Tag Archives: Tantrums

Borderline Personality Disorder Awareness: BPD Explained

May is mental health month in the United States. It is also borderline personality disorder awareness mnth. BPD is my current diagnosis. I have written a few posts on this condition already, but most required some previous knowledge of BPD or mental illness in general. In honor of mental health month and BPD awareness month, I am going to write about my experiences with mental illness in this post and will share facts along the way.

I have always struggled with rapidly shifting emotions and mood swings. If it had been popular at the time and my parents had sought help for me, I might’ve been diagnosed with a childhood-onset mood disorder. I do not have bipolar disorder or major depression now, but these conditions are thought to affect children differently. In the current edition of the psychiatrist’s manual, the DSM-5, there is a diagnosis for children with severe mood swings, dysphoric (sad or angry) moods and extreme temper tantrums. This disorder is called disruptive mood dysregulation disorder. It is thought not to be lifelong, as it can only be diagnosed in children under age eleven.

I remember as a child of about nine already experiencing suicidal thoughts and making suicidal threats, particularly during meltdowns or tantrums. This is not necessairly a sign that the child is going to attemtp suicide – I never did -, but this is also not just “attention-seeking”. It is, in fact, a sign that a child is in serious distress.

Making repeated suicidal threats or attempting suicide is one of the core symptoms of borderline personality disorder. It is commonly thought that most people with BPD only threaten suicide and “aren’t serious about it”. In fact, however, about ten percent of people with this diagnosis die of suicide.

As a teen, I started self-injuring. Self-injury is also a core feature of BPD. This may have many functions other than “attention-seeking”. Of course, some people with BPD do not know how to ask for attention and instead use self-harm as a way to get it. Even then, attention is a human need and withholding it altogether will not usually solve the problem. Other functions of self-injury may include to express pain, to numb out feelings or conversely to feel something when one is feeling empty or numb.

Chronic feelings of emptiness are another symptom of BPD. Generally, a person with BPD is somewhat depressed or numb. This feeling of numbness is also common with major depression, post-traumatic stress disorder and dissociative disorders, all of which commonly co-occur with BPD.

Dissociation is the feeling of being disconnected from oneself, one’s thoughts or feelings or one’s surroudnings. Symptoms of dissociation, particularly depersonalization (feeling “unreal”), are common in many mental illnesses. The most well-known specific dissociative disorder is dissociative identity disorder, also known as multiple personality disorder. My former therapist, who diagnosed me with BPD, believed that BPD and DID/MPD are on the same spectrum.

Paranoia is also common in people with BPD. However, as opposed to people with schizophrenia or related disorders, people with borderline personality disorder experience paranoia only briefly when under stress. For example, when I am overwhelmed with eotions, I tend to mistrust people and situations, while I am not usually paranoid.

Lastly, people with BPD have difficulties in relationships. Firstly, they often have an intense fear of abandonment and go to great lengths to prevent people from leaving them. Some may push people away (“I abandon you before you can abandon me”). Others, like me, are excessively clingy. People with BPD may also alternate between idolizing and devaluing the people who are important to them.

No two people with BPD or any other mental illness are alike. For a diagnosis of borderline personality disorder, you only need to meet five out of nine criteria. I meet between six and eight depending on how you look at it.

Borderline personality disorder bears similarities to post-traumatic stress disorder, dissociatve disorders and mood disorders, particularly bipolar. However, the difference between bipolar and borderline personality disorder is that people with bipolar disorder experience long-lasting mood episodes, whereas people with BPD have rapidly-shifting moods. BPD cannot be diagnosed in children, although of course they can have mood swings. They may then be diagnosed with disruptive mood dysregulation disorder. Psychiatrists are beginning to diagnose BPD in adolescents starting at arund age fifteen. This is good, because, the earlier someone gets treated, the more likely they are to reach recovery.

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Diary Entry: September 21, 1999

Mama’s Losin’ It has some great writing prompts this week. One is to share a diary entry from when you were younger. You are allowed to make one up, but I’m going to share a real one. I was orignally intending to share one of my myDiary.nl entries. This was (and I think still is) a diary site in the Netherlands where I kept a diary between age sixteen and eighteen. I however deleted all entries from the site and the document I saved them to is in a format I can’t read now. Then I thought of sharing an entry from my earlier offline diary. It dates fromw hen I was thirteen. It is translated because the original was in Dutch, and I altered some bits for privacy reasons, but it is a real entry. I at the time addressed my entries to a fictional character named Claire. Probably got the idea from reading Anne Frank at the time. This is a short entry, because it is my second attempt at sharing something (computer crashed), and I am too lazy to translate a long entry now.

Tuesday, September 21, 1999

Dear Claire,

I am once again the home bitch. I have a figurine in the shape of a mouse. Its tail broke off and I attempted to make it, but that didn’t work. Logically, since tape doesn’t stick to stone. My sister got involved, and so now I’m in my room. Mom by the way says that my sister never gets attention and I always want attention, but she can decide for herslef whom to give attention. So, it is the day of arguments today.

Yours, Astrid

Don’t ask me what the broken figurine and my sister getting involved had to do with my spending time in my room. I probably had a tantrum over the figurine breaking, but not sure what my sister or “always” wanting attention had to do with it. I now realize my behavior did draw attention to me, but that of course is not the same as wanting attention.

Mama’s Losin’ It

We Don’t Stop Playing Because We Grow Old

This week’s spin cycle theme is “grow”. Ginny Marie over at Lemon Drop Pie asks: “Are your kids growing like weeds? Are the weeds growing in your garden? Does your garden have vegetables growing? Or are the veggies in your fridge started to grow mold?” Since I don’t have kids, a garden or a fridge, I need to invent another topic to post about. After reading Ginny Marie’s contribution, I thought of something. I want to write about growing up, too, but I struggle. As a kid, I always feared growing up, because it’d mean I needed to stop playing.

For a long time, from around age twelve on, I thought playing meant you were childish and being childish meant you were bad. When I was eleven, the school psychologist wanted me to become a residential student at the school for the blind. My mother explained to me that I was troubled because I had too many toys. I till this day don’t see the connection. Sure, I had quite the toy collection, but so did other kids. Sure, I had trouble making friends, and my interests were not the same as those of my age peers. I doubt they were all into books, which my mother said I had to be into in order to fit in. Books or music. While my age peers in the neighborhood were into music, I didn’t fit in once I listened to the music they were into and had Backstreet Boys posters covering my walls. Not that this period lasted long, because I’d quickly had enough.

Besides, I wasn’t troubled because I had few friends. That wasn’t the reason the school psychologist wanted to institutionalize me. The reason was my meltdowns and tantrums, and I have no clue what they had to do with toys. Sure, I had a tantrum when my Barbie doll’s leg broke off, but I had and still have similar outbursts when my computer crashes. Maybe that means computers aren’t the right interest either.

However, I internalized the idea that to play is to be childish and to be childish is bad. I remember when I was thirteen I kept track of my behavior problems, like tantrums, and soon added any sort of childlike behavior, including playing with Barbie dolls. I was going to regular education in a month, and it had become very clear to me that regular kids my age don’t play with Barbie dolls.

Once at regular school, I listened to the right music and read the right books. It didn’t change my outcast status. It didn’t lessen my meltdowns. It didn’t make me not fear growing up. It did make me grow old. We don’t stop playing because we grow old, after all, but we grow old because we stop playing, according to George Bernard Shaw.

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Me Want It (But Me Wait): Teaching Self-Control to Children

In the summer of 2013, Sesame Street released a fabulous video in which Cookie Monster is learning about self-control. Self-control is an important skill for children to master, as it will help them succeed at school and manage their behavior at home. Naturlly, young children have no self-control. Children with ADHD or similar issues may lack self-control up till a much older age./P>

There are many ways in which a parent can teach a child self-control. With babies, you need to begin by modeling. Remain calm yourself when your child is distressed. There may be various ways in which a baby is calmed. Some need lots of physical contact, while others need to be laid down for a bit. People vary in their opinion on self-soothing, ie. whether you need to attend to a baby when crying or ignore them. I think it depends on the baby.

Listening skills are a first requirement. Teach your child to come when you call them. Rigidly enforcing social skills like eye contact may not be appropriate for some children, like those with autism, but your child needs to learn to listen to their name and to attend to you.

When a young child cannot get what they want, cannot do what they want to do, or for another reason gets frustrated, they may tantrum. For a one-year-old, consequences don’t work, but distraction does. When your child is a little older, like from the age of two on, use brief time-outs as a consequence for tantrums. Like I’ve said before, make sure your child knows when the time-out is over. This means for a young child that you will need to call them back out of time-out. Again, this reinforces listening skills. For older children, you can ask that they come back when they’ve calmed, but this may not work for children who are still unable to understand their own emotions, like most children with autism. You can point out signs of them being calm again when you call them back out of time-out. This may help children learn about their own emotions and behaviors.

Besides giving consequences for impulsive behavior or tantrums, it’s also very important to reward self-control. If you’ve promised your child ice cream after dinner and they’ve behaved according to your reasonable expectations, give them the ice cream. That way a child learns that not only will impulsivity be punished, but also that patience and self-control are indeed going to get you farther along in life.

Motivation is not the same as self-control. If a child can focus fine on a computer game but not when tidying their room, that’s not a problem with self-control. It is more likely that they lack the motivation to tidy their room. It is however possible to change your attitude. Children will need help with this. For example, as a parent, you may turn tidying the child’s room into a game. You also need to model the right attitude. If you approach tasks like they’re nasty chores, much energy will go into motivating yourself to do the task. If you approach them with a positive attitude, you will find it’s much easier to stay motivated and thereby use your self-control skills. With children (and as adults!) who have a special interest, you can use the special interest as part of the nasty chore.

Of course, there are other skills required for completing tasks besides motivation. Your child will need to have the attention span to focus, the working memory to remember what they need to do, and the organizational skills to plan their task and get it actually finished. Until I did my research for this post, I thought this was the problem with me, but then I realized I can focus fine on this blog post, which requires reading and summarizing multiple sources. I’m now thinking that motivation may be an issue for me, and see above for solving that.

However, when someone truly has poor atttenion, working memory and/or organizational skills, these skills still can be trained at least in children. Computer-based games that reinforce memory or attention have some evidence of effecitveness behind them. Similarly, there are games that reinforce self-control directly. You know the game of stop and go, where a green light means go and a red light means stop? When the child is used to these rules, reverse them and your child will practice keeping their impulse to follow the original rules in check. I’m pretty sure there are computer-based variations to this game.

Handling Tantrums and Meltdowns in Children with Autistic Spectrum Disorders

Many children with autsitic spectrumd isorders, including pathological demand avoidance syndrome, have meltdowns. They can have different causes. A child may act out because they’re impulsive and find it hard to delay gratification. This is different from being spoiled, although the difference may be subtle. I still act out when I ask for help and am not told when I can get it. If someone is clear when they can offer me what I need (I don’t act out for not getting something I merely want, for clarity’s sake), I usually don’t have a meltdown.

On the other hand, as a child, even up to early adolescence, I used to have tantrums when my sister got candy or a gift and I didn’t. This is not normal for a neurotypical adolescent, but that doesn’t make it not a tantrum. An autistic child beyond the typical age for temper tantrums may not be able to take the other person’s perspective, so they may feel they’re being mistreated. This can be explained in a social story, but if a child still tantrums when they’re simply not getting their way, treating it as a regular temper tantrum is best.

Some children or adults act out because they’re frustrated and don’t knwo how to solve a problem. This is something inbetween a temper tantrum and a meltdown. I often used to be frustrated if my computer was having problems, but I would not use strategieis that would solve the problem, either socially acceptable (asking for help) or not (screaming for help). In one case when I was sixteen, I totaled my computer trying to make it work again, losing five months worth of important documents.

According to Adelle Jameson Tilton and Charlotte E. Thompson, authors of The Everything Parent’s Guide to Children with Autism, 2nd edition, a child can also have a meltdown because they’re denied something they want, but they lose total behavioral control and don’t “switch off” suddenly again if the wish is granted. Children in a meltdown do not take precautions to prevent themselves from being injured. They will not care if someone is watching or reacting, and the meltdown winds off gradually. I had meltdowns often when I was at the independence training home, throwing objects in my own apartment while no-one was there. I did need help cleaning up the mess, but usually I had calmed down and wasn’t asking for what I had originally wanted once the staff helped me clean up.

