What is rumination? My therapist and I have identified that rumination traps me in painful emotional states. Put simply, ruminating means thinking the same anxious or upsetting thoughts on repeat. A useful distinction between rumination and worry is that the former tends to involves repetitive thoughts about the past, whereas the latter usually concern the future. The main topic of my rumination is relationships and it often happens when I say bye to someone I love or leave a social situation. For example, I might meet up with a friend and on the bus home ruminate on what I said and how I acted. What is rumination like for me? For me, ruminating is like replaying a film over and over again in my head about what just happened. Instead of enjoying this film however, I’m watching for all of the things I did ‘wrong’ or why someone I care about might be unhappy with me. Ruminating is not enjoyable in the way that thinking about happy memories or daydreaming can be. Furthermore, rumination rarely presents an accurate portrayal of what happened. Rather, it is a rewriting of events which inevitably recasts me as the villain of my own story. I question myself repetitively: Did I say something awful? Did I come across as demanding? Will they want to see me again? My answers are anxious and do not fit the facts of the situation. I am left feeling fearing abandonment, feeling sad and fearful. What helps? Since identifying what rumination is and when I’m doing it, I’ve been able to replace it with something else. Instead of listening to my thoughts, I listen to audiobooks and podcasts. I use the mindfulness skills I learnt in DBT group to focus on the words of the story or conversation. If I notice myself losing focus on the words of the recording I try to gently bring my awareness back. It’s not a problem if I lose focus- I can rewind if necessary. I would estimate that since I’ve started listening to audiobooks and podcasts, I’ve had an 80% reduction in the time I spend ruminating. As a result, my BPD symptoms such as fear of abandonment, intense anxiety, sadness and impulsive behaviours as a result of this sense of impending doom have lessened significantly. I feel lighter and less like a prisoner in my own mind. I also make my way through so many more books than I did when I only read physical books! Last month I enjoyed Michelle Obama’s Becoming, Sally Rooney’s Conversation With Friends, Normal People and Yuval Noah Harari’s Homo Deus. (Please note that Sally Rooney's books self-harm and suicide Do you struggle with rumination? If so, is there anything that helps? Have you tried listening to something in order to manage rumination?

Lately I have been overwhelmed. I am coming through the other side of this burn out and wanted to share the things I do that help.

Last month, I completed a Master’s degree in Medical Humanities. Handing in my final essay was a huge moment for me because I had wrestled with my BPD to get to that moment. Doing a full time degree alongside working part time as a teacher and managing my Borderline Personality Disorder was really hard at times. I thought I would share four tips with you that helped me cross the finish line of my degree. 1. Disclose if you feel safe enough to do so I disclosed my BPD diagnosis once I started the course because I was sure I would be met with support. I told my tutors, the academic department and the university support services. I didn't think I would be discriminated against, but I felt that if that happened then I was in a strong enough position to challenge that. Disclosing enabled me to get extra encouragement from tutors in times of mental health crises and to be granted extensions when needed. The amount of time I needed to manage my mental health left me with less time to complete assignments than I otherwise would have done if I didn't have this condition. I also wanted to disclose because the course I was on involved a lot of discussion of illness, lived experience and patient testimony. The course was a mix of medical professionals and people with an interest in health, disability and illness. I wanted to be able to speak freely about my personal experience so as to get the most from the course and the group. 2. Planning out your time One of the key things that helped was being able to see my time visually. I blocked out time for classes / my teaching job / essay writing / DBT group & 1-to-1 sessions. I also ring-fenced time for spending with my family, my boyfriend, friends, doing blog stuff and yoga. Being able to plan out what, where, when and for how long gave me a sense of control over my time and the competing demands. Some people love digital diaries like Google Calendar, some are more old-school with paper ones. I have a Passion Planner and I love it because there is loads of space to plan and the paper is thick enough to use with highlighters, ink and even watercolours. Passion Planner have a free PDFs for download on their website too. 3. Having time out Sometimes I felt like I had to so much to get done that I couldn't take a break. These were actually the times I needed a break the most! Sometimes I didn't notice this until it was too late and I was burnt out. There were times I had to ask for an extension because I was approaching a crisis and I needed to take time out in order to regain mental stability. I tried my hardest not to feel guilty about resting and putting my health first. 4. Using student support services If you feel comfortable enough to ask for support, I would recommend making the use of any help that might be on offer. Student support services vary a lot between institutions, but if there is something that might help you then I would say go for it. During my undergraduate degree, I spent a lot of time wondering if I was 'ill enough' or 'deserving' of help. During my masters however, I felt like I could ask for support without feeling guilty. I think that's because I had spent four years coming to terms with my borderline personality disorder and what it means for me. I was able to walk into the disability support centre as if I had a right to be there- which I most certainly did. *** Are you a student with BPD? Do you have any tips to share? I would love to hear them.

1. Noticing my pain Sometimes observing the pain I'm in lessens it. I try to use validating 'I statements', such as 'I am in agony right now' or 'I feel a huge amount of sadness today'. Even though noticing emotions is the opposite of ignoring them and sounds counter-intuitive, and it really can work to lessen their intensity. This is something I learnt from DBT. 2. Reducing my schedule If I'm feeling overwhelmed (which I usually am!), then cutting something from my schedule helps. I often feel overwhelmed by how many things I have in my diary, on top of therapy, collecting my medications and attending medical appointments. Often choosing to have a night in rather than going out with my friends pays off in the long run. 3. Finding a helpful distraction For me, this is usually doing something creative such as drawing, writing or crafting something such as cards or gifts for people I love. It helps me to create something from nothing and usually gives me a sense of achievement. The Nintendo game Animal Crossing tends to help a huge amount. 4. Keeping a long-term goal in mind This for me is emotional stability. I want to get to a place where my life is no longer marked by suicidal episodes, floods of painful emotion and self-critical thoughts. When I feel the urge to act on my emotions, I try to stop and ask myself whether doing that thing will take me closer to my goal. Pausing to reflect for a moment is a skill that has taken me time and practice to master. 5. Strengthening my self-worth This has been really hard for me and is work-in-progress. Believing that I'm a person of worth with something to offer who deserves to take up space has been, and still is, incredibly hard. Working towards this means that I can start to assert myself, value my needs and cope a bit better in the face of criticism. * Do you have any tips? I would love hear them!

[TW This post discusses suicide and self-harm.] Living with BPD, in my experience, comes with a double whammy of difficulty. As if the various aspects of borderline personality disorder are not difficult enough, the condition tends to be very misunderstood. These are 5 things I wish people understood about my BPD. I realise that everyone with this diagnosis is an individual and so if your list might look very different to mine! Okay, here goes... 1. The intensity of the emotion This is the thing I most wish people understood. If people knew just how extreme emotions can feel for me, then perhaps they would understand my behaviour when I am upset. I sometimes describe as being 'electrocuted' