This is a bit of an unfocussed post so I’ll apologise in advance for that.  I’ve been feeling intense vertigo and stinging in my chest over the last few weeks which are hard to explain properly, and this post is kind of about that and the loss of a close friendship and ways I’ve been trying to deal with it.  A lot of it will be about DBT skills because I’m finding more and more that it’s the only approach I’ve found that really does seem to have any sort of positive effect and at the moment, my life feels like a constant attempt at emotion and occasionally crisis management which is EXHAUSTING and horrible but I’m trying to trust the DBT philosophy that emotions eventually peak and subside and I’m trying to be mindful of that and the way it’s affecting my body and thoughts as well instead of acting instinctively or impulsively to reduce the intensity.  It’s been a bit up and down but I’m still writing blog posts and haven’t totally quit everything so that’s a definite positive!

This scene from ‘Harry Potter and the Order of the Phoenix’ is, for me, one of the most emotional scenes of the whole HP series and one that’s definitely underrated.  It’s from the end of the book after Sirius has died and Harry’s struggling to cope with the loss and with his guilt about Sirius’ death.  In this scene, Dumbledore is annoyingly calm and detached which makes Harry feel even more angry, hurt and alone and when I first read it aged 16, I could completely relate to Harry’s violent urges to hit Dumbledore and smash his things because that intensity of emotion is HORRIBLE especially when it involves feelings of hurt, guilt and loss which are three of the hardest negative emotions to manage even on their own.  Harry’s reaction of ‘I DON’T CARE’ is a completely natural and typical response to being unable to deal with intense and conflicting negative emotions in a situation that you don’t understand and can’t control, but Dumbledore’s reply of “You care so much you feel as though you will bleed to death with the pain of it” describes exactly how that intensity feels physically.  There’s so much emotional complexity in this scene that goes far deeper than the loss of Sirius- Harry’s feelings of intense hurt and confusion from Dumbledore’s apparent indifference towards him over the year, his guilt in being a part of the situation that killed Sirius, his fear of being completely alone.  It all culminates and builds up inside him in a way that he can’t express or manage, and his experience of intense emotion is something that a lot of people who experience intense, overwhelming or conflicting emotions that they can’t understand or express can relate to.

A while ago, a close friend asked me not to keep contacting her which really, really hurt, and I’ve been finding it increasingly hard to manage my feelings about it.  At first, I felt really upset and cried a lot which was (I think) a typical reaction to the loss of a close friendship, but it started to hurt more intensely as time went by and the urges to contact her again became stronger.  It felt like intense vertigo and like there was a ‘vacuum’ inside me as though someone had sucked out all my organs and gradually that emptiness became filled with a heavy, cement-like feeling which is still there.  I started to feel more zoned out and ‘slowed-down’, and have found it hard to concentrate on anything much over the last few months which hasn’t helped with starting a new job (which, thankfully, I’m nearly at the end of the contract for now).  Then, over the last few weeks, I started to get a stinging feeling in my chest which feels like someone’s opened a wound there and is tipping salt into it, and I keep randomly crying with no real trigger or becoming so exhausted and overwhelmed with the feelings that I fall asleep which is both a massive relief and annoying because I feel zoned out for the rest of the day.

It also hasn’t helped that there’s been a lot of (unrelated) stuff going on recently which has involved a lot of things that remind me strongly of my friend, and that’s made the urges to contact her so strong that they’re sometimes so overwhelming that I’m physically hitting the side of my head to try to get rid of them and last week, I acted on the urge and sent her a message which she didn’t respond to and although it helped to reduce the urge at the time, I felt like the worst person in the world and so guilty about it the next day.  The feelings are so horrible at the moment that I can totally relate to Harry’s ‘I’VE HAD ENOUGH…I WANT OUT, I WANT IT TO END’ but I know there’s no constructive way to do that apart from the obvious which isn’t an option because of children I’ve worked with and am very close to, and the possible impact that could have on them.  I’ve also had a lot of thoughts recently about distancing from the kids and from the two people I’m currently ‘friends’ with, but I think that could hurt them even more and I don’t want to hurt anyone at all.  So I’m not really left with many options but I REALLY needed to do something because I genuinely can’t deal with it much longer and I’m scared I’ll do something impulsive and stupid to manage the feelings- I’ve kept it at low level bingeing/purging and superficial cutting at the moment (using DBT skills to manage the intensity which I’ll come to later) but I’m a bit worried the bingeing will swing to full-scale bulimia if I’m not careful or I’ll stop eating completely in the hope of getting rid of the emotion completely (see Obsessions for more info about that).

It’s been particularly bad over the last couple of weeks and I’ve been thinking a lot about unfriending my friend on Facebook so that I don’t have her updates on my feed but also so that I can’t act on the urges to keep messaging her (I don’t know her current email or home address and she lives abroad so texting’s out).  It was a really difficult decision for several reasons- I didn’t want to completely lose touch with her because even though she’s hurt me a lot over the last year or so, I still really miss her and the connection we had; I really, really don’t want to hurt or upset her, or make her feel the way I have done over the last few months and I’m not sure I could cope with the guilt if she did; we were friends for nearly 20 years which is a really, really long time and she knows more about me than anyone else ever including mental health professionals I saw for seven years; it’s my fault the friendship broke down because I was too intense/clingy and I really don’t want her to be upset because I’m shit at managing relationships and get paranoid.  But last night, I spoke to an old friend I haven’t seen in nearly ten years but who I was close friends with at school and she pointed out that if my friend had realised the impact asking me not to contact her would have, she wouldn’t have said it the way she did and that shows that the close connection we had’s already broken, and that made so much sense so last night, I unfriended my ex-best friend.

It was genuinely one of the hardest things I’ve ever done and I feel like such a bitch about it.  I couldn’t stop shaking and spent most of last night fighting urges to email her via her old email address, send her another friend request or try to message her but someone I really trust told me not to email because it would make her more upset so I didn’t contact her but I feel like the worst person in the world and a really, really selfish, bitchy and horrible person for unfriending without an explanation.  I’m feeling less shaky today but still really, really guilty and a bit zoned out.  I HATE my brain and how selfish I am.  I know that now it’s up to her if she wants to contact me and that she knows my email address and phone number so if she wants to, she can but I’m really, really hoping she won’t be feeling upset or hurt that I’ve unfriended her.  It’s not that I don’t like her- I do, but I can’t cope with this sort of feeling any more and I need to do something for self-protection and so that I don’t lose any relationships I currently have.  But I hate myself so much at the moment- I know it’s totally my fault and if I wasn’t so selfish, clingy and paranoid, it wouldn’t have got to that stage in the first place but this happens with nearly every relationship I have and I don’t know how to stop it.  I hate the way my brain (and body) react to situations like this and how intense it is, and I especially hate the intense urges which swing from ‘I need to contact this person NOW’ to needing to binge/vomit or cut to try to force out the guilt and horribleness inside my body.  I HATE MY BRAIN and I hate the way my body reacts physically.

Since I unfriended her, the vertigo has intensified and it feels like someone’s trying to pull my stomach out through my chest, and the intense stinging is like my heart’s being twisted and ripped out.  It’s horrible and it’s affecting the way I’m feeling in general- it took four attempts at getting dressed this morning to find something I felt OK in to go out the house and my mood’s even lower and more ‘shaky’ than it’s been over the last few weeks.  I’ve slowed right down to present moment and thankfully I don’t have work today, and I’m focussing on getting through each hour at a time.  I still feel like such as bitch though and I really, really want to apologise but DBT interpersonal skills say that you shouldn’t apologise unnecessarily even if it feels like you should.  So that brings me to the first DBT skill I’m going to look at- FAST.

FAST stands for fair, apology, stick to values and truth.  The aim of the skill is to manage interpersonal relationships without compromising your own self esteem or emotional wellbeing, and I think it’s a really useful (as well as really difficult) skill to use.  Being ‘fair’ applies to the other person but also to yourself, and involves being assertive and also listening to the other person.  I’ve tried this already and although I haven’t been as direct as I’d like to have been with her, I’ve been open with her in the past and she knows me well enough to know that I wouldn’t unfriend her in a passive-aggressive way.  It’s self-protection and although I haven’t said that directly, it would probably make things worse if I did.  I genuinely have tried to be as fair as I can.

According to DBT, over-apologising when it’s not completely justified can have a detrimental affect on self esteem and self respect, and make negative emotions worse.  It also points out that by apologising unnecessarily, you negate the effect when you actually do apologise which is something I hadn’t really thought about but is probably true.  I’ve been thinking about the situation a lot and although I still think I should apologise for unfriending her, I can see that by doing that, I’m emphasising my ‘fault’ in the whole situation and that’s not going to be helpful for trying to reduce guilt and get over it.  So I’m trying to be mindful of the guilt and urges to apologise without acting on them which is HARD but I think that if I can manage it, it could be a really positive thing.

Sticking to values means keeping to things that are important to you.  I find the concept of values hard but I know that being fair, direct, accepting, honest and assertive are qualities that I really respect and value in other people so I’d hope that they are values I can try to embody too.  In this situation, I don’t feel like I’ve really stuck to those values but I can’t see any way I could do without actually contacting her and explaining.  I have been accepting of her decision to stop the contact though and I think I’ve been as fair and direct as I can be, so maybe I’m halfway there.  It’s a hard skill though and I think I need to practise it a lot more before I’m able to actually use it properly.

Truthfulness is something that’s really important to me anyway and I think I’ve been as truthful as I can be.  Before we lost contact, I had mentioned to her that I was getting paranoid about people not actually being friends with me or wanting to keep in touch and I’ve always been open and honest with her, so I think she knows enough about how I think and react to know why I’ve acted like this.  If not, I’m h0ping she also knows me well enough to know that I’ll always be honest and truthful in emails so she can email me if she wants.

 I’ve also been using a LOT of the emotion regulation skills to try to deal with the intensity of emotion, both physical and emotional, I’ve been experiencing.  I won’t go into opposite action because I’ve already talked about it a lot in Opposite Action in action- more DBT!, but I’m going to look at other strategies such as seeing emotion as a wave and being mindful of emotions.  Both of these involve trying to distance from the emotion and seeing it as something that happens to you rather than being a part of you which I find really hard to get my head around in relation to emotions but I’ve managed in relation to thoughts via the bitch in my head (Inside my head…), and I’ve been trying to link this to emotions by seeing my emotional state as something that the bitch in my head can hijack and gain access to via a skeleton key she’s got which gives her direct access to my feelings and emotions which she can then use to her advantage.

So for me, a big part of emotion regulation is trying to prevent her from having access to my emotions by accepting what she says without believing it, talking back to her and trying to be more compassionate towards her so she’s not as angry and sometimes that helps but sometimes she gets in before I’ve realised it.  That’s when the DBT emotion regulation skills come in and they’re a lot easier to apply when the emotions are a result of the bitch in my head rather than being an intrinsic part of ‘me’ and how I’m thinking or feeling.  Seeing emotion as a wave is based on the idea that emotions peak and eventually subside so if you try to distract or tolerate the emotion, it will eventually ease off to a more tolerable level.  I have a distress tolerance card which I’ve been relying on a lot recently to try to manage emotions, and it’s something I would recommend to anyone who experiences intense emotions- the idea is that you do at least two things from the card before any unhelpful behaviour and sometimes it does distract for long enough for the emotion to start to subside and (for me) the positive feelings associated with not acting on the emotion are often enough to help it subside completely to a point where I can manage it more easily.  It’s definitely worth making a card if you don’t already have one.  Mine’s colour-coded to make it easier to use when I’ve feeling intense emotion and that can help for some people.

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I’ve also been trying to be mindful of emotions which is really hard but it’s a skill I’m finding increasingly useful the more I practise it.  The basic idea is to observe and be aware of your emotions (even if you can’t identify what they are) and not judge them, and just ‘let’ them rise and fall.  It links to the wave idea and I’ve been trying to imagine emotional intensity rising and falling like waves, and sometimes this is easier than waiting for the wave to peak because it often feels like it won’t!  It’s really hard not to judge emotions though especially guilt or anxiety, and DBT thought and emotion defusion teaches you imagine the thought or judgement like leaves on a stream- recognise and acknowledge them but let them pass without fixating on them and this takes a LOT of practice but I’m starting to find it useful, especially with obsessive thoughts.

Outside of DBT skills, the other thing I find really useful for managing difficult emotions and trying not to act on them is use fictional characters as a sort of ‘channel’ or outlet for that emotion.  I’ve been doing this in various ways ever since I can remember but the most useful ones at the moment are the Sims and through Carrie Mathison from Homeland (I did a post on this a while ago called Learning emotion regulation via Carrie Mathison).  The Sims is a bit of a weird one because it can either be really, really useful or makes things a million times harder so I’m always a bit wary when I use it, but sometimes it can be really useful.  In a situation when I’m missing someone but know that contacting them would be too much, it’s actually really beneficial to ‘talk’ to that person on the Sims because it really does feel like you’re actually communicating with them and it can help you feel less lonely.  At the moment, that’s not a good idea in this particular situation because even seeing her as a Sim makes me feel really upset but what I have found useful on the Sims is creating an ‘ideal’ version of me and levelling up skills and career roles so it feels like I’m actually achieving something and that stimulates the same dopamine release as if you were actually doing something positive.  I know it’s not ‘real’ but as a short-term emotion management technique, it’s pretty useful and doesn’t involve annoying other people.

The other thing I’ve found really useful is rewatching parts of Homeland season five and trying to learn about relationship skills and emotion management from Carrie’s relationship with Saul.  Throughout the first few seasons, Saul is Carrie’s mentor and close friend and she really respects and looks up to him in a way she doesn’t with any other character, and there are several examples where they save each other’s lives or connect with each other on a deeper, more personal level and in season four, Carrie is described as “his child, practically”, and that really is the kind of relationship they have (although much more from Carrie’s perspective; there are also examples where Saul has ‘used’ Carrie to suit his or the agency’s needs).  But in between seasons four and five, Carrie and Saul have had a breakdown of their relationship and are no longer talking.  Carrie finds this difficult to deal with, particularly as Saul’s values seem to be diametrically opposed to her own, and throughout the season she attempts to reconnect with him.  When she is led to believe that Saul is trying to kill her, she describes their relationship as “someone I trusted more than I’ve ever trusted anyone” and there are a lot of examples of this throughout the series and of their mutual trust and respect for each other which, in some places, borders on an almost familial love.

In the other post, I wrote that “We don’t find out in Homeland what could have happened to make them split so intensely but I think from a self-protection perspective, Carrie couldn’t allow herself to become so emotionally vulnerable again which is why, when Saul tried to make up with her, she wouldn’t let him, telling him, ‘I’m not that person any more.’  When I first saw this, it genuinely made me cry but I really do accept why Carrie made that decision- she needs to protect herself and she’s come so far since season one/  Sometimes it’s really hard but you need to move on and accept that sometimes even very close, long term relationships end.  People change and you can’t do anything about that . It’s horrible, genuinely feels like you’re being punched repeatedly in the stomach and your chest is being ripped open but staying attached to the person that someone used to be isn’t helpful for either person.  Carrie made what is for her the right decision, and Saul needed to accept that.  It’s not going to be easy for either of them and there is an intense part of me that really, really wanted them to make it up but I know that wouldn’t have been possible and that one of them would have had to change and compromise themselves which wouldn’t be the basis for a healthy relationship.  Saul helped Carrie to grow and develop as a person and she provided him with emotional support and trust when he needed it, but they both changed and it was time for them to move on.”

I’ve been watching that scene over and over and although it’s made me cry and feel as though my heart’s being ripped several times over, I can see how Carrie needs to completely distance from Saul in order to rebuild emotionally and to protect herself from that intensity of feeling.  I’m guessing she must feel as guilty as I do at the moment, especially when Saul says, “Goddammit Carrie, I need you” and she replies, “And I said, I’m not that person any more”, and it must have been so hard for her to make that decision knowing that it was partly because of her that the friendship broke down and that she’s hurting Saul by cutting him off emotionally, but I think it really was the right decision.  She needs to protect herself and not allow herself to become emotionally vulnerable, and she can’t risk the same friendship break up happening again.  The emotional bond broke when they first became distanced from each other and that would be impossible to rebuild.

I found that really, really useful to think about because Carrie was as close to Saul as I was to my best friend, and they were close for a similar length of time.  Like me and my friend, they were very different people and the friendship was intense but also dependent on mutual communication.  Saul changed and moved on in a very similar way to my friend but Carrie stayed in the same emotionally intense state she’s always been in even if she’s learning to manage it more effectively now, and I think Saul just got to a point where he couldn’t tolerate it any more.  As Carrie grows, both as an officer and as person, she starts to act outside of Saul’s influence or instruction a lot more and doesn’t need his approval as much as she did in the past and Saul’s focussed on his career progression and the agency, so once they’ve split it’s really difficult for them to bond in the same way again.  I think it’s similar with my friend- we’ve both gone in very different directions over the last few years (or, more accurately, she’s moved on and I’ve stayed in the same place) and we don’t have the same sort of mutual connection any more that we had growing up.  It’s really hard to deal with and it really, really hurts but there’s nothing I can do to change that and that’s where the DBT skills come in.

It’s still hurting too much to draw any sort of line under it and I’m feeling like a mess of intense vertigo and stinging pain at the moment, but I’m hoping that I can get to the point that Carrie reached where, although there was a massive part of her that wanted to reconnect with Saul, she realised that it wasn’t possible, ‘real’ or healthy and made the decision to consciously distance herself and move on from it.  I have no idea how this will turn out and if my friend will even realise I’ve unfriended her, but I can’t do anything more and I need to distance from the whole situation.  So I’m going to try not to fixate on it or obsess over possibilities, and I want to eventually move on and accept whatever happens from here…


This picture came up on my Facebook feed this morning and made me smile because it’s pretty much an accurate description of my brain!  I’ve had obsessions ever since I can remember- when I was really little, it was the colour yellow (EVERYTHING had to be yellow and when I started school, I wouldn’t use a pencil unless it was yellow and my mum had to explain to the teacher that I had a fixation on yellow and that it wasn’t an issue but it would be easier for everyone if I was allowed to write with a yellow pencil) then it changed to Button Moon and Maple Town before Play Days and the Sooty Show which I can still remember episodes of vividly now at the age of nearly 30 and occasionally show kids I babysit, and at age 7 the yellow obsession changed to purple which was more socially acceptable at school and also happened to be the colour of the Unicorn Club in Sweet Valley which became a pretty major obsession from the age of 8 and is still there in the background now as is my lifelong merpeople obsession.  Over the last 20 years, my ‘major’ obsessions have ranged from Bad Girls and Disney to languages and fairy tales, David Bowie and Pink Floyd to Narnia and Harry Potter, Formula One and astronomy to Pokemon and the Sims and most of them have carried on in the background mainly as coping mechanisms, occasionally reactivating while my ‘current’ obsession is very much Homeland and Carrie Mathison in particular.

These sorts of obsessive interests are something that’s really changed who I am, how I live my life and the way I look at things in a mostly positive way, and now I think of them as ‘good’ obsessions.  I haven’t always seen them in that way- until I was in my early 20s, I hated my obsessions because they were ‘weird’ and people often commented on the intensity of them.  As a teenager, I tried to write my GCSE English coursework about Bad Girls (which wasn’t allowed), virtually lived on the Bad Girls message board which I’ve recently reactivated, watched Bad Girls DVDs incessantly, took the book with me everywhere, tried to get other people to watch it too…  My mum thought it was ‘wrong’ that I was that obsessed with a TV show and banned me from mentioning it at home, and that made it even harder.  At school, I was obsessed with languages which led to a slight idolisation of my languages teacher and I was told that that, and the fact that all my friends were several years younger than me, was “worrying”.  If I’d been born two years later, I’m pretty sure my Asperger’s diagnosis would have come a lot early than age 19 and maybe I wouldn’t have felt like such a weird obsessive freak but in the late 90s/early 00s, not many people had heard of autism and I had no idea that obsessive interests are one of the key characteristics of autistic people, along with difficulties making friends your own age, needing to stick to routines, ‘latching on’ to specific people, seeming ‘weird’ or not fitting in, getting exhausted or overwhelmed being around people, and basically everything I thought was ‘wrong’ and hated about myself growing up.  Which is one of the reasons I’m so passionate about promoting awareness of autism now!

Now, at the age of nearly 30, I actually really like and appreciate my obsessions and wouldn’t want to lose the ability to hyper-focus on specific topic, have an encyclopaedic knowledge of everything about it, and having the amazing, hyper-excitement of watching/reading about/writing about whatever it happens to be.  Thanks to the internet, I’ve been able to start a Homeland blog which people actually read even though each blog post is obsessively detailed and close to 10 000 words per post.  I’ve since expanded into twitter, instagram, Facebook and email accounts for my Carrie blog and a lot of people seem to think that I’m actually involved with the show or with the character which I’m very definitely not and keep reinforcing that but it’s so nice that people think that level of interest or obsession is a positive thing and so many people have given me lovely feedback and seem to consider me some kind of Homeland expert which is AMAZING.  If the internet had existed the way it does now when I was a teenager, my Bad Girls obsession might have been more acceptable and this sort of connection is one of the main reasons I use the internet so much.

The downside to having an obsessive-type brain is that there are also ‘bad obsessions’ which I hate more than any other aspect of any mental health issues I’ve experienced and which I’m still trying to find strategies to deal with.  These didn’t start to develop until I was in my early teens and I can remember vividly the first time I experienced it at the end of Year 8.  They range from OCD-type thoughts to paranoia and sometimes both, and nearly always involve other people.  My first experience of it was when I was 13 and went to a kids’ club during the summer.  I made ‘friends’ with one of the young leaders who was 19 at the time, and started to really look up to her.  This meant that I started be become hyperaware of everything I did/said and started to get a lot of anxiety about upsetting her or doing something wrong.  I was only in the kids’ club for two weeks but the fixation about wanting her to like me lasted about nearly six months.  I had no idea what it was and really, really hated it as well as being a bit scared of the way my brain was fixating on another person.  It wasn’t a ‘crush’- there were no romantic or sexual feelings, but I ‘needed’ her approval and that really freaked me out because I hadn’t experienced anything like that before.

That sort of fixation happened several times when I was a teenager with different people I looked up to (teachers, adults I admired, college tutors, nurses etc) and I had no idea how to manage the feelings.  It was INTENSE- like constant vertigo/anxiety and occasional palpitations if I got too affected by it, and it made me feel so guilty and physically sick.  There wasn’t any sort of physical attraction and I kind of wished there was just so it would ‘fit’ into some sort of category (a ‘crush’ would be so much more acceptable than a weird, intense ‘need you to like me’ sort of thing) but it sort of took over my life when I was a teenager to the point that that person’s approval was the most important thing in the world to me and I would do ANYTHING not to upset them.  Apparently this sort of thing is actually pretty common in people, particularly females, with ASD but since I’d never heard of autism or anything even vaguely related to that when I was a teenager, I was convinced there was something seriously wrong with my brain and that I was a weird freak who would end up as some kind of stalker when I was older.

Because I didn’t understand the obsessive thoughts and feelings, I had no idea how to manage them and they started to manifest more physically- vertigo and nausea, and almost constant shakiness.  I’m still not totally sure how it got to the stage that it did but at the beginning of Year 9, I decided (completely irrationally) that the reason I was getting these thoughts/feelings and the reason I didn’t have many friends was because I’d put on too much weight and developed too early.  I think it might partly have been because the intense obsessive feelings started around the same time I got my first period and I’d put on a lot of weight over that year (which I know now is a biological change due to developing breasts and hips), but I decided to be ‘healthy’ and lose weight in an attempt to get rid of the feelings.  So, at the beginning of Year 9, I stopped eating anything that wasn’t 100% healthy and became slightly obsessive about what I did/didn’t eat.  I can’t remember much from that time except that my mum thought I wasn’t eating enough and when I passed out at school, she made me go the GP who referred me to an eating disorders service but I never went to the appointments and I think people must have forgotten about it.

I didn’t really lose weight at that point even though I’d cut down a lot on my food intake which I can see now was because I was still growing but I thought it was because I wasn’t trying hard enough.  By Year 10, the obsessions had intensified to a point where I genuinely couldn’t deal with it much longer- it was starting to really interfere with my schoolwork and a lot of people at school, including teachers, were commenting on it and I felt like a really, really horrible person.  So I started skipping lunch at school partly because of nausea and vertigo, partly because my friends were all a lot younger than me and had a different time to go into lunch, and partly because I wanted to actually lose weight.  I realised pretty quickly that being hungry ‘overtook’ the vertigo and started to miss breakfast too.  By Year 11, I was going days without eating then being ‘made’ to eat by my mum which would lead to bingeing and vomiting, and I had the amazing realisation that vomiting was the most effective solution I’d found for ‘getting rid’ of the vertigo and nausea because it was physical and ‘forced’ the feelings out of my stomach.  They came back pretty quickly afterwards but during the binge/purge itself, there was a brief escape which I started to get dependent on.  After GCSEs, my mum made me go back to the GP because I’d started to feel dizzy a lot but I didn’t tell her about the vomiting and just said I’d been tired so she did a blood test and told me I was anaemic.  That was OK for my mum so I started to take iron tablets and since I hadn’t really lost weight at all, she didn’t comment on my eating habits.

That cycle carried on for the whole of Year 12 but by the summer, I realised that it wasn’t enough- it was helping to ‘manage’ the obsessive thoughts/feelings and stop them from getting too overwhelming but I really needed to actually get rid of them.  They’d spread to friendships by that point and I’d lost several close friends by being too intense/clingy or getting paranoid that they weren’t talking to me and over-texting, and I was finding it so hard to deal with.  I also had A levels coming up and I hadn’t done as well in my GCSEs and AS levels as I knew I could have done because about 80% of my brain was taken up with obsessive or paranoid thoughts, and I knew I needed to do something about it.  The bingeing was OK but it was only a temporary relief and I’d stopped getting hungry when I missed breakfast and lunch.  So, in Year 13, I decided that I was going to try to ‘take control’ of my body and try to get rid of the vertigo/nausea completely.  I devised a ‘healthy’ plan which involved exercising several hours a day, not eating anything that might trigger a binge (because I was aware that you retain about 70% of the calories from a binge and I knew that might be a reason the vertigo came back), and eating less than 800 calories a day spread out during the day to try to speed up my metabolism.

At first, I still didn’t lose weight and the vertigo/nausea continued but after a couple of months, I noticed that I’d started to get hungry again which again overrode the vertigo.  I got really excited about that and reduced my calories to 500 a day, and finally started to lose weight.  Amazingly once I’d lost just over a stone, the vertigo and obsessive thoughts disappeared completely and I just felt numb and slightly zoned out which was like euphoria compared to the intense vertigo/nausea I’d experienced for the previous few years.  So I kept up the weight loss, reducing calories to 300 a day when I stopped getting hungry again, and by the time I did my A levels my brain was clear again and I could actually focus on revision and getting the work done.  I ended up getting a lot better A level results than I thought I would- big improvement on GCSE and AS levels, and I felt calmer and more ‘acceptable’ than I had done since primary school.  Unfortunately, the weight loss had become an issue physical health-wise and I had to go into treatment as an inpatient in an eating disorder service which kind of took over for the next few years which I won’t go into here because that’s not the point of this blog post.

The really frustrating part of all of it is that I kind of have to choose between ‘bad’ obsessions and ED thoughts and for me, the ED side is actually easier to deal with because I don’t feel like such as weird, horrible freak and it’s more ‘understandable’.  It’s also complicated by the ‘bitch in my head’ (see Inside my head… and Thinking about the Impostor Phenomenon and the Inner Critic) who approves of the ED restriction and exercise (although she hates the bingeing) and criticises me constantly for being such as weak, obsessive freak and giving in to obsessive thoughts and urges while also telling me that people hate or aren’t talking to me which makes my brain feel like it’s jammed and totally contradictory.  She shuts up when I lose enough weight which is another reason that being a low BMI feels safer.  But I know that being severely underweight isn’t a good idea for so many other reasons (osteoporosis, heart problems, impact on kids, people judging you, feeling like you’re genuinely going to die every time you get even a minor cold) and my metabolism seems to have adjusted to a low calorie intake now anyway and I gain weight if I eat more than about 600 calories in a day.

I’d love it if my brain could just have ‘good’ obsessions and never have the horrible, paranoid, vertigo-y obsessive thoughts that have led to losing nearly every close relationship I’ve ever had, but I have no idea how to have one without the other.  Another reason I don’t like being underweight is that I feel dissociated and numb most of the time which means no ‘bad’ obsessions but also no positive ones which wasn’t a problem when I was a teenager and thought the obsessions were weird anyway but now I really rely on them as a way to channel extreme emotions or distract from paranoid thoughts.  It feels like my life’s a constant distraction technique though and I always seem to be trying to manage obsessive thoughts or compulsive urges and intense vertigo or a stinging/choking sensation in my chest, and I don’t know if this is just part of having ASD or if there’s something else I can do to get rid of it.  Am currently trying to access mental health services in a new area in the hope that someone can tell me what it is and how to get rid of it, so am REALLY hoping something will help although having been accessing various services on and off for the last 16 years, I’m not overly optimistic…!

So far, the positive strategies that I’d found that do seem to have some sort of useful effect are writing (blogging and creative), DBT skills particularly the emotion regulation and distress tolerance, Harry Potter skills (see Mental Health Awareness Week 2016, Part One: HARRY POTTER and Occlumency), some aspects of ACT like being compassionate to or ‘accepting’ the bitch in my head and trying to acknowledge what she says without actually believing it, and seeing the bitch in my head as a separate ‘being’ who isn’t reflective of absolute truth or what is actually going on in my brain.  They don’t always work and some days, nothing seems to work but the thoughts and feelings are definitely less intense than they were when I was a teenager (which is definitely partly due to medication but I don’t think that’s the only reason) and I’m really hoping that I’ll come across a strategy/therapy/model that actually works completely some day…  Any input welcome!!

Bipolar Affective Disorder and the Autism Spectrum: Looking Through the Eyes of Carrie Mathison — Carrie Mathison’s Diary

Obvious disclaimer before I start this blog post: I am not a psychiatrist, and I am not attempting to ‘diagnose’ Carrie with anything apart from obviously recognising the bipolar disorder that we already know she experiences. I’m writing this from an interested perspective and as a way to look more deeply into Carrie’s character. From […]

via Bipolar Affective Disorder and the Autism Spectrum: Looking Through the Eyes of Carrie Mathison — Carrie Mathison’s Diary

Mental Health Awareness Week Part Two: Relationships

I know Mental Health Awareness Week was a couple of weeks ago now but I don’t think it’s ever a bad time to raise awareness about and acceptance of mental health and mental health issues, and since the official theme this year was relationships I thought I should probably write a post about it!

I chose that particular quote from Carrie Mathison (Homeland character) because I really identify with her as a character in a lot of ways and because a big part of her character development over the five series so far has been her growing realisation that people can’t exist totally independently without any relationships with other people but also that you need to be able to rely on yourself and that relationships aren’t always reliable and you need to be able to adapt and manage that.  Carrie as a character has bipolar disorder and a lot of her difficulties with relationships and boundaries are linked to that (which I’ve written about in another blog post called Learning emotion regulation via Carrie Mathison and in my other, Homeland-focussed blog Carrie Mathison’s Diary).  The two quotes that really get me are when Carrie says in season one “I’m gonna be alone my whole life, aren’t I?” and then this quote, “Maybe I don’t want to be alone my whole fucking life!” which is part of her starting to realise that she really does need relationships with other people.