From my experience, I can tell that a meltdown can also occur when I am overloaded either cognitively, emotinally or sensorially. I remember a few weeks ago completely melting down even though I had gotten the attention I’d wanted already, because I couldn’t cope with overwhelming emotions and had failed at channeling my overload. When later asked why I had had this meltdown, I had no clue. This is in my experience a distinctive characteristic of a meltdown: meltdowns do not necessarily have an underlying reason.

Meltdowns can also happen after a small seizure, according to Jameson Tilton and Thompson. I read in my neuropsychology textbook that aggression during a seizure is very rare and usually stereotyped, but aggression after a seizure may be more common. If a child seems to be totally uninvolved in their environment for a few minutes before mtling down, this could be a sign of a silent seizure.

In children with pathological demand avoidance particularly, a meltdown may come on as a result of anxiety. Phil Christie and others in their book Understandign Pathological Demand Avoidance Syndrome in Children, make a rigid distinction between aggression with the purpose of avoiding demands and meltdowns out of anxiety, but in my experience this distinction isn’t always clear. After all, demand avoidance often stems from anxiety and/or overload. In situations where an autistic or PDA child is overloaded or panicking, it is important that adults reduce the demands placed on the child, use simple language and do not enforce social niceties such as eye contact.

It may help to evaluate your own behavior as the adult managing a child’s meltdown. You can ask yourself whether the demands you placed on the autistic or PDA child were reasonable, whether they were truly non-negotiable (so that you were willing to endure a meltdown for them), whether you reacted properly or may’ve overreacted, etc. Remember, a meltdown, unlike a temper tantrum, is not a power play, and as a parent, carer or teacher you shouldn’t make it about power.

If the person who had the meltdown is an older child or adult, and you have a trusting relationship with them, involve them too in the evaluation process. (Note: if you do not have a trusting relationship with them, this is something you’ll need to work on!) Evaluating should be done in a non-judgmental way, avoiding the blame game. For some children, social stories may be appropriate, while others can tell you what you need to do differently to help them prevent or minimize a meltdown. This is again not to say that you’re to blame for the meltdown, but many children and adults in a meltdown do need external support.

Mood Disorders in Children

Mood disorders in children, especially bipolar disorder and explosive mood disorders (also known as severe mood dysregulation and called disruptive mood dysregulation disorder in DSM-5), are controversial. Many children after all have temper tantrums, hyperactivity, sleep problems, etc., yet do not need a diagnosis. I found a list of fifteen symptoms of childhood bipolar disorder, of which I easily met the required four as a child. However, I never had the classic symptoms of bipolar disorder and do not have bipolar disorder now that I’m an adult. I did have mood disturbances as a child, but these could also be due to my autism and emotion regulation disorder.

Dsiruptive mood dysregulation disorder (DMDD) has much stricter criteria than those proposed in the above article for childhood bipolar disorder. In order to be diagnosed with DMDD, a child needs to meet many criteria, including temper outbursts on average at least three times a week over a twelve-month period, persistent irritability most of the day, nearly every day, symptoms occurring in at least two contexts and being severe in at least one (home, school, or with peers), etc. The diagnosis cannot be made in a child under six and should not be made for the first time in adulthood.

The diagnosis of disruptive mood dysregulation disorder cannot co-occur with oppositional defiant disorder (ODD), intermittent explosive disorder or bipolar disorder. If a child meets both criteria for DMDD and ODD, only the mood disorder needs to be diagnosed. If a child has ever had a manic or hypomanic episode, only the diagnosis of bipolar disorder must be made. For childhood bipolar disorder, the same criteria for a manic or hypomanic episode apply as for adults, except that the duration may be shorter. According to the accompanying text in DSM-5, rates of conversioon from DMDD to adult bipolar disorder are low. Adults with a history of DMDD are more likley to suffer frm depression or anxiety.

Mood disorders, including DMDD, can however co-occur with other disorders, such as ADHD or autism. ADHD and autism can also mimic a mood disorder. For example, if a child with autism or ADHD won’t stop talking, this shouldn’t be confused with the talkativeness seen in a (hypo)manic episode. However, mood symptoms can also be missed if a child has ADHD or autism, because irritability, temper outbursts, etc. are seen as a normal part of the ADHD or autism.

If a child’s mood disturbances are interfering with their daily functioning, take them to their doctor or psychologist for assessment. It isn’t always necessary to give them additional labels or prescribe them medication. Sometimes, just a change in handling strategy may help. You could’ve noticed this already, but, with a problem child, it’s often helpful to have a professional be your second pair of eyes.

Disciplining the Autistic Child

Many autistic people, if not all, exhibit challenging behavior, such as anger, aggression, obsessive-compulsive behaviors and sterotypical (self-stimulatory) behaviors. Whether and how you intervene with these behaviors, depends on their function. Autistic children exhibit normal childhood misbehavior too. For example, they may nag and tantrum when you won’t give them candy, refuse to tidy their room, or be rude. This behavior can be punished in the same ways that you would use for a same-age typical child, such as by time-out, loss of computer or TV time, etc. Take into account that some consequences may not work for your child. For example, an aloof autistic may find time-out comforting, and most autistics do not get non-verbal cues. Therefore, even with an older child, you need to say explicitly that you are disapproving of their behavior. You also need to make sure the autistic child understands what they are punished for. If they are rude, for example, explain what they said that was rude, how they can make amends, and what they need to do differently the next time. When sending a child to their room, onto the naughty chair, etc., make sure they understand when they can come back. I was often sent to my room and stayed there for hours because I didn’t know when it was okay to come back. Don’t tell a child to come back when they “can behave”. Instead, set a specific time or make concrete rules on what they must do to come back.

As I said, whether and how you intervene with your autistic child’s behavior, depends on its function. Often, a function is presumed based on typical chhild development. For example, suppose your child refuses to tidy their room. You assume they are defiant or lazy, but do they know how to tidy their room? Even if you’ve shown them before or they’ve helped, you cannot expect all autistics to know when or how to do their own tidying or cleaning. I remember when I went to live independently out of an independence training home, my support worker told my knew staff that I knew how to clean. I did, but I had no idea where to start in my new apartment. This may in part be due to blindness, but even as I became familiar with my apartment, I still didn’t know how to organize my cleaning.

Then there are those behaviors that are often due to autism, such as sensory overreactivity, self-stim, or meltdowns. Give yoru child a time and place to engage in self-stim or compulsions, of course with the premise that they won’t damage property or harm themself or others. In 2007, when I was diagnosed with autism, my diagnostician told me that I really needed to unlearn to twirl my hair. Indeed, my parents had told me countless times that I needed to stop this behavior. While it is true that it is annoying and distracting to others, autistics need to be allowed their time to stim. Home is where a child should be safe to be themself. When talking about self-stim and how annoying it is when it’s an autistic doing it, I often refer to a lecture I was going to in college prep. Two students were modeliing appropriate and inappropriate communication skills in their filed. One of them was constantly clicking his pen, and I was assuming at first that this was meant to be inappropriate. It wasn’t. My point is, neurotypical people stim too.

When an autistic person becomes aggressive, be it verbally or physically, you need to intervene. However, it is still important to recognize the function of the aggression. For example, if a child constantly screams or hits when there’s loud noise, screaming at them to stop, will make it worse. Time-out in a quiet place where the child can rage away may be the most appropriate intervention. I strongly disagree with locking up an aggressive person in their time-out area unless there is no other way (except for restraint) to get them to stop. Locking the child up should never be used as a threat or for punitive purposes, and I doubt its effectiveness for verbal aggression. That may be my blindness though, as verbal aggression to me is as scary if it happens in the locked room next door. As for restraint (physically holding the child down), that’s only okay if a person is physically aggressive towards people.

One important point I want to make to finish off: be mindful of your own feelings when handling your autistic child. The moment you start feeling powerlessness or feel you’re going to lose your temper, step back. My parents often lost their temper with me, and this usually only made the situation much worse. I won’t say that you can always feel calm when handling your autistic child’s behavior, but strong emotions can be best handled away from your likely already distressed child.