others’ feelings into account. I realize that cognitive distortions are not necessarily willful, and that the thought that you can’t handle any frustration is not the same as the thought that the world revolves around your need for gratification. What I mean to say, however, is that most people, and especially autistic or otherwise neurodiverse people, do not just think they have difficulties. We genuinely do process stimuli differently, and this means that “can’t” is not just a cognitive distortion most of the time. That doesn’t mean that autistics doon’t have cognitive distortions, too. What it means is that you need to take into account autistics’ genuinely different processing style when assessing or treating cognitive distortions. As I was being told for the umpteenth time that my daily living skills deficits are largely due to fear of failure, I begun to wonder whether NTs can truly evr make such a judgment.