Relationships are vital for everyone and especially for people experiencing mental health issues who can often become socially isolated or feel alienated from people around them. There are so many different reasons for this from factors relating to others such as fear of judgment, bullying, lack of motivation or energy to be around people or stigma to internal factors like paranoid thoughts, delusions or anxiety and it’s important to recognise that everyone experiences different thoughts and feelings. Statistics from the Mental Health Foundation say that nine out of ten people with mental health issues have experienced stigma about their mental health which is horrible and can be really detrimental to people’s social relationships. Relationships are fundamental to being a human- we really are social animals. I feel a bit ironic writing this- I remember a psychologist I used to over a decade ago repeatedly telling me that and I didn’t believe her; it took until several years of volunteering in teenage self esteem groups through Mind and meeting people as an adult who have genuinely changed my life to realise just how important social relationships are. But we need them to survive and they are essential for mental health.

One way we can tell how important relationships are is by thinking about language and communication- across the world, different cultures have evolved their own ways to communicate but it’s the communication itself that is vital, and not just in humans. Relationships were important in prehistoric times because they allowed people to gather and share food, protect each other, build shelters, find sustenance, reproduce, take care of each other and basically maximise chances of survival and that need is hardwired into the way our brains work (for anyone interested in neuroscience, have a look at how the amygdala and the neocortex are involved in relationships and attachment- it’s really interesting but don’t want to turn this post into a science essay!). I’m not going to go into the psychological, sociological, linguistic or neuroscientific aspects of attachment because that could be several PhDs in itself but wanted to highlight the way in which relationships are essential for human survival.

The main types of relationship I’m going to look at in this post are family relationships, friendships and ‘functional’ relationships. The last one sounds a bit negative but I really don’t mean it to- I just mean relationships with very specific constraints or boundaries but serve a function. Relationships can be positive or negative and you don’t necessarily have to like someone to have a relationship with them and it’s defined by repeated social contact with someone rather than how much you like them. I used to see a psychologist who I didn’t particularly ‘like’ but I saw her every week and although I hated the therapy sessions they were actually useful in a very indirect way so that was a positive functional relationship even though I didn’t like seeing her. I think a lot of young people have similar relationships with teachers! You can also have close or distant relationships depending on how close (emotionally) you feel to someone and that doesn’t depend on physical distance- for years, my best friend lived on the other side of the world but she was still my closest friend because of how much I trusted her and how close we were emotionally whereas I lived in the same house as my brother but I didn’t feel anywhere near as comfortable emotionally around him.

It’s important to have a mix of relationships around you, close and distant, in order to have stable mental health and to feel like you are connected to people around you. Too many close relationships can make you vulnerable or prone to becoming overwhelmed whereas too many distant relationships without closeness can lead to social isolation. It’s a balance and it’s hard to manage, especially for people with mental health issues who can often experience difficulties with boundaries. I’m definitely prone to this- I’ve lost a lot of friendships in the past from being ‘too intense’ or contacting people too much and I find it hard to regulate because when I feel comfortable around someone, I REALLY like them and want to contact them all the time but I’m a lot more aware of it now and am learning to manage it. Last year, my best friend of twenty years asked me not to contact her any more and that was so hard to deal with (and still is) but I’ve learned a lot from that experience. Close relationships are important but it’s even more important not to be reliant on them because you can’t control other people and you seriously never know what might happen in the future.

Family relationships are always a minefield and I don’t want to talk about them too much because I know it can be a sensitive topic for some people but they’re there from the minute a person is born, and are massively influential on a person’s development both in childhood and how it affects you as an adult. I’m lucky to have a fairly massive family- I have thirty cousins, lots of ‘extended cousins’, aunts and uncles, my nan and her ‘man friends’ (one of whom was like my granddad growing up which is why I’ve mentioned them), parents and a brother who (mostly) get on relatively well. Apart from my parents, they mostly live in Glasgow so I don’t see them that often but my family is very, very close and I love spending time with my cousins although I only see them a couple of times a year. One thing I really wish is that I’d grown up in Scotland so I could feel more like a part of a big, close family- my cousins are awesome and I love staying with them but it’s not the same as if I’d actually grown up with them.

I’m also really, really lucky to have a second ‘pseudo family’ who I am really close to and who seem to accept me completely which is probably the thing in my life I’m most grateful for- acceptance means a lot to me, and I’m aware I’m not always the easiest person to be around although I’m trying really hard to work on it. It’s weird but before I met them, I didn’t really think relationships were that important and although I had two close friends, they both lived far away from me and I only saw them once or twice a year. We messaged most days and were still emotionally very close but it was like a ‘virtual’ friendship rather than a ‘real’ one and for me, that was enough and I didn’t think I’d ever really need much more than that. I also had a few, very intense (mostly one-way) friendships where I would ‘latch on’ to a particular person and would become very, very close to them almost to the point of dependency until they inevitably got fed up with me and the intensity of the relationship and asked me not to contact them again. That really, really hurts and I’ve had that experience repeatedly since I was about 13 but I’m a lot more aware of it now and able to talk about it more openly and touch wood it hasn’t happened much over the last few years which is partly because I’m more able to recognise it, partly because of the ‘real’ relationships I’ve started to develop and partly because my current obsession is Homeland’s Carrie Mathison who is a fictional character and therefore incredibly unlikely to reject me. Although that doesn’t stop me from getting paranoid that Homeland producers are going to contact me asking me not to write or talk about Carrie any more because I’m too obsessive!

Anyway, back to the pseudo family relationship… A few years ago, I started to babysit for some kids I’d known from a school I worked in and who I’d got quite close to at school (I have a tendency to get a bit over-attached to kids I work with), and my views on relationships started to change. I’m not completely sure how but I was close to the kids already and babysitting meant that I developed a really nice, apparently two-way close relationship with them which was amazing. I also got on really well with their mum and felt weirdly safe and comfortable around her which doesn’t happen very often around people and I think it all kind of fed into itself so it got to a point where I realised that I felt more safe spending time with them than I did anywhere else and I loved spending time with them. And, weirdly, it really does seem to be a two-way relationship, which is very, very strange in a really nice but slightly unbelievable way.  It also really helps that, because of how the relationship developed, there were clear boundaries and even though it’s more of a friendship/family relationship now, I know their mum would tell me if I crossed any sort of boundary by mistake and that is so important in any relationship because it makes you feel safe and massively reduces anxiety.  I have a similar relationship with my best friend and I know I’m really, really lucky to have that.

Over the last few years, it’s really made me realise that genuine, two-way close relationships are actually incredibly important and that they can change and even save your life without you or them even realising it. I am not a particularly emotional person and I don’t usually like hugs or physical contact of any type but there have been some kids from school who have ‘attached’ themselves to me a bit and wanted hugs or to sit on my knee which I don’t really mind and I’ve found that it’s one of the things that can make me feel ‘connected’ or real even when I’ve been feeling rubbish and zoned out all week. I’m putting it partly down to oxytocin which I’m realising is an absolute lifesaver hormone but also down to the fact that I genuinely love the kids unconditionally. It’s a really weird feeling and it’s not something I’ve ever experienced before, and it scares me quite a lot as well as feeling intensely safe and amazing. It’s scary because of the intensity (‘good’ intensity that’s real and stable, not like the obsessive, volatile fixation I used to experience a lot) and because of the way I would do ANYTHING for the kids.  I seriously have no idea how parents manage it- it’s intense enough when they aren’t your own kids!

This is probably going to make me sound incredibly selfish (sorry in advance, but I do try to be honest on this blog) but usually most of my relationships are one-way and I’m aware of that, so it ends up being mainly about me contacting them, trying to spend time with them and, to an extent, idealising them so the thought of not being able to contact them at all is absolutely unbearable because I know (deep down) that if I didn’t contact them, they wouldn’t contact me and the relationship would be non-existent. But by that point, I’ve idolised them to an extent where that seem like the worst thing in the world so I need to keep contacting them and trying to keep the ‘relationship’ going even though I know now that they’re not real relationships because they’re not two-way and it’s more like a fixation or imaginary friendship than an actual social relationship.

With the family I babysat for, it’s different I think because they genuinely seem to accept and maybe even like me back, and (I don’t want to jump to conclusions, sound selfish or jinx anything here) I kind of think that if I didn’t contact them for a while, they would probably notice and maybe contact me or at least not forget I exist which isn’t something I’ve felt much in social relationships before. And because of that, there is so much less anxiety and paranoia around the relationship which makes a massive change from nearly every relationship I’ve had in the past. I really, really appreciate that so much and I really do love them in a way I’ve never really experienced before. It scares me that I can feel that intensely but it’s also amazing. And it’s made me realise that genuine relationships really can change your life- the kids are getting older now and are becoming more aware of mental health issues and I really, really don’t want the way I often feel to affect them which is the main reason I’m trying to hard to ‘recover’ or at least manage my thoughts and behaviours to a point where they don’t interfere with my life as much as they have done over the last fifteen years. It’s HARD but I really, really don’t want to affect the kids and I’d rather cut them off completely than risk affecting them negatively although I know that that would also hurt them so it’s a bit of a no-win situation! So I really, really need to learn to manage how I’m feeling…

The relationship with kids has also indirectly saved my life, which is another thing that scares me but not necessarily in a bad way. Since losing a very close friendship last year, I have been experiencing waves of suicidal thoughts that come and go but can sometimes be insistent and intense over several weeks and lead to repeated, vivid dreams of attempting suicide which make me feel weird, selfish and kind of jealous of my dream self and that makes me feel even more selfish and like a really horrible person. But the reason I’d never attempt suicide in real life is because of the impact it would have on the kids and that’s a really scary thing to realise. A few years ago, I didn’t even consider the effect that having a chronic eating disorder was having on my body and there was a part of me that actually wouldn’t have minded if it was severely detrimental because there were times when I would be trying to sleep feeling my heart stop-starting and ‘jumping’ in my chest from electrolyte imbalance or extreme cold and not waking up actually seemed like a better alternative to continuing to feel horrible, guilty, selfish and obsessive but now, the thought of the impact that something like that could have on the kids makes me feel incredibly selfish and guilty but in a ‘productive’ way and I really, really don’t want to hurt the kids. So I really do want to learn to manage my ED and I’m still finding ways to do that…

My relationship with the kids’ mum has also been a massively positive influence on my life and I’m really grateful for that. She lets me spend time at their house, accepts me even though she knows more about me than anyone else apart from my best friend (who I met as an inpatient and have been in psychotherapy groups with so she knows more about me than anyone else probably ever will!), and is genuinely supportive and accepting. She’s an amazing person who I really look up to and she’s a really positive role model in a lot of ways, and I really appreciate the way she’s accepted and put up with me since I first started to babysit for her. And again it’s helped me to realise how important positive relationships are in your life- I feel safer around her and the kids than I do anywhere else and I think it’s mostly because of the acceptance, positive boundaries and honesty in the relationship. Positive and trusting relationships are incredibly important for anyone, and for people experiencing mental health issues of any kind they can be life changing.

Friendships are more complicated and I’m still learning how to make, keep and manage friendship-type relationships.  Since I’ve talked about this so much in previous posts (and probably will again), I won’t go into too much detail again here but I’m really lucky to have at least one close friendship (outside of family/pseudo-family) who is amazing, accepting and so understanding of any sorts of anxiety, paranoia or intense moods which makes such a massive difference because it means I feel ‘safe’ around her and can be totally honest, and I know she would be too.  We met as inpatients so we got to know each other probably too well very quickly, but that’s one of the best and safest bases for a relationship I know.  She is awesome and I am so, so lucky to have her in my life even if I don’t see her that much because we live quite far away from each other.  As well as the Friendships and mindfulness post, I wrote a list of things I’d learned about friendships in another post and I’ll replicate it here because I think it sums up everything I’ve learned about friendships so far and am still learning…

  1. Take every friendship at face value. Don’t overthink it, make assumptions, have unrealistic or idealistic expectations, or make any judgements at all. Try to take the friendship as it comes and use mindfulness or grounding techniques to manage anxiety.
  2. Friendships are fluid and changing. There is no such thing as a ‘best friend’ or ‘forever friendship’, however amazing that would be. Enjoy the relationship when you can but don’t have any expectations that it will last forever. Practise ‘beginner’s mind’ (seeing every experience as the first time you’ve experienced it, without any preconceptions or judgements) and don’t overthink it.
  3. People change and that’s part of life. If a friendship ends, it might not have anything to do with you whatsoever- the other person might have changed or moved on and THAT’S OK. Growth is part of life and people move on at different rates. That doesn’t make it any painful, but taking away the guilt or self-criticism will help you move on from it a lot more easily.
  4. Be open with people. Honesty and openness in relationships is the most important part of a healthy relationship and will reduce anxiety more than almost anything else. Anxiety and particularly paranoia come from uncertainty and thrive in self-doubt or assumptions. If you’ve got a gut reaction to something- check it out. Don’t let it spiral into full-on paranoia or depression because then everything’s skewed through a fog of thoughts and judgements and you’re likely to damage the relationship without realising it. Sounds cliched but if the other person’s worth being friends with, they’ll be honest with you.
  5. TRUST. This is one of the hardest ones for me and there’s different ways it’s relevant to friendships but the some of the key points are to trust that the friendship will still exist even if you’re not constantly contacting the other person, trust that the other person will be honest with you, and trust that the other person really does want to stay friends with you. I find all of these really hard, especially the last one, but they’re so important and I think they get easier the more you do them… It really relates back to the mindfulness idea and I’m trying really, really hard to use that in my current friendships.

The last type of relationship I’m going to discuss is ‘functional’ relationships. By that, I mean relationships that are positive in that they have a beneficial or constructive effect on your life but you don’t necessarily need to ‘like’ the person. Sometimes friendships or family relationships can cross over into this category too but not necessarily. A typical example of this is teachers- when I was at school, I had a teacher who I really didn’t like but who was very strict and boundaried and I felt ‘safe’ in her lessons because I knew what was expected and what I was meant to do. I ended up learning a lot from that relationship about respect and fairness, and it was a constructive relationship in that sense because it had a positive effect on how I felt and behaved and it’s something I’d love to be able to model when I’m working with young people now. Another, more recent example is a psychologist I used to see in an eating disorder service. I didn’t feel massively comfortable with her and I wasn’t a big fan of her approach but I did learn a lot from the sessions even if it didn’t feel like it at the time and again it had a positive, longer term effect on how I felt. Friendships can also be functional such as people you like hanging out with but wouldn’t necessarily want to have in depth discussions with, or conversely people you trust and would go to for advice but wouldn’t feel comfortable enough to spend a lot of time with. Relationships aren’t binary and can merge into different categories but the main differences are whether they’re positive or negative, and how close they are.

Another type of relationship that isn’t mentioned as much as it should be is human-animal bonding which can be just as useful and important as human-human social relationships.  I have had cats since I was in primary school and, growing up especially, this has been a really, really positive impact on my life.  Until recently, pets were the only ‘beings’ I’d ever said “I love you” to, and I get the same oxytocin release from cuddling my cat as I do with kids I babysit or work with.  Oxytocin is a really, really powerful hormone and massively underestimated- it can more powerful than any mood stabiliser, promotes the strongest feeling of acceptance and safety I know, reduces anxiety and depression, and is the best cure for loneliness I’ve ever come across.  This is why pets can be vitally important for people at risk of social isolation and for anyone with or without mental health issues.  I love my cat so much and can’t imagine not having one- to the point where, after my previous cat died and my parents didn’t want to get another one, I waited until they’d gone away for a week before going to cat rescue and adopting one who is now my ‘cat-baby’ and I really, really love her.  It’s amazing how much cuddling her and feeling her purr can affect my mood, and it’s the same tingly-chest feeling I get from hugging the kids.

Writing this post really reminds me of a verse from David Bowie’s song ‘Five Years‘ which is written about alienation of society and the whole song is based around the idea that the world will end in five years.  He sings “And all the fat-skinny people, and all the tall-short people, And all the nobody people, and all the somebody people, I never thought I’d need so many people.”  This line really gets to me because I can completely relate to how that feels, and ten years ago I’d never have thought I’d have the sort of social relationships I have now, or how much I would appreciate and ‘need’ them.  The Ziggy Stardust album is written about an alien rock star and Bowie inhabited Ziggy as a character while writing and performing in the early 1970s, and that means that the lyrics and concepts are intense and real, and a lot of the songs are written about alienation, fragmentisation and the way in which people are dissociated from each other.  Bowie’s albums nearly always deal with this idea, and a lot of his exploration seems to be about characters feeling alienated in some way and how destructive or dangerous this can be.

For people with mental health issues, relationships are particularly important because they can reduce the risk of social isolation or exclusion, which can exacerbate existing issues such as depression or paranoia. It’s a lot more complicated in practice because many mental illnesses can lead to a person self-isolating because of lack of motivation or energy to go and meet people, anxiety about being around people, paranoid thoughts or any combination of factors and also because there is still a lot of stigma about mental health issues and some people are judgmental or just scared of it which again leads to people experiencing mental health issues to become isolated or lonely. But positive relationships can be as beneficial for people with mental health issues as medication or therapy if not more beneficial and it’s so important to raise awareness and understanding of mental health as a spectrum, how to accept and support someone experiencing mental health issues, and the importance of developing and maintaining positive relationships.

Eating disorders and the autism spectrum

I wrote this a while ago but thought it might be relevant for this blog and people might find it interesting 🙂

 For Eating Disorders Awareness Week, I’m writing about the link or crossover between eating disorders and the autism spectrum, particularly in women. I became interested in this area from personal experience of being diagnosed first with anorexia nervosa and then informally diagnosed with an autism spectrum disorder which was genuinely like someone had suddenly explained my whole life experience to me and it suddenly made sense.

 My first introduction to the autism spectrum came from a psychologist I was seeing in an eating disorders service when I was 19. She gave me an article written by Janet Treasure who is a psychiatrist specialised in eating disorders and who has been investigating the link between ED and ASD. I didn’t really know what the autism spectrum was before that time, but the mention of routines and obsessive interests caught my attention straight away as these were something I associated very strongly with having an eating disorder. More recently, I’ve been reading a lot of articles and studies about this area and have been genuinely excited about what has been found.

 I don’t want to go into massive amounts of detail about research studies because that could be very boring to read, but will summarise some of the most interesting studies I’ve read so far as part of research. The majority of research has focussed particularly on anorexia nervosa although there are a few studies that look at bulimia nervosa and EDNOS. I think it’s important to look at all aspects of eating disorders because, for many women with ASD, an eating disorder can be as focussed on controlling overwhelming emotions or feelings you don’t recognise or understand as it is linked to weight or body image. After summarising the articles, I will give a personal perspective which is only one experience of ED and ASD- everyone’s experience of either is different and the interaction of both is unique in every person who is affected by it.

 In the study ‘Aspects of social cognition in anorexia nervosa: Affective and cognitive theory of mind’ in 2008, Russell et al looked at aspects of social functioning in anorexia nervosa (AN), focussing on affective and cognitive theory of mind. They used female participants diagnosed with anorexia nervosa (both restrictive and binge-purge sub-types) and female healthy controls who were screened for Axis 1 disorders, neurological disease, history of head trauma and current use of psychotropic medication prior to the study and administered two tasks which assessed both aspects of theory of mind to identify which, if any, was impaired in individuals with anorexia nervosa. They used theory from previous studies such as Keys et al’s 1950 experiment on the effects of starvation on healthy individuals and Connan et al’s 2003 study into the neurodevelopmental effects of starvation during critical stages of development to pre-empt a possible difficulty of distinguishing between traits associated with AN and the effects of starvation of the brain and focussed their study on aspects of theory of mind associated with social cognition rather than emotional recognition which was formed the basis of the majority of previous studies. The main limitation of this study is that, as with the majority of other studies found, it only used participants with current AN rather than a comparison with weight restored participants which restricts the results to a current AN state which, as the authors note, could be affected by starvation which affects the brain physiologically in a way that mimics some autistic symptoms, and the relatively small sample size of 22 AN participants and 22 healthy controls. The study is interesting because is differentiates between two different forms of theory of mind and finds a sub-group of AN participants with specific ToM difficulties due to the higher proportion of participants performing poorly on the task which is interesting because it suggests that a particular aspect(s) of theory of mind or social cognition could be affected in AN.

 In relation to bulimia nervosa, DeJong et al carried out the 2011 study ‘Social cognition in bulimia nervosa: A systematic review’. They reviewed studies that looked at aspects of social cognition in bulimia nervosa (BN) and evaluated them to examine whether there are deficits in social cognition in individuals with BN. The article is significant because, as a contrast to the majority of previous studies, it focusses specifically on BN as opposed to current anorexia nervosa and is therefore not restricted to a low BMI or possible effects of starvation. They differentiated aspects of social cognition such as social perception, social knowledge, attributional bias, theory of mind and emotional awareness and reviewed each separately looking at studies from PsychInfo, PubMed and Scopus which used participants with BN and healthy controls. They referred to theory about socio-emotional factors associated with BN such as social anxiety and interpersonal difficulties and point out that these could be made worse by the bulimic symptoms and also mention common co-morbidities with BN such as borderline personality disorder (BPD) which I found interesting because some of the symptoms of BPD such as difficulties processing complex social information and social anxiety are also present in both eating disorders and ASD. Although the article did not find significant differences in all areas of the studies reviewed such as theory of mind and emotion recognition, the results in terms of attentional bias are towards specific emotions such as anger are interesting and the finding that people with BN appear to have difficulties with inferring both the emotions of self and others in interpersonal scenarios is interesting in relation to ASD, especially looking at difficulties with emotion recognition.

 Another 2011 study, ‘Is Anorexia Nervosa a Version of Autism Spectrum Disorders?’ carried out by Oldershaw et al looks directly at the link between AN and ASD. They aimed to do a direct comparison study looking at the cognitive profile of AS compared to published ASD data using tests to assess empathy, executive function and central coherence. They referred to theory and studies that have examined the crossover of AN and ASD, giving examples of different aspects of this such as eating disturbances and statistics to support the theory. I found this article particularly useful because it covers both AN and ASD perspectives and referred to the work Gillberg et al (1995 and 1996) which suggests that there is a higher proportion of individuals who meet the criteria for ASD in AN population and also that there is a sub-group of people with ASD who will experience a clinical eating disorder (Kalvya, 2009) which is the inverse of the majority of previous studies. They also pointed out limitations to tests used in previous studies such as the systemising scale used by Hambrook et al (2008) which could be seen to have a gender bias towards interests commonly associated with men which might exclude females who could be seen to be high systemisers, and this is particularly interesting for women seeking an ASD diagnosis. I found this study particularly relevant because it focussed on three cognitive features which appear to occur together specifically in AN and ASD (empathy, executive function and central coherence) although the study used participants with current AN so, like previous studies, the effects could be partly a result of starvation and are restricted to current AN rather than other eating disorders or weight restored individuals. As a contrast to this article, which questioned whether AN is a “version” of ASD, I am going to look at the area from an inverted perspective and look at whether high ASD traits could lead to the development of a clinical eating disorder and any differences from eating disorder traits in individuals without ASD traits which is referred to in the article but not fully explored.

 Yet another 2011 study (seems to have been a very busy year for this research!) by Harrison et al looked at ‘Social emotional functioning and cognitive styles in eating disorders’. They looked at the structure of both cognitive and social emotional functioning and how it correlated to severity or duration of eating disorders. I particularly liked this study for its breadth: the study looked at the maintenance of eating disorders as well as their onset and possible premorbid traits, and used a range of participants with variations of current eating disorders (restricting and binge-purge sub-types of anorexia nervosa, bulimia nervosa and EDNOS), participants recovered from AN and healthy controls. The scale of the study which uses 225 participants is also significant. They referred to contemporary models of eating disorders and possible premorbid traits, and they gave several examples of observed behaviours or previous studies to support their theory. The use of a recovered group of participants was particularly valuable because it avoided the possible objection that the results could have been affected by starvation although there is still a possibility that long term starvation could have had an effect on the cognitive or social emotional functioning of the brain. Harrison et al mentioned this in their discussion and suggested that further research could include a longitudinal study into this area to further investigate whether the cognitive or social emotional functioning is a premorbid trait that serves to maintain the eating disorder or if it is an effect of the illness.

 There are many more studies which look at the link between eating disorders and the autism spectrum from a psychological or scientific perspective, but I am aware that summarising them all would be very long and possibly boring to read! I’m definitely not an expert but I do have a strong interest in this area. From what I’ve read about eating disorders and the autism spectrum as well as personal experience, the main areas which I’ve found cross over from one to the other are structure and routines, emotional immaturity or fear of ‘growing up’, possible lack of sexual interest or (perceived) inappropriate sexual attraction, obsessiveness, difficulties in social relationships or ‘reading’ other people, wanting to ‘fit in’, difficulty recognising and/or managing emotions, and logical or ‘black-and-white’ thinking. Obviously not all of these will apply to everyone, but I think they are relevant. Eating disorders develop for different reasons in different people and every case is individual, but a common trigger can be the need for control or control over emotion which can be a reason that EDs often start in teenage years as emotions are often overwhelming at that time and for girls with ASD particularly, a sudden influx of emotion that you don’t necessarily understand can be terrifying.

 For teenage girls with ASD in particular, emotional changes which are already intensified in neurotypical adolescents can seem overwhelming for an autistic girl. Autistic sexual development is the same as neurotypical sexual development but usually occurs over a much longer period of time- although a person with ASD matures physically at the same rate as their peers, social and emotional development is often delayed and typical adolescent characteristics such as sexual interest might not occur until a person is in their 20s or even 30s. The combination of both of these factors can seem unbearable for teenagers, particularly teenage girls, on the autism spectrum and especially if the autism is undiagnosed or not fully understood as this impacts on a person’s self esteem and how they perceive themselves, or how others might perceive them. This also links with the difficulty that a lot of people with ASD have with understanding and expressing emotions and this again can lead to eating disordered behaviours as a way to manage or reduce intense emotions.

 From a personal perspective, my eating disorder began when I was a teenager and I’m still not totally sure when. I’d always been very routine-oriented anyway, and this became a coping mechanism for when I felt completely overwhelmed in the first few years of secondary school and I owed seemingly endless amounts of late homework (organisation has never been a strong point) and I seemed to have no ‘real’ friends. When I became a teenager, I realised that I was ‘weird’ compared to most people in my year group because I was still obsessed with Disney films and children’s books, and had no sexual or romantic interest in either sex. The feeling of weirdness got stronger when I developed an obsessive interest in one of my subjects at school, which then transferred to the teacher of that subject. At the time, I had never heard of the autism spectrum and was totally unaware that obsessive interests are very common, and that, in girls particularly, these can often be transferred to people you look up to or who are associated with your special interest. I knew there was no sexual or romantic attraction but this was confused in my mind because I had no interest in any form of relationship with anyone at all, and the idea of any form of sexual relationship terrified me (at 29, it still does). I was completely confused and felt really guilty about what I was thinking and feeling, and it was made worse as my obsessive interests began to annoy or bore other people and I was convinced I was a weird, obsessive freak. Most of my friends were at least three years younger than me because I felt more comfortable with them, partly because I genuinely felt much younger than people in my year group and partly because being friends with people outside of your year group takes away a lot of the social pressure.

 I know now that a lot of this is typical of girls with ASD and that what I was experiencing was a natural part of adolescent development but at the time, ASD was not commonly talked about (I’d never heard of it) and Asperger’s syndrome or high functioning autism often went unrecognised. For me, the most distressing part of it was the obsession with a person which I didn’t understand and which made me feel like there was something seriously ‘wrong’ with me or that I was some kind of creepy stalker. Obsessiveness also led to a lot of rejection, both in friendships where I would often over-text people because I was worried they weren’t talking to me or that if I didn’t contact them they’d forget I existed, and also (more obviously) with people I’d ‘latched on’ to or become obsessive about. The hardest one to deal with as a teenager was a fixation I had on the teacher who taught my favourite subject and at the time, that was all I could think about and it completely took over my life which sounds like an exaggeration and now, I find it hard to imagine, but she was my ‘default thought pattern’ and everything I did was to try to make her like me or to be like her. That was the most important thing to me at the time- if she was nice to me, it made me feel amazing for the rest of the week but if she ignored me or told me off for something, it felt like the worst thing that could ever have happened. This sort of fixation with people continued into my 20s with various people (the ‘obsessions’ would usually last a couple of years, or until the person asked me not to contact them again) and over the last few years, they have gradually become less intense which I think is partly due to more acceptance and understanding of ASD and partly as a result of taking anti-depressant and mood stabilising medications.

 I first began to experiment with my food intake when I was 13 because, as many teenagers seem to think, I thought that losing weight would somehow make me more ‘cool’ or acceptable at school. I had no idea how to diet, and my obsessiveness took over as I became obsessed with not eating any form of fat or ‘junk’ food. I lost a small amount of weight but the anxiety over it increased which led to bingeing. After a binge, I would restrict or stop eating completely for the weekdays, then binge again at the weekend. This continued for the next few years as I realised slowly that restricting numbed feelings of not fitting in or not being good enough, and bingeing reduced anxiety. My weight fluctuated slightly but not drastically, and at that point, it was much more about controlling how I felt and numbing overwhelming emotions which I couldn’t understand or, much of the time, even recognise and I felt like I was in a constant state of vertigo and guilt.

 When I was in my final years of school, the obsessive interests became more of a problem and less acceptable, as did my friendships with people several years younger than me. I also began to realise that soon I would be leaving school and that terrified me- much as there were a lot of things I found difficult at school, particularly socially, the idea of leaving behind a ‘safe’ structure and routine seemed much worse. When I turned 18, I made my own ‘routine’ around timings, food and exercise and decided to stick to that as a sort of bridge to leaving school and becoming an adult. The bingeing stopped and I stuck to the routine religiously, and my weight began to go down. As it dropped, my obsessive thoughts became focussed on food and weight instead of focussing on a particular interest or person, or what people at school thought of me, and this felt much safer. When my weight went below a certain point and my periods stopped, I realised that my ‘teacher obsession’ had gone away completely which was the biggest relief of my whole teenage years and I became convinced that I was weird because I had been so fat and that I had to stay under a certain weight to be ‘normal’ or acceptable.

 After that, my obsessiveness took over and I lost a lot of weight very quickly and was admitted as an inpatient in an eating disorders service later that year. I did not identify as having an ‘eating disorder’ as my experience seemed different to most of the other people there, and I found the ‘social’ aspect of living with the same people every day very difficult although the highly structured environment of an inpatient ward definitely helped while I was there, but I have found it very hard to ‘break’ that routine and even now still stick to ‘safe’ foods and the same timings for meals. I had three admissions over two years until I realised several months into my last admission that, for me, being an inpatient was not helping much beyond weight restoration and could even be detrimental because of the social difficulties and the obsession with routine. I discharged myself and have not been an inpatient since. I think that inpatient ED services can be very useful and are often essential for people who are at a very low weight or whose physical health is affected but they can also be detrimental for some people, particularly people with ASD, because they are necessarily structured which can reinforce the difficulty with breaking routine or initiating change, and because of the intensity of living so closely with other people. I know that an admission is sometimes unavoidable but I also think that there should be more focus on developing new strategies to deal with ED thoughts and behaviours and particularly how they link to other issues such as managing emotions or identity issues which are common in both people with EDs and with ASD, and working on flexibility or spontaneity rather than enforcing another ‘routine’ which can be even more difficult to break. I haven’t been an inpatient since 2007 but I still stick to the same meal times and basic foods which I have found it very, very difficult to even try to change.

 It was later that year that the psychologist I was seeing in the ED service first mentioned the autism spectrum. I had never heard of it but once I read more about it, something seemed to ‘click’ and suddenly things seemed to make a lot more sense. I did a lot of reading about the autism spectrum and started to use online message boards and forums, and it was as though someone had explained my whole mindset to me in a way that made sense. Self esteem-wise, it was about the most useful thing I have ever discovered because, slowly over the following few years, I realised that I was not ‘just weird’ or an ‘obsessive freak’ and that there was an explanation for why I got so panicky without a routine, or annoyed people without realising it, or didn’t seem to ‘fit in’.

 I still have obsessive interests now but I make use of them in a constructive way- my current obsession is the television programme ‘Homeland’ and I have a very detailed blog written from the point of view of Carrie Mathison, the main character, who has a diagnosis of bipolar disorder but also displays a lot of autistic traits (if anyone’s interested, it’s called Carrie Mathison’s Diary and I also have a Facebook page under the same name). Amazingly, there are actually people who read it (!) and it really helps to channel emotions and overwhelmingness by writing through Carrie’s perspective. My ‘people obsessions’ are a lot less intense than they were as a teenager, and I think this is partly because I have come to accept them more and am often relatively open with people about them which really, really helps. And writing fiction can be a very powerful tool- I wrote a creative writing piece a few years ago about a teenager who has a non-sexual ‘crush’ on a teacher which really helped to deal with the underlying feelings I hadn’t realised I still had, and I also play the Sims PC game which helps to ‘practise’ all sorts of social situations- I would recommend it to anyone on the spectrum. Fiction can be a great way for expressing or dealing with feelings or emotions if you don’t necessarily know what they are. For teenagers especially, it’s important that emotional awareness is taught in an explicit and clear way, and that strategies to manage difficult emotions are explained specifically in a way that the person can relate to and use effectively, which will be different for each person.

 Something I have found really useful for both recovering from an eating disorder and dealing with overwhelming emotions and social skills related to ASD is using skills from dialectical behavioural therapy (DBT). I recently discovered a book called ‘The Dialectical Behavior Therapy Skills Workbook’ and it is amazing- would recommend it to anyone on the spectrum struggling with any form of eating disorder, anxiety, depression or almost any other mental health issue. It’s split into four sections on distress tolerance, mindfulness, emotion regulation and interpersonal effectiveness and the structured, practical format is really accessible and teaches a lot of useful skills. Not all of it will be relevant but it’s definitely worth having a look at, and doesn’t involve any interaction with other people so is a lot less intimidating than accessing support can sometimes be. I’ve found the parts about managing emotions particularly useful and have a ‘coping card’ which is a laminated card where one side gives strategies to deal with intense anxiety or anger (such as sensory grounding, running cold water over your wrists, counting sounds or lists and other things I’ve found that work for me) and the other side relates to low mood or being ‘zoned out’ (such as listening to certain music, smelling salts, drawing or colouring, watching TV shows I’m currently obsessed with etc). There are about twenty things on each side and the idea is that if you’re experiencing intensely distressing emotion of any type, the ‘rule’ is to try at least two things from the card before resorting to bingeing or self harm. The idea is that by using distraction techniques, the intensity of the emotion will reduce and become easier to manage.

 I think the concept of ‘recovery’ from an eating disorder is very complex anyway, and even more when it comes to people with ASD because of the need for routine or structure and difficulties with change. I’ve been a ‘normal’ weight for the last six years and am physically ‘recovered’ but the ED thoughts are much stronger and harder to deal with at this weight than they ever were when I was a low weight. When you are severely underweight and your periods have stopped, your emotions, obsessions and difficult thoughts are much less intense and this is one of the factors that I think can make it particularly difficult for people with ASD to fully ‘recover’. It’s also very difficult for anyone with an ED to vary their diet but especially for people with ASD who often like to stick to the same things and routine in all aspects of life, not just food. As an inpatient, I was able to eat a more varied diet because that was the ‘rule’ but as a general rule, I eat the same few foods (even when bingeing) and I haven’t managed to change that yet because of the intense anxiety it causes which I know is typical of people with EDs but I think it’s also related to ASD because I also don’t want to change the times of meals or how I eat them and this extends to most things I do and not just food (I need to be in bed by a particular time, get up and be dressed by a particular time and get very anxious if I don’t have a routine for the day). It’s also an issue with accessing support because many ED and mental health services don’t want to work with people with ASD because it’s a neurological difference rather than a ‘mental health issue’ and some areas don’t have autism services for adults. Some psychiatric medication can be helpful for people with ASD in relation to managing obsessions or anxiety, with low mood and with sleep but it is not a long term solution and there still needs to be a lot more awareness of ASD and co-morbid mental health issues such as eating disorders or obsessive compulsive disorder.

 I think that eating disorders can develop in women on the spectrum for many different reasons, and everyone is unique- my experience is personal to me, and every person is different. But having said that, there are many traits of ASD which are similar to ED traits which can increase susceptibility to eating disorders, particularly if self esteem is already low as it often is with women on the spectrum. Both eating disorders and ASD are self-focussed and isolating, which can also increase the possibility of other mental health issues such as anxiety or depression and this makes it even more important to raise awareness about eating disorders on the autism spectrum. Women are underdiagnosed with ASD compared to men and it is often harder to spot, which makes it vital that people are aware and accepting of it. Autism is a difference and not necessarily a negative, and it’s so important that people know and understand what it really is and how it impacts on people’s lives.

What I’ve learned from distance running

I wrote this in the middle of an ultra last year- it was a 12 hour overnight run and I took my usual 20 min break at 2am, and started to list things I’d learned over the previous seven hours. It’s amazing how runnign for that long really clarifies your thoughts and puts things into perspective!  The notes turned into a poem which I haven’t edited since because I want it to reflect my thoughts mid-ultra.  So…

What I’ve learned from distance running:

There’s no secret or special skill. 
You just put one foot in front of the other 
and keep going. 
Don’t forget to look at how far 
you’ve already come. 
Sometimes you feel fucking amazing 
like you can do anything; 
other times it hurts like hell and you feel  
shit. There are times when you want to quit, 
you can’t seem to get rid of negative thoughts, 
or everything seems too overwhelming.  
Then you need to slow down, assess, stop 
if you need to, or take a break. Focus 
on the moment you’re in, 
try your best in that moment.   
Don’t even think about speed or times. 
Fuel yourself properly 
and drink lots of water. 
alk the hills- you’ll get there 
in the same amount of time. 
Run your own race. Don’t feel guilty 
for running at your own pace.  
Look around you at the scenery, find 
something nice in every moment.  
Breathe. Have fun. 
The same rules apply to life. 

A found poem for David Bowie

It’s been nearly four months since David Bowie died and I still can’t process it properly.  Not so much the fact that he’s dead- it’s not as though I’ve ever met him personally and his concept and personae are still very much alive in my head, more the fact that he’ll never release any new music and I’ll never get to see him live in concert.  There’s a (horrible) part of me who’s angry at him for that and thinks he’s selfish for not going on one last tour after The Next Day but he’s an enigma and always will be, and his physical self doesn’t represent the amazing personae and characters he inhabited.  So I’ve written a found poem in his memory, constructed from lyrics taken from nearly all of his albums.  RIP David Bowie ⚡️🎸⚡️🎸⚡️

Friendships and mindfulness

I really, really wish I could believe this!  This quote came up on my Facebook feed recently and it got me thinking again about how DBT skills (particularly mindfulness) can relate to and be helpful for managing friendships and social relationships.  I find friendships particularly difficult, both the practical aspects like actually meeting people and making friends as well as the confusingness of boundaries, knowing what is a friendship and what isn’t, managing paranoia or intense feelings of guilt about social interactions, and keeping a friendship in a healthy way.  Some of the interpersonal skills from DBT have been really, really useful for this (particularly DEARMAN which I’m going to talk about in more detail in another post) but also, surprisingly, some of the mindfulness skills.  To be completely honest, mindfulness is the aspect of DBT which I find hardest and often miss out, partly because it’s more abstract and not as ‘practical’ or logical as the other components (distress tolerance, emotion regulation and interpersonal skills) and partly because it’s genuinely HARD and takes a lot of practice to actually have any effect at all.  But recently I started to fill in a DBT diary every day which has a checklist of skills from every component of DBT so I’ve been reading more about the mindfulness skills, and one in particular really got to me and I haven’t been able to stop thinking about it.  I would never have thought to look at friendships in this way but it really makes sense- here’s the extract from the book (‘The Dialectical Behavior Diary’, Matthew McKay and Jeffrey C. Wood):

I can really, really relate to this!  Even though I’ve done a lot of work on black-and-white thinking over the last fifteen years, in therapy and trying to apply it to life situations, I still find it really difficult not to think of everything in extremes.  This is especially true in friendships and I know I tend to either over-idolise people and think they’re amazing in every possible way or think that they hate me, aren’t talking to me or don’t trust me, and there’s very rarely anything in the middle.  I’m not as bad with it as when I was a teenager (when nearly everyone I knew fell into one of the two categories and I was in a state of constant paranoia about upsetting people) but it’s still something I find hard to balance.

There are so many useful points in this extract and I’m going to look at them one at a time.  The first one is the main point of the section- the idea of beginner’s mind.  Beginner’s mind is where you try to look at a situation or interaction as though you’ve never experienced it before and that counts both for the actual situation and for the people involved.  So there are no judgements, preconceptions or anxieties about it at all- it just IS.  This is really hard to get your head around (at least for me!) but it basically means that you don’t have any expectations at all about how the situation might go (I did another post on this recently- see Celebrating 400 years of Shakespeare with DBT skills…) and in theory this should reduce any anxiety around it, stop you from acting according to emotions or judgements, and minimise negative interactions that could come from anxiety or paranoia.  I really like this concept but it’s so hard to do in practice!

The next part which I find particularly useful is how this concept links to black-and-white thinking.  The part about best friends really, really got to me and I can relate to it so much, and hadn’t thought about it in that way at all but it makes so much sense.  I recently lost a very close friendship and I’ve found it really, really hard to deal with.  It happened in December and it’s now May but the intense feelings of guilt and hurt, the inner ‘vacuum’ as though someone’s punched me in the stomach and sucked out my insides, obsessive thoughts about wanting to contact her or get back in touch, and the bitch in my head telling me constantly that it’s completely my fault, I’m horrible and obsessive, and that I don’t deserve any friends haven’t eased off at all and sometimes even seem to be getting stronger.  I’ve tried distress tolerance skills to manage them which work temporarily but after a few months, it’s starting to feel like I’m just ‘existing’ and that there’s not really any point because my default state is paranoia and I don’t have the energy or motivation to keep fighting it, so I really need to try a different approach.

I think that one of the reasons the loss of the friendship hit me so hard was because I genuinely thought that the friendship could never break and that we’d be best friends forever.  We’d been friends for 19 years which is a really, really long time and although we didn’t see each other much in person (she lived a long way away from me), we texted and emailed regularly and she’d always be the person I’d message in a crisis or if I had any particularly exciting news that I wanted to share.  I think that’s the part I miss most- being able to message ANY TIME about basically anything without it seeing weird or inappropriate and I still get urges to text her about something on an almost daily basis then have to cope with the fact that I can’t, and the hurt hits all over again just as intensely (if not more) than it did the first time.

This is where I think the mindfulness idea is really, really useful- one of the reasons it hurt so much was because of the ‘expectations’ from how I saw the friendship.  She was my ‘best friend’ and I thought we’d ‘always’ be friends, and we would ‘never’ fall out or lose touch.  It really was a black-and-white perspective and I think that’s something that made the friendship break up really hard to deal with.  In the Shakespeare post, I talked about putting people on a pedestal and how that means it hurts more if something happens to knock them off the pedestal and the same idea applies here.  It’s really important to realise that people are people and no one’s perfect, and that sometimes friends change and move on and that’s OK, and part of life.  It’s not realistic to see any relationship as ‘perfect’ or faultless, and disagreeing is part of any social relationship.  It’s important because it shows you that you can disagree on something and still be friends, which helps to reduce unrealistic expectations about the friendship.  It’s hard because, for me anyway, there’s a big part of me that thinks that I’m lucky that person wants to spend time with me in the first place but that’s not a healthy relationship.

I like the concept of beginner’s mind in relation to friendships because it takes away anxiety/paranoia about how a friendship ‘is’ or what the other person’s thinking.  It’s impossible to be paranoid about upsetting someone or what they think of you when you’re taking the friendship as it comes, treating every interaction like a new encounter and trying not to fixate on the friendship when you’re not actually interacting with that friend.  It’s really, really hard and you can’t ‘stop’ yourself from thinking about it, but another DBT skill which can be helpful with this is the ‘leaves on a stream’ thought defusion exercise (also a mindfulness skill) where you acknowledge thoughts but don’t fixate on them, and visualise them like leaves floating down a stream- you’re aware of them but not focussing on them.  By trying to get rid of thoughts, especially obsessive thoughts, you actually reinforce them so this is a really useful skills to practise although, like nearly all the mindfulness skills, it takes a lot of practice to actually have an effect.

This whole idea reminds me of a Harry Potter quote from Prisoner of Azkaban where Sirius says to Harry, “Besides, the world isn’t split into good people and Death Eaters.  We’ve all got both light and dark inside us.  What matters is the part we choose to act on. That’s who we really are.”  Even though I’ve read the book over and over since it was released in 1998, this quote still really gets to me and can still make me cry.  And it’s so true- no one’s perfect and it’s important not to expect people to be.  People have different perspectives and grow and change, and sometimes that means that a friendship can break down not because of anyone’s fault, just because of natural growth and change.  In the book, Sirius was betrayed by Peter Pettigrew who he had considered a friend but who had chosen to act on his ‘dark side’.  I think talking about Snape would need several posts to itself but the whole concept of friendship, love and change is prevalent throughout the Harry Potter books and it’s really helpful to look at it sometimes.  I love Luna’s quote “I liked the DA meetings.  It was like having friends” and for Luna, people accepting her and spending time with her is enough to count as friendship.  She doesn’t fixate on the relationships and genuinely does have a ‘beginner’s mind’ approach to friendships, and that really seems to work for her and she ends up with several ‘real’ friends which means more to her than it does to any other character (the linked pictures in her bedroom still make me feel emotional).

I’m going to finish by reposting the list of things I’ve realised recently about friendships from the Shakespeare post.  Hopefully some of this has made sense!

  1. Take every friendship at face value. Don’t overthink it, make assumptions, have unrealistic or idealistic expectations, or make any judgements at all. Try to take the friendship as it comes and use mindfulness or grounding techniques to manage anxiety.
  2. Friendships are fluid and changing. There is no such thing as a ‘best friend’ or ‘forever friendship’, however amazing that would be. Enjoy the relationship when you can but don’t have any expectations that it will last forever. Practise ‘beginner’s mind’ (seeing every experience as the first time you’ve experienced it, without any preconceptions or judgements) and don’t overthink it.
  3. People change and that’s part of life. If a friendship ends, it might not have anything to do with you whatsoever- the other person might have changed or moved on and THAT’S OK. Growth is part of life and people move on at different rates. That doesn’t make it any painful, but taking away the guilt or self-criticism will help you move on from it a lot more easily.
  4. Be open with people. Honesty and openness in relationships is the most important part of a healthy relationship and will reduce anxiety more than almost anything else. Anxiety and particularly paranoia come from uncertainty and thrive in self-doubt or assumptions. If you’ve got a gut reaction to something- check it out. Don’t let it spiral into full-on paranoia or depression because then everything’s skewed through a fog of thoughts and judgements and you’re likely to damage the relationship without realising it. Sounds cliched but if the other person’s worth being friends with, they’ll be honest with you.
  5. TRUST. This is one of the hardest ones for me and there’s different ways it’s relevant to friendships but the some of the key points are to trust that the friendship will still exist even if you’re not constantly contacting the other person, trust that the other person will be honest with you, and trust that the other person really does want to stay friends with you. I find all of these really hard, especially the last one, but they’re so important and I think they get easier the more you do them… It really relates back to the mindfulness idea and I’m trying really, really hard to use that in my current friendships.



“Consider the kind of body that enters blueness, 
made out of dead-end myth and mischievous 
whispers of an old, borderless  
existence where the body’s meaning is both more and less.”
– Eavan Boland, ‘How It Was Once In Our Country’

Liminal, caught in the suction 
of waves falling back to the sea. 
Hybrid, fluid between worlds which 
split genderless identity; 
consider the kind of body that enters blueness. 

Luring lost sailors onto rocks, 
rulers of river, rain and sea. 
Prototype virgins, sexless souls, 
paradoxical history. 
Made out of dead-end myth and mischievous 

narratives that flow with the tide; 
shape-shifting siren, lost and found 
with knife-slashed legs and open mouth 
a bleeding hole whose only sound 
whispers of an old, borderless 

story echoed through centuries. 
Transient tides hide paradox, 
detached pain and volatile self 
which rise and crash like waves on rocks. 
Existence where the body’s meaning is both more and less.

Celebrating 400 years of Shakespeare with DBT skills…

Seeing as I live in the Midlands, it was pretty much impossible to miss the celebrations of 400 years of Shakespeare’s legacy, particularly as I was working in Stratford this afternoon.  I did an English degree and was particularly interested in Shakespeare at one point (although via science fiction- long story) but I haven’t had much exposure to his work recently.  I was googling quotes that might be interesting to share, and this one really got to me.  I know my mind’s a bit DBT-focussed at the moment but this quote (which is actually a paraphrase of a quote from ‘All’s Well That Ends Well’) really does seem to link to some of the mindfulness and interpersonal skills from my DBT workbook.

One of the aspects of mindfulness in DBT which I’ve been working on really hard recently is mindfulness in relation to friendships.  The basic concept is that a lot of people who experience rigid or ‘black-and-white’ thinking can often extend this to areas of their lives like social relationships and this can be damaging not only for the relationship itself but for the person’s emotionally wellbeing.  The example given in the book is thinking of your best friend as someone who would never hurt you or let you down.  This puts a person into an idealistic perspective which isn’t real or feasible in every day life meaning that if that person does upset you (which is pretty much inevitable at some point in any relationship), it really, really hurts to an unbearable extent and often the friendship is lost.  The idea is to try to be ‘mindful’ of your friendships- take them at face value and don’t put unrealistic or extreme expectations on them, and try to look at it non-judgmentally.

It works both ways- you try not to have rigid views on what the friendship ‘should’ be and at the same time, you don’t jump to conclusions or make assumptions about what the other person might be thinking.  You take every interaction as it comes and try to stay in that moment instead of overthinking or judging what might or might not be happening, and don’t have any expectations about it.  In theory, the anxiety and/or paranoia about the friendship should subside which minimises the possibility of a negative reaction from the other person and the actual impact of a negative interaction should also be reduced because there are no unrealistic or ‘pedestal’-like expectations towards the other person.  The cliche about ‘the higher the pedestal, the further there is to fall’ really is true, and it’s taken me nearly 30 years to realise that.

I can relate to this a lot at the moment because I recently lost a very close friend who, for nearly 20 years, I saw as my ‘best friend’ and often referred to her as someone who would never hurt or judge me.  Just before Christmas, she ended the close friendship which really, really hurt and it’s taken a long time to come to terms with.  I think in part this was because I genuinely thought we’d be friends forever and that we would never have any sort of disagreement (on reflection, this is partly because I always avoid any sort of conflict which I know now isn’t healthy in any relationship), and it really was was one of the hardest things I’ve ever dealt with.  I had her up on the highest pedestal possible and the force of the hurt almost crushed me- figuratively, but it’s the closest I’ve come to totally giving up for nearly ten years.  I feel like my insides have been sucked out and I’m left with a vertigo-y vacuum, and I still feel like I’m running on autopilot a lot of the time.  BUT the most important key to surviving it (literally) is to accept and learn from it, and that’s where DBT comes in.  So, things I’m learning…

  1. Take every friendship at face value.  Don’t overthink it, make assumptions, have unrealistic or idealistic expectations, or make any judgements at all.  Try to take the friendship as it comes and use mindfulness or grounding techniques to manage anxiety.
  2. Friendships are fluid and changing.  There is no such thing as a ‘best friend’ or ‘forever friendship’, however amazing that would be.  Enjoy the relationship when you can but don’t have any expectations that it will last forever.  Practise ‘beginner’s mind’ (seeing every experience as the first time you’ve experienced it, without any preconceptions or judgements) and don’t overthink it.
  3. People change and that’s part of life.  If a friendship ends, it might not have anything to do with you whatsoever- the other person might have changed or moved on and THAT’S OK.  Growth is part of life and people move on at different rates.  That doesn’t make it any painful, but taking away the guilt or self-criticism will help you move on from it a lot more easily.
  4. Be open with people.  Honesty and openness in relationships is the most important part of a healthy relationship and will reduce anxiety more than almost anything else.  Anxiety and particularly paranoia come from uncertainty and thrive in self-doubt or assumptions.  If you’ve got a gut reaction to something- check it out.  Don’t let it spiral into full-on paranoia or depression because then everything’s skewed through a fog of thoughts and judgements and you’re likely to damage the relationship without realising it.  Sounds cliched but if the other person’s worth being friends with, they’ll be honest with you.
  5. TRUST.  This is one of the hardest ones for me and there’s different ways it’s relevant to friendships but the some of the key points are to trust that the friendship will still exist even if you’re not constantly contacting the other person, trust that the other person will be honest with you, and trust that the other person really does want to stay friends with you.  I find all of these really hard, especially the last one, but they’re so important and I think they get easier the more you do them…  It really relates back to the mindfulness idea and I’m trying really, really hard to use that in my current friendships.

Not sure how much of that makes sense but hoping it’s useful anyway!  Thank you Shakespeare for helping me link DBT skills to real life 🙂