Do you have nagging thoughts that you’re not good enough? Are you secretly assaulted by self-doubts? 


You’re not alone.  Those private self-bullying conversations are common to many of us. Often called the “inner critic,” this negative, self-critical voice can undermine how we feel about ourselves, our goals, and our effectiveness in life and work.


According to self-compassion researcher Kristin Neff, Ph.D. (2011), the antidote for self-criticism is self-compassion. Self-compassion is treating ourselves kindly – accepting our strengths and imperfections and treating ourselves with the same goodwill we would share with someone we care about.


Research indicates that self-compassion is not only better for our well-being but a more effective motivator than fear (Neff, 2011).  Self-compassion can quiet the inner critic, opening doors to greater confidence and feelings of security. This kind of goodwill guided inward boosts the body’s capacity to produce oxytocin, a hormone that influences social interaction and emotional bonding. Conversely, fear provokes feelings of insecurity and self-doubt, putting our brains and bodies on alert and triggering a fight-or-flight stress reaction.


Research reveals that self-compassion is not just a soft, feel-good choice. Rather “self-compassion involves valuing yourself in a deep way, making choices that lead to well-being in the long term” (Neff, 2011, p. 166). By offering themselves self-compassion, people are more able to cope with tough situations like illness, divorce, loss of job, and more likely to engage in healthier lifestyle behaviors such as nutritional eating and exercise (Neff & Germer, 2019).
If you want to flourish in your personal and professional life, conquering the inner critic can help you reach your full potential. Here are a few approaches to help you create a kinder, more productive relationship with yourself.


1 – Notice what you’re thinking about. Acknowledge the thought and then remind yourself that the inner critic voice is just a thought – that just because you’re thinking about something, it is not necessarily true. Remind yourself that thoughts and attitudes can be inaccurate, exaggerated, and biased by our personal experiences. 


2 - Respond to the inner critic by replacing negative critical thoughts with more accurate information. For example, a thought such as “I make too many mistakes, I’ll never reach my goal” can be balanced with a statement such as “I learn and grow from my mistakes and each one is another step toward reaching my goal.” Try writing down repetitive inner critic thoughts and the alternative statement you want to tell yourself.


3 – Release the Inner Critic. This strategy to manage the inner critic may seem silly, but many find it useful. When you notice that critical inner voice, release it. For example, if you’re working on a project and thinking a self-critical thought, you might toss it in the garbage can or throw it in a jar and tightly close the lid. This strategy can offer a respite so you can move forward toward completing the task.


4 – Embrace imperfection with compassion. Self-compassion is kindness channeled inward toward ourselves. Neff and Germer (2019) suggest that rather than resist our internal bullying, we can accept that life is difficult – that we are all imperfect beings in the human condition living imperfect existences. Try this:

• Pause.
• Gently ask yourself the question “What do I need now?”
• Grant yourself a moment of warm-hearted self-compassion, simply acknowledging that you are where you are, even if you don’t know the answer or how to respond to your needs or the situation right now.

5 – Remember you’re part of a larger whole. Check in with a supportive friend, colleague, or family member when your inner critic is shouting and you need a boost. Discuss the situation, request a reality check and some cheerleading. Have a “shortlist” of people you trust and can count on to offer encouragement and compassion when you need it.

6 – Each day be kind to yourself with self-care. Can you offer yourself a few minutes to take care of your mind, body, spirit? For example, take a walk, go for a swim, do some yoga, or engage in a mindfulness practice.

** This post is for educational purposes and should not substitute for psychotherapy with a qualified professional.

https://www.psychologytoday.com/us/blog/flourish-and-thrive/201912/is-your-inner-critic-driving-you-crazy​

For some, the holidays are synonymous with a strong sense of familial closeness and love. But it can all be quickly sabotaged when relatives trigger each other, and chaos ensues. You’ve waited all year to be with those who you love, and then people don't getting along.

This time of year is also problematic if you are isolated without a close family support system. Loneliness is magnified. Memories flood in and what was painful becomes intolerable. Over half of Americans are socially isolated. (1) The medical wards are usually full because many people have increased problems around drugs and alcohol. It is helpful to understand the powerful nature of these childhood memories and how they are manifested in adulthood. 

Triggers
Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.


One of the most perverse aspects of the human experience is that the deeper your connections to others, the stronger the triggers. It is the reason why family dynamics can be so volatile. Most of your reactions to the world are programmed by your parents during the first 12 years of life, especially the first few. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from a chaotic family, your reactions to the present will be intense, although the present “danger” might be minimal. You needed to be hypervigilant as a child and your nervous system continues in this state as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.


During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder the Holidays can be problematic. Landmines are everywhere.


Suggestions
Now it’s the Holiday season, you have missed your family and want to be with them. What are you going to do? How are you going to handle if the situation if you are being triggered? Because it is likely to happen at some level. Here are a few suggestions, most of which I have learned the hard way. 

• Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
• Don’t give unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent at any age?
• Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
• Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
• If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
• Be curious and genuinely interested in what your family is up to.
• Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.

Appreciate the fact that you have the opportunity to be with your family. Loneliness is crushing. If you are in this situation, you have my deepest consideration. We will talk a lot more about this later. Reconnecting with the world is a significant part of your healing journey.

The Mighty | By Kristi Hugstand
https://themighty.com/2019/10/husband-suicide-warning-signs/?fbclid=IwAR0Wo6UO4C4y2F4obrK_L6Wq0p2S70z7EXx_FHFdecQc8yKsNxzi3vi1whc

My husband, Bill, died by suicide on an autumn day in 2012 after months of deteriorating mental health.
Through the wise and regretful lens of time, I now see that Bill’s suicide plans were plain – if not obvious. Today I live with the regret of failing to recognize the severity of the warning signs he showed in the weeks and months before his death. I share these here in my desperate hope for a future with fewer devastated wives, fewer heartbroken parents and, most importantly, fewer Bills.


He lost interest in things he once loved.
Bill wasn’t just a gym rat; he was a fitness fanatic. He competed in bodybuilding competitions across the country. He prioritized his workouts above everything else. But in the months and weeks before his suicide, Bill didn’t seem to care as much. When a friend canceled workout plans, he wouldn’t go to the gym on his own. His muscle-ripped, 250-pound frame began to shrink. He just didn’t seem to care as much.
He talked about death.
It was usually theoretical, almost like he was just making obligatory conversation, but Bill frequently, even daily, talked about death. He mentioned deceased friends or family, stories from the news or even hypothetical scenarios about his own. I knew Bill was depressed, and while the talk was morose, I assumed it was typical of someone with depression and anxiety. What I didn’t know was that it is a hallmark warning sign for suicide.
He was abusing substances.
Bill didn’t just abuse substances; he was completely dependent on them. After years of steroid use to help him excel in the competitive bodybuilding world, Bill “needed” a host of prescription painkillers and anti-anxiety drugs to combat those side effects and cope with his deteriorating mental health. Sometimes Bill would quit these cold-turkey, sending him into a spiral of withdrawal that seemed worse than the dependence. It was a cycle he could never seem to break.
His friends died by suicide.
Bill wasn’t a stranger to suicide. In fact, three of his friends had died by suicide. At the time, I had no idea that knowing people who died by suicide increased your risk for doing the same. Now I do.
He isolated himself.
While he looked like the quintessential bodybuilder, Bill was a big softie at heart. He loved people. He loved helping friends. He loved talking to strangers. He called his parents regularly. But before he died, Bill became quieter, more subdued. His happy, easygoing self was clouded with worry and sadness. Once he disappeared for long enough that I called the police to report him missing. He returned, completely surprised by my panic, simply saying he just needed some time to think. As Bill cut himself off from the people he loved, it was a clear warning he was in trouble.
He’d attempted it before.
This wasn’t the first time he’d reportedly harmed himself. Months before his death, I awoke to a suicide note, short and to the point, and panicked before hearing Bill in the shower. I ran into the bathroom, and Bill told me he’d taken a whole bottle of pills the night before. After three days at the hospital, Bill was released.


These warning signs aren’t just lists included on suicide prevention websites – even though they appear on many. They’re the regretful reflections of a devastated wife. As autumn approaches, it is a significant season for me. October 10 marks the seventh anniversary of Bill’s suicide – seven years I’ve replayed these behaviors in my head, wishing I’d recognized them for what they were.
As I brace for the memories inevitably triggered by this date, it’s almost appropriate that September, National Suicide Prevention Month, precedes it. As I consider how best to honor my husband’s memory, I can think of no greater way than to help prevent more losses. If someone you love is exhibiting warning signs for suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255, or call 911 for immediate help.


RESOURCESIf you or someone you know needs help, visit our suicide prevention resources.
If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.

Ace* started therapy when his girlfriend of three years moved out of their home. He was depressed, lonely, and sad. At times, he said, he felt like letting go. “Life just doesn’t have meaning for me anymore,” he said. “I don’t understand what happened. How could she just stop loving me? What went wrong?”


Noreen* suffered some of the same feelings when her college boyfriend ended their relationship. “He said he just didn’t want to be tied down. But I think he found someone else. I wasn’t good enough for him.”


What Ace and Noreen were struggling with is not unusual. According to many studies, the end of a marriage or a romantic relationship is high on the list of life stressors at any age. One recent study found that many individuals who are not normally depressed can experience symptoms of depression after a breakup. In her research into the stress of breakups, psychologist Kristin Gillen of Kalamazoo, Michigan, found that “romantic relationship issues are among the most common presenting concerns in university counseling center settings.” 


It might seem like a no-brainer to understand why the end of a loving connection with someone, especially someone you thought you might spend the rest of your life with, is not only stressful, but also painful. 


But here’s something that we don’t always think about in connection with a breakup: The end of an intimate relationship can also damage the way that you think about yourself. In other words, you can lose your sense of who you are in the world, what psychotherapists call your “self” or your identity. Understanding this loss of identity can help you figure out how to recover.


When Jules* left her boyfriend of five years, she expected to feel nothing but relief. “We were angry at each other all the time,” she said. “But I didn’t realize how much I took it for granted that he would be there when I came home. It’s lonely in the apartment without him.


"But there’s something else. We had a lot of mutual friends. We’d gone to college together, and we worked together, so our friendships were all woven together. Some of our friends have stayed connected to both of us. Some have chosen sides. But that’s not the problem. What’s really bad is that I don’t feel like myself with them anymore. I’m…I don’t know…they don’t treat me the same, and I don’t feel the same. It’s subtle. I can’t always pinpoint what’s happening. But it’s there…” 


Popular literature is full of examples. Robert B. Parker, author of the well-loved Spencer mysteries, describes the loss of self in his book Early Autumn:
 
You’ve been through a lousy divorce. For sixteen years or more you’ve been a housewife, and now all of sudden there’s no man in the house. You’re a little lost. 


Author Lauren Layne describes a similar experience in one of her popular romance novels. A thirty-five-year-old woman who discovered that her now-dead husband cheated on her says:  “I’m just so aware that my only identity these days is widow. And even more alarming, even before Brayden died, my only identity was wife. Before that it was girlfriend. I just have the weird sense that I’ve lost sight of who I am. If I ever even knew.” 

That loss of identity can happen after almost any breakup, even if the relationship was short and there was no marriage involved. The truth is, it isn’t a simple loss of identity, but a loss of a feeling of continuity as well. We often feel defined not just by a relationship, but within it. Some, or many of our friendships may be tied to that partnership. We often feel that people only see us as part of the relationship, so it’s not surprising that when it ends, we might feel that we’ve lost the essence of who we are—our self.


Psychotherapists today are very much aware that our sense of self is normally somewhat fluid. In other words, we don’t have one single way of being, but rather what the psychoanalyst Phillip Bromberg calls “a multiplicity of self-states,” all living under an umbrella of an overarching sense of coherence and “me-ness.” It is this mixture of “me’s” that leads to a feeling of becoming a childhood self when we go home to visit our parents, or allows us to feel pleased with ourselves one minute and self-critical in the next. It’s a sense of being able to contain all of the different selves in a cohesive and coherent, if loosely woven whole that helps keeps us resilient.


Interestingly, according to studies in the fields of attachment and neuroscience, our sense of identity is often framed within the context of others. That’s why we say things like “he brought out the best in me,” or “she brought out a side of me I’ve never seen.” It’s not that someone else can actually “make us” feel a certain way, but that we interact with different parts of ourselves in relation to different people. In the best of circumstances, a love partner can support and know a wide range of our “selves” and help us feel an overall sense of well-being and self-satisfaction, even while recognizing and accepting some of our less likeable “selves.”


When a relationship falls apart, it’s often because a partner isn’t serving that function, and we feel more like our worst selves in interaction with them. But even when that’s the case, the end of a relationship can leave us feeling lost, disorganized, and without a coherent sense of who we are.   


Dr. Gillen studied a particular aspect of this loss of self at the end of a relationship, in order to see if she could understand something about the ways that we recover from a breakup. She looked at a specific dynamic, called Sense of Coherence (SOC), a concept was first described in the late 1970’s by Aaron Antonovsky, who was trying to understand what made some people more resilient than others. SOC is, in general, a feeling that things make sense and will work out (albeit not necessarily as planned) in the end. In other words, as Dr. Gillen explains, SOC consists of three basic components: a sense that things are comprehensible, manageable, and meaningful. 


When a relationship ends, we can lose that sense of comprehensibility, manageability, and meaningfulness, and along with it, we can lose a sense of our own cohesive self. That self can, and usually does, return over time, although frequently with some new components added as a result of both the old relationship and the breakup. 


But Dr. Gillen found that a Sense of Coherence offers an extra factor in healing from a breakup. She found that individuals in her study who had a strong SOC managed their pain in part by looking at some of the ways in which they had grown from the experience. Sometimes they saw the relationship itself as having been a learning experience, and sometimes they saw the breakup as an opportunity for personal growth, and sometimes a little of each. 


Being able to see the ways in which you grow after a breakup doesn’t take away the sadness, pain, or feelings of loss. But it can help increase your resilience and make it easier to bounce back from the experience. Some of us have more difficulty looking for these signs of growth than others, and for some of us it takes longer to get there. But if you start looking, you’ll very likely start to see some ways that you have grown in the process. And that growth is going to be part of the self that you move forward with into the rest of your life.  

​https://www.psychologytoday.com/us/blog/the-couch/201911/after-breakup-putting-yourself-back-together

Psychotherapist Salvador Minuchin developed the concept of enmeshment to characterize family systems with weak, poorly defined boundaries. The entire family may work to prop up a single viewpoint or protect one family member from the consequences of their actions. In these family systems, individual autonomy is weak, and family members may over-identify with one another. For example, a child may be unable to see their own interests as distinct from their parent’s and may defend that parent’s interests even when doing so is harmful.
Enmeshment inevitably compromises family members’ individuality and autonomy. It can also enable abuse. Abuse within an enmeshed family system is a unique sort of trauma. Some survivors of such trauma may not recognize their experiences as traumatic and may even defend their abusers. Because boundaries are weak in these family systems, family members who correctly identify their experiences as traumatic may be ostracized or even labeled as abusive.
CHARACTERISTICS OF ENMESHED FAMILIESMost healthy families are loyal to one another and may share certain values. In an enmeshed family, this loyalty and shared belief system comes at the expense of individual autonomy and well-being. For example, the entire family might support the idea of the father as a wonderful parent or great leader, even though he is physically abusive.
Enmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions.
Some characteristics of enmeshed family systems include:

• Each family member fills a specific role. In most cases, these roles enable dysfunctional behavior from other family members. For example, the family peacemaker may smooth over conflicts the family abuser creates or might guilt other family members for attempting to build healthy boundaries.
• Enmeshment often begins when one family member has a mental health condition or substance abuse issue. Enmeshment normalizes harmful behavior and can be a way to avoid treatment.
• Enmeshed families often view dissent as betrayal.
• Enmeshed families may demand an unusual level of closeness even from adult children. For instance, an adult child with children of their own may be expected to spend every holiday with the family. If they spend a holiday with in-laws or with their own family, the enmeshed family may shun or otherwise punish them.
• Family members’ emotions are tied up together. It can be difficult to discern where one person’s emotions begin and anther’s end.
• There may be unspoken family norms that family members take for granted. Outsiders may rightly view these norms as unusual or dysfunctional. For example, an enmeshed family may have a norm of never calling the police on a family member who abuses their partner.

Some people also use enmeshment to refer to covert, or emotional incest. This is when a parent or other caregiver treats a child as a partner or equal. The parent may rely on the child for support and unconditional love rather than filling these basic needs for the child.
HOW ENMESHMENT ENABLES ABUSEEnmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions. Enmeshed family members may be reflexively defensive of one another and view even deeply harmful behavior as normal and good.
Enmeshment can make it difficult for a person to form close relationships with other people. Without these relationships, it is very difficult for enmeshed family members to recognize that their family’s relational style is not healthy.
Even when enmeshed family members do form outside relationships, their enmeshed family may intrude on these relationships. Alternatively, the enmeshed person may view their family as normal and their partner as the problem. For example, an adult who gets married may still prioritize their childhood family over their spouse or may expect their spouse to defer to family members or accept abusive behavior.
THE TRAUMA OF ENMESHED FAMILIESEnmeshment itself can be traumatic, especially when enmeshment normalizes abuse. In other cases, though, enmeshment is the byproduct of trauma. A serious illness, natural disaster, or sudden loss may cause a family to become unusually close in an attempt to protect themselves. When this pattern persists well beyond the initial trauma, enmeshment loses its protective value and can undermine each family member’s personal autonomy.
Enmeshed family systems are often dismissive of trauma. A parent might dismiss their drunken night of abuse as a normal reaction to a child’s bad grades. In adulthood, siblings may defend a parent’s abuse by insisting that the parent was under immense stress or that the abuse was actually the children’s fault. By dismissing trauma as normal or deserved, enmeshed family systems make it difficult for family members to understand their emotions and experiences. In this form of gaslighting, a family might consistently substitute the family’s collective judgment for an individual’s feelings. Over time, the individual family member may struggle to distinguish their own emotions from the emotions the family insists they should have.
TRAUMA BONDING AND ENMESHMENTPeople who experience trauma or intense emotions together may bond in unusual and unhealthy ways. Patrick Carnes developed the concept of trauma bonding to characterize these relationships.
With trauma bonding, the cycle of abuse tightly binds family members, creating intense emotional attachments. In abusive relationships, the abuser may become abusive and frightening, then apologetic and extremely loving. Some abusive parents attempt to compensate for their abuse with gifts, special outings, or intense love. Many survivors of abuse report that, when their parents were not abusive, they were extremely creative, dynamic, and loving.
This intermittent reinforcement of love and affection can be very difficult to escape. The longer it persists, the more difficult it may become for a person to leave. Abuse survivors may truly love their abusers and believe that their abusers love them, too.
Even when survivors correctly identify the abuse and establish boundaries or leave the relationship, trauma bonding and enmeshment can affect future relationships. The cycle of abuse can feel normal in these situations, as an intermittent schedule of love and affection becomes the person’s point of reference for a relationship. This may cause trauma and enmeshment survivors to seek out and remain in abusive or enmeshed relationships. It can also make it easier for their family to pull them back into the abuse and chaos.
People who grow up in dysfunctional family systems may ignore their own emotions. They may question their memories, wonder if their trauma really happened, or believe that they deserve to be abused. Even when a person is able to see their family through a more objective lens, establishing boundaries can prove difficult. Holidays, family vacations, and other times of intense family closeness can trigger old habits and lead to new trauma.
Therapy can help a person draw clear boundaries, take their emotions seriously, and move beyond enmeshment. A therapist is also an outside voice who can help a person understand that the behaviors their family normalized are not healthy and that they do not have to remain trapped in their usual family role forever.
To begin your search for a compassionate therapist, click here.
References:

1. Carnes, P. J. (1997). The betrayal bond: Breaking free of exploitative relationships. Deerfield Beach, FL: Health Communications, Inc.
2. Green, R., & Werner, P. D. (1996). Intrusiveness and closeness-caregiving: Rethinking the concept of family enmeshment. Family Process, 35(2), 115-136. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1545-5300.1996.00115.x
3. Trauma bonding. (n.d.). Retrieved from http://www.abuseandrelationships.org/Content/Survivors/trauma_bonding.html

© Copyright 2019 GoodTherapy.org. All rights reserved.

Original article found at https://www.goodtherapy.org/blog/when-family-relationships-become-toxic-the-trauma-of-enmeshment-1016197

The Centers for Disease Control and Prevention and Kaiser Permanente conducted a longitudinal study comprising 17, 377 middle-class adults with an average age of 57 years. The study examined the impact of Adverse Childhood Experiences (ACEs) on physical health and social functioning. They also examined the relationship between ACEs and adult health-risk-taking behaviors. The ACE Study divided childhood adverse experiences into ten categories. Under Child Abuse the three categories include emotional abuse, physical abuse, and sexual abuse; Child Neglect the two categories include emotional neglect and physical neglect; and Household Challenges the five categories include a mother treated violently, mental illness, divorce or separation, substance abuse, and an incarcerated family member. Participants were instructed to check the categories that reflected their childhood experiences. Each category equaled one point and based on the number of categories that were checked the participant could receive a score ranging from 0 to 10. 
The study results showed that adverse childhood experiences are common and two-thirds of the participants had an ACE score in two or more categories and one in six participants had an ACE score in four or more categories. The study revealed that high ACE scores in the first eighteen years of life are linked to poor outcomes in physical and mental health and social functioning. People with high ACE scores were significantly more likely to, as adults, engage in behaviors that placed their health at risk. The study found that an ACE score of six or more, decreased one’s life expectancy by approximately twenty years compared to those participants with an ACE score of 0.  It was also found that an ACE score of 7 or more increased suicide attempts by 3,100% compared to participants with an ACE score of 0.
One mechanism by which adverse childhood experiences result in long-term health consequences is by engaging in adult health-risk-taking behaviors. These include alcohol and drug abuse, having multiple sex partners, cigarette smoking, and compulsive eating leading to obesity. Adult health-risk-taking behaviors such as these are often an individual’s attempt at coping and self-regulating the experiences of emotional pain, anxiety, anger and/or depression related to unresolved adverse childhood experiences.
Cigarette smoking is associated with emphysema, lung and larynx cancer; and cardiovascular disease, such as heart disease and stroke. There is also a strong link between a high ACE score, child sexual abuse, and obesity. Obesity is linked to multiple poor health outcomes, including high blood pressure, Type 2 diabetes, osteoarthritis, and breast, colon and liver cancers. Since the outcome of physical diseases associated with cigarette smoking and morbid obesity are not manifested for many years, the root causes of the diseases can easily go unnoticed. Felitti (2003) illustrates the disconnect between adverse childhood experiences, adult health-risk-taking behaviors, and biomedical disease by using the following example of cigarette smoking:
Smoking, which is medically and socially viewed as a ‘problem’ may, from the perspective of the user, represent an effective immediate solution that leads to chronic use. Decades later, when this ‘solution’ manifests as emphysema, cardiovascular disease, or malignancy, time and the tendency to ignore psychological issues in the management of organic disease makes improbable any full understanding of the original causes of adult disease (Felitti, p. 254). 
Participants who received high ACE scores but did not engage in adult health-risk-taking behaviors were still susceptible to disease and negative physical health outcomes. Felitti suggests that long-term chronic and unrelieved stress overstimulates the brain and body, weakens the immune system, and poses increased risk for the development of cancers and autoimmune diseases like multiple sclerosis, rheumatoid arthritis, and lupus. 
References
1. Vincent J. Felitti, V.J. (2003), “The Origins of Addiction: Evidence from the Childhood Experiences Study.” Department of Preventive Medicine, Kaiser Permanente Medical Care Program. CA: San Diego, pp. 1-8. 
2. Karr-Morse, R. and Wiley, M.S. (2012). Scared Sick: The Role of Childhood Trauma in Adult Disease. New York: Basic Books.

By GoodTherapy Staff
In a time when novelty and variety may be especially fashionable, it’s not surprising many people could view the idea of sticking to a routine as passé. However, consistently performing healthy behaviors might be the key not only to a calmer morning, but to improved mental health throughout your day.
Multiple studies have shown that establishing routines filled with healthy habits is a great way to move more efficiently through your day while expending less mental energy and even willpower in the process. A 2015 study on the psychology of habits demonstrated that people may rely more heavily on habits when stressed, suggesting that forming healthy routines could help people maintain physical, emotional, and mental health during stressful times.
HOW MUCH TIME DO YOU HAVE IN THE MORNING?
When building your morning routine, it’s important to consider how much time you have. Even if you only have 20 minutes to spare each morning, you can use that time to promote good mental health.
If you have a very limited amount of time in the morning, try identifying your biggest pain points or stressors as you move through your morning rather than seeking to cram a variety of activities and tasks into a small window of time. Then consider how forming a habit could help you mitigate those pain points. For instance, someone who routinely doesn’t have time for breakfast might plan and prepare their meals ahead of time so that a healthy option is always available to grab on their way out the door.
Having somewhere to be first thing in the morning doesn’t have to mean limited time for a morning routine. If you are a morning person or prefer to rise at an earlier hour than most, you may have more time to dedicate to a morning routine.
Those who have close to an hour or longer to dedicate to a morning routine might take a different route when choosing which habits will best support their well-being throughout the rest of the day. Someone might decide to dedicate more time to a physical activity and go for a walk or run, take an exercise class, or practice yoga. Spending more time on meditation, planning the rest of the day, or preparing a healthful meal might also be easier to accommodate with this schedule.
11 BUILDING BLOCKS OF A MORNING ROUTINE FOR MENTAL HEALTH
Morning routines can vary depending on individual needs. What works for one person may be burdensome for another. Explore the building blocks of mental health friendly morning routines below and start thinking about what elements you could incorporate into your morning to enhance your well-being throughout the day.
1. Prepare: You’ve likely heard it before, but a successful morning routine is only as strong as the bedtime routine that came before it. Which aspects of your bedtime routine should you use to ensure the success of your morning routine? Try preparing what you’ll need, such as coffee, meals, or an outfit, the night before. Making sure your keys, bag, and other essentials are near the door, especially if you need to leave home first thing in the morning, can also help reduce stress and chaos.
A solid bedtime strategy often comes together with good sleep hygiene, and good sleep hygiene can help you get a more refreshing night of rest. Quality sleep, meanwhile, can help minimize symptoms of mental health issues like anxiety and even psychosis (while lack of sleep may exacerbate these symptoms), so your morning routine may only support your mental health to the extent that you slept well that night.

2. Let light in: Exposure to bright light first thing in the morning increases feelings of wakefulness. To clear away morning grogginess, try turning on a lamp or your bedroom lights, or take in some sunlight within the first 5 to 10 minutes of waking up in the morning.
Those who live in higher latitudes (father away from the equator) will experience more seasonal darkness. Individuals who live farther away from the equator have been shown to experience higher rates of seasonal affective disorder (SAD), and sleep issues have been identified as a key factor in SAD. A morning routine may help individuals who experience more hours of darkness continue to feel awake each morning, even if the sun has not yet risen.
For those who routinely wake up before the sun has risen, blue light has been proven to help people feel awake in the morning. Using the right kind of light first thing in the morning could help decrease morning drowsiness and increase alertness more quickly.

3. Make your bed: It takes minutes to make a bed, but bed making is still a task which many people neglect. If aren’t currently in the habit of tidying up your bed each morning, you might want to reconsider. Surveys by Hunch.com and Sleepopolis have shown that the habit of making one’s bed are positively correlated with better sleep and an overall happier mood.
Now are people who are already happier and get better sleep also more likely to make their bed in the morning? Perhaps. But some experts argue that making one’s bed first thing in the morning is an effective way to boost your self-esteem. By completing a task first thing, you’ve boosted your own confidence in your ability to set things in order and may be more likely to continue that trend throughout the day.

4. Hydrate: According to a study published in Nutrition Reviews, dehydration can negatively impact cognitive function. As most of us wake up a little dehydrated after a night’s sleep, rehydrating first thing in the morning can help improve cognition. Dehydration has also been linked to fatigue as well as symptoms of low mood, including irritability and confusion.
While adequate hydration alone probably won’t cure mental health issues such as depression or anxiety, chronic dehydration also isn’t likely to make those conditions any easier to handle. Drinking water is a good way to hand yourself the energy to deal with the symptoms that come with many mental health issues.

5. Nourish: When asked what might be one of the best things someone could do for their mental health first thing in the morning, licensed mental health counselor Nicole Urdang, MS, NCC, DHM recommends getting something to eat. “Eating something within an hour or so of rising brings your blood sugar level up and prevents crankiness. You’ve been fasting all night. Eating something, especially something with complex carbs, fat and protein, will not only improve your mood, but will give you an energy boost to carry you through your morning activities,” she explains. “Never underestimate the power of a balanced blood sugar level throughout the day to help manage your mood.”
Many studies back this claim. A study published in the International Journal of Food Sciences and Nutrition found that those who ate breakfast daily were less depressed than the control group who did not eat breakfast every day. Those who ate breakfast also reported lower levels of stress. Another study found a link between the regular consumption of breakfast cereal and lower cortisol (stress hormone) levels.
Research also continues to tell us that while breakfast is an important meal, what’s more important may be what it’s made of. Boost the benefits of eating breakfast by incorporating some protein, healthy fats, and complex carbohydrates. Nuts, yogurt, and eggs have been shown to support mental health in those who experience anxiety, for example.

6. Write down what you’re grateful for: Research shows that gratitude can increase an individual’s happiness, improve relationships, and enhance one’s sense of well-being. A study described in the University of California Berkeley’s Greater Good Magazine demonstrated that even dedicating a short amount of time to gratitude each day can help improve symptoms for those who experience mental health issues.
To start your day off with a grateful mindset, try writing down three things you’re grateful for, and keep them present in your mind as you start your day. Even when you keep your list private, studies suggest you’re very likely to benefit from the practice of fostering gratitude.

7. Motivate: Motivation plays a science-backed role in reducing sleepiness and promoting wakefulness. When motivation is hard to come by, getting out of bed can be difficult. If you routinely struggle with the will to get out of bed first thing in the morning (and you’re already getting adequate sleep), consider adding something to your routine that adds a spark of joy and motivation—something that helps pull you out of bed and boost your mood. This could be anything from an activity you enjoy, such as walking a dog, to a new type of coffee you’re excited to try.
Some individuals with depression may experience diurnal mood variation, also known as morning depression. This depression symptom can, in many cases, make it incredibly difficult to get out of bed in the morning. If you think depression may be preventing you from summoning the motivation to get out of bed in the morning, it may be time to talk to a mental health professional.

8. Avoid technology: While technology can be used strategically to enhance a person’s mood and mental health, smartphone use in particular can easily become a compulsive behavior that erodes rather than fortifies mental well-being. Research has found that problematic smartphone use is linked to increased anxiety and depression.
Consider avoiding or cutting down on the time you spend looking at a smartphone screen first thing in the morning. Doing so may help increase your mental clarity and sense of purpose for the day while shielding you from information about news stories, politics, or social media drama, which can often contribute to a low mood.

9. Meditate: Morning meditation can help you center yourself for the rest of the day and has many proven mental health benefits. Even 15 minutes of daily meditation can produce the same stress-relieving effects in the body as taking a vacation. Meditation has also been shown to reduce stress, anxiety, depression, and even pain.
If you have time, try a 5 to 15-minute meditation as one of your first morning activities. Find a quiet, comfortable place to sit. Set a timer for the time you have to meditate that day. Then meditate. One popular way to meditate is to close your eyes and focus on the present and on your breaths. Many people also use guided meditations to get started.

10. Make a list: Writing a to-do list at the beginning of your day can help you plan what you need to get done and more effectively organize and execute the tasks on your list. Often, we have so much to do that we can’t hold it in our minds all at once, and the idea of forgetting an obligation can be anxiety-inducing. Take a couple minutes to jot down your goals for the day, and you won’t need to worry about forgetting to do anything on the list!
List-writing works by reducing chaos and lending structure to your day, as well as support for your memory. To write an effective list, start with your top objectives for the day. Keep it small, realistic, and focused–monitor negative talk and watch out for tasks that aren’t necessary or contribute to distraction. Organize yourself around your values and goals and seek to channel your best “you.”

11. Physical activity: For those with busy schedules, getting moving first thing in the morning is one good way to make sure they get exercise that day. As exercise is proven to have a positive effect on mood and can help reduce symptoms of depression and anxiety, it’s something to consider prioritizing. While your physical activity can include a morning run, it doesn’t have to. If you’re short on time, even stretching and some jumping-jacks can give you a chance to get your blood flowing.
Exercise releases endorphins, which can help reduce stress and anxiety; in the morning, this can contribute to a sense of calm that helps guide the first part of your day.
​
Whether you have 5 spare minutes or multiple hours each morning, a routine can help individuals set themselves up for better mental health throughout the day. Choose morning activities that allow you to work with rather than against yourself. And if you find you’re struggling with mental health symptoms that interfere with your well-being and daily activities, reach out to a licensed and compassionate mental health professional.
References:

1. Berwick, C. (2017, August 30). 9 really good reasons to exercise early in the morning. Retrieved from https://www.nbcnews.com/better/health/9-really-good-reasons-exercise-early-morning-ncna795656
2. Choi, K., Shin, C., Kim, T., Chung, H. J., & Suk, H. (2019, January 23). Awakening effects of blue-enriched morning light exposure on university students’ physiological and subjective responses. Scientific Reports, 9(1). doi: 10.1038/s41598-018-36791-5
3. Chunn, L. (2017, May 10). The psychology of the to-do list—Why your brain loves ordered tasks. The Guardian. Retrieved from https://www.theguardian.com/lifeandstyle/2017/may/10/the-psychology-of-the-to-do-list-why-your-brain-loves-ordered-tasks
4. Ferrer-Cascales, R., Sánchez-SanSegundo, M., Ruiz-Robledillo, N., Albaladejo-Blázquez, N., Laguna-Pérez, A., & Zaragoza-Martí, A. (2018, August 19). Eat or skip breakfast? The important role of breakfast quality for health-related quality of life, stress and depression in Spanish adolescents. International Journal of Environmental Research and Public Health, 15(8), 1781. doi: 10.3390/ijerph15081781
5. Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L., Nickless, A., Harrison, P. J., Emsley, R., Luik, A., et al. (2017). The effects of improving sleep on mental health (OASIS): A randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), 749-758. doi: 10.1016/S2215-0366(17)30328-0
6. Gocłowska, M. A., Ritter, S. M., Elliot, A. J. & Baas, M. (2018, June 11). Novelty seeking is linked to openness and extraversion, and can lead to greater creative performance. Journal of Personality, 87(2), 252-266. doi: 10.1111/jopy.12387
7. Improve your mood every day: Just eat breakfast. (2017, May 17). Retrieved from https://wexnermedical.osu.edu/blog/improve-your-mood-just-eat-breakfast
8. Leproult, R., Colecchia, E. F., L’Hermite-Balériaux, M., & Cauter, E. (2001, January 1). Transition from dim to bright light in the morning induces an immediate elevation of cortisol levels. The Journal of Clinical Endocrinology & Metabolism, 86(1), 151-157. Retrieved from https://academic.oup.com/jcem/article/86/1/151/2841140
9. May, C. J., Ostafin, B. D., & Snippe, E. (2018, August 23). The relative impact of 15-minutes of meditation compared to a day of vacation in daily life: An exploratory analysis. The Journal of Positive Psychology. doi: 10.1080/17439760.2019.1610480
10. Popkin, B. M., D’Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition Reviews, 68(8), 439-458. doi: 10.1111/j.1753-4887.2010.00304.x
11. Rowley, J. A. (2006, September 14). Measuring the ability to stay awake: Role of motivation. Sleep and Breathing, 10(4), 171-172. doi: 10.1007/s11325-006-0071-0
12. Rozgonjuk, D., Levine, J. C., Hall, B. J., & Elhai, J. D. (2018). The association between problematic smartphone use, depression and anxiety symptom severity, and objectively measured smartphone use over one week. Computers in Human Behavior, 87, 10-17. Retrieved from https://www.sciencedirect.com/science/article/pii/S0747563218302450
13. Sharma, H. (2015). Meditation: Process and effects. An International Quarterly Journal of Research in Ayurveda, 36(3), 233-237. doi: 10.4103/0974-8520.182756
14. Singh, M. (2018, December 24). If you feel thankful, write it down. It’s good for your health. National Public Radio (NPR). Retrieved from https://www.npr.org/sections/health-shots/2018/12/24/678232331/if-you-feel-thankful-write-it-down-its-good-for-your-health
15. Smith, A. P. (2009, July 6). Breakfast and mental health. International Journal of Food Sciences and Nutrition, 49(5), 397-402. doi: 10.3109/09637489809089415
16. Smith, A. P. (2001, January 9). Stress, breakfast cereal consumption and cortisol. Nutritional Neuroscience, 5(2), 141-144. doi: 10.1080/10284150290018946
17. Stinson, A. (2018, September 14). The benefits of making your bed every day are actually worth the effort, survey shows. Retrieved from https://www.elitedaily.com/p/the-benefits-of-making-your-bed-every-day-are-actually-worth-the-effort-survey-shows-11921745
18. Stoewen, D. L. (2017). Dimensions of wellness: Change your habits, change your life. Canadian Veterinary Journal, 58(8), 861-862. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508938
19. Weir, K. (2011). The exercise effect. Monitor on Psychology, 42(11), 48. Retrieved from https://www.apa.org/monitor/2011/12/exercise
20. Wirz-Justice, A. (2008). Diurnal variation of depressive symptoms. Dialogues in Clinical Neuroscience, 10(3), 337-343. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181887
21. Wong, J., & Brown, J. (2017, June 6). How gratitude changes you and your brain. Greater Good Magazine. Retrieved from https://greatergood.berkeley.edu/article/item/how_gratitude_changes_you_and_your_brain
22. Wood, W., & Rünger, D. (2015, September 10). Psychology of habit. Annual Review of Psychology, 67(289), 289-314. doi: 10.1146/annurev-psych-122414-033417
23. Yang, A. C., Huang, N. E., Peng, C., & Tsai, S. (2010, October 28). Do seasons have an influence on the incidence of depression? The use of an internet search engine query data as a proxy of human affect. PLOS ONE, 5(10). Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0013728

© Copyright 2019 GoodTherapy.org. All rights reserved.

Original Article: https://www.goodtherapy.org/blog/11-tips-for-a-morning-routine-that-supports-mental-health-1022197

When the days get shorter, the sun shines lower in the sky, and the weather gets colder, people often experience a drop in mood. For some, the change is serious: They have difficulty getting up in the morning and feel lethargic much of the day. They crave sunlight and certain foods, and have to fight the urge to burrow under the covers until spring comes.

These are all symptoms of Seasonal Affective Disorder. SAD is seasonal mood disorder that usually erupts in October and November, when the days become shorter, and typically remits when spring approaches. SAD can look and feel much like depression, but it has a seasonal pattern—usually beginning and ending with fall and spring, and tending to happen similarly in consecutive years.

Here are 10 common symptoms of SAD:

1. Depressed mood most of the day nearly every day.
2. Loss of interest in things you used to find interesting or enjoyable.
3. Changes in sleep patterns—primarily oversleeping.
4. Low energy and lethargy.
5. Difficulty with concentration and focus.
6. Feeling anxious or irritable, or having difficulty managing stress.
7. A reluctance to engage with others and a desire to be alone.
8. Decreased libido and sexual desire.
9. Craving sunlight.
10. Craving carbohydrate-rich foods (and resulting weight gain).
    
    

If you think you might be suffering from SAD you should consult a mental health professional. In addition, there are a number of things you can do to ease your symptoms:

1. Try light therapy.
SAD is fundamentally about a lack of light (and not the lower temperature). You should prioritize getting outside on sunny days as much as you can. But aside from that, light boxes, lamps, and visors can provide up to 10,000 LUX of light, functioning as a "sun replacement." Light therapy has been shown to be very effective for treating SAD. Be sure to get your device from a reputable company and to follow the "dosing" guidelines.

2. Maintain a steady sleep schedule.
Since SAD often induces sleep disturbances and disturbances in circadian rhythms, it is important to maintain a relatively strict sleeping schedule.

3. Spend time outdoors.
SAD can make you want to hibernate and lock yourself indoors until spring. Spending time outdoors and in nature combats this desire and restores mood and energy levels.

4. Go on vacation (as therapy).
Winter vacations to sunny climates can be an important way to alleviate the symptoms of SAD and break up the long winter. (Plus, it’s easier to justify a vacation if it counts as therapy, too.)

5. Eat a balanced diet.
Craving carbs can make you gain weight, which itself can contribute to a bad mood and negative outlook. Try to find a balance between indulging your craving for carbs and eating sufficient amounts of protein and vegetables, while not going over your normal caloric intake. It is natural to gain a few pounds over the winter but the only way to make sure it doesn’t become more than that is to be mindful of your food intake.

6. Medication.
Many people who suffer from SAD take antidepressants seasonally, starting in the fall and then weaning off of them in the spring. If you think you could benefit from antidepressants, make an appointment with a psychiatrist or your primary-care physician.

​https://www.psychologytoday.com/us/blog/the-squeaky-wheel/201510/10-signs-seasonal-depression-and-6-ways-fight-it

By Fabiana Franco, PhD​
​Posttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) are related but distinct from each other. C-PTSD is thought to be an enhanced version of PTSD. C-PTSD is, in turn, related to borderline personality (BPD).
ONGOING INTERPERSONAL TRAUMA AND C-PTSDPTSD is usually caused by a single traumatic event (or a series of traumatic events) that result in a real or imagined threat to one’s life or bodily integrity. Events that could cause PTSD include exposure to war, a terrorist attack, physical or sexual assault, or even the threat of such attacks. C-PTSD is different in that it’s typically caused by ongoing trauma which is often interpersonal in nature. C-PTSD tends to be associated with continued trauma that occurs at a young age. Children who grow up in neglectful or abusive environments may go on to develop C-PTSD (Giourou et al., 2018).
BORDERLINE PERSONALITY AND ONGOING INTERPERSONAL TRAUMABorderline personality is also connected to ongoing interpersonal trauma during childhood. Researchers have linked exposure to chronic fear and stress as a child, as well as suffering from physical, sexual, and/or emotional abuse as a child, to the development of BPD. Growing up with a parent who had a serious mental health issue is also a risk factor for the development of BPD.
BPD and C-PTSD share an association with maltreatment in childhood, and up to 71% of individuals who experience BPD report severe abuse in childhood.
BPD is a serious issue characterized by a constellation of emotional, social, cognitive, and behavioral dysregulation. The most notable features of BPD are difficulty managing emotions, impulsivity, identity problems, and dysfunctional interpersonal relationships (Hecht, Cicchetti, Rogosch, & Crick, 2014).
COMMON CHARACTERISTICS OF C-PTSD AND BPDBPD and C-PTSD share an association with maltreatment in childhood, and up to 71% of individuals who experience BPD report severe abuse in childhood. BPD and C-PTSD also share symptoms. Overlapping symptoms relate to the areas of emotion processing and regulation, security in relationships, and self-concept (Ford & Courtois, 2014).
Some common symptoms of BPD and C-PTSD include:
Emotion processing and regulation difficultiesPeople with BPD and C-PTSD are known to have difficulties managing and regulating emotions. When experiencing uncomfortable emotions such as anger, fear, or sadness, the person may have difficulty controlling the intensity and duration of the emotion. It can be very hard to “let things go” and return to a neutral or uplifted mood once they’ve been thrown off balance.
Relationship issuesThose with BPD and C-PTSD often have relationship issues. Relationships may be unstable, insecure, and can often be traumatic or stressful for one or both partners. We start learning how relationships work in childhood. If our caregivers in childhood were neglectful or abusive, we tend to carry these learned perceptions of ourselves, such as “I’m bad, worthless, or not worthy of support,” into our adult relationships, as well as lessons about relationships, such as “They are unpredictable, unreliable, and sometimes dangerous.”
Individuals with BPD may have an especially difficult time trusting and relating to others. It is thought that because they may not have experienced empathy from their primary caregivers during childhood, they have developed limited abilities to see past their own emotional responses and understand how others may be feeling.
Adults with C-PTSD may also have difficulty with empathy and relationships, although it depends on the nature of the trauma and whether they had access to at least one caring adult during their childhood. We are all unique, and how we develop and respond to early trauma is variable and can depend on many different factors within the environment and the individual.
Self-conceptBPD and C-PTSD are both associated with impulsive behaviors and dissociation. People may behave in ways that are self-destructive and reckless. Unsafe sex, abuse of drugs and alcohol, and disregard for one’s own safety can occur.
Dissociation is highly prevalent in BPD, and it’s known to occur in PTSD as well (Krause-Utz & Elzinga, 2018). Dissociation can result in a feeling of being disconnected from oneself and the world. Especially during times where stress levels are high, dissociation can act as a defense mechanism where the sufferer feels detached from themselves and what’s happening around them. In certain cases, amnesia may result, as well as a feeling of “lost time.” Identity confusion can also occur, and the person may feel as though they don’t have a strong sense of self or that their identity seems to shift depending on the circumstances and the environment they find themselves in.
High levels of worry, sadness, and shameBorderline personality and C-PTSD are associated with high levels of general distress. Many feel isolated and empty, as a significant portion of their symptoms can affect their relationships and connection with others. They may have high levels of shame and sometimes experience a feeling that they have been permanently damaged. This can lead to the desire to withdraw from others, as relationships are often a source of stress, insecurity, and/or conflict.
WHAT IF YOU HAVE SYMPTOMS OF BOTH C-PTSD AND BPD?Complex posttraumatic stress and BPD require treatment and support. If you are experiencing symptoms of C-PTSD and BPD, it can help to first receive an accurate assessment and diagnosis. It is important to understand that nobody is permanently damaged, and there are treatment approaches that have demonstrated effectiveness for both C-PTSD and BPD.
Therapy can help you develop strategies and techniques that allow you to better cope with stress and manage difficult emotions. Ongoing support from a therapist who understands what you are experiencing and where your feelings and symptoms are coming from can be enormously helpful for your healing journey. Find a therapist near me.
If you are struggling, it is important to reach out and take advantage of the support and options available. With treatment, you can not only feel better, but also avoid the negative consequences of behavioral and emotional symptoms. Feeling better and coping with stress can improve other areas of your life as well, such as how you function in professional and personal relationships.
References:

1. Ford, J. D., & Courtois, C. A. (2014, July 9). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. doi: 10.1186/2051-6673-1-9
2. Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018, March 22). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12-19. doi: 10.5498/wjp.v8.i1.12
3. Hecht, K. F., Cicchetti, D., Rogosch, F. A., & Crick, N. R. (2014). Borderline personality features in childhood: The role of subtype, developmental timing, and chronicity of child maltreatment. Development and Psychopathology, 26(3), 805-815. doi: 10.1017/S0954579414000406
4. Krause-Utz, A., & Elzinga, B. (2018). Current understanding of the neural mechanisms of dissociation in borderline personality disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. doi: 10.1007/s40473-018-0146-9
5. Luyten, P., Campbell, C., & Fonagy, P. (2019, May 7). Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. Journal of Personality. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jopy.12483

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Fabiana Franco, PhD, therapist in New York City, New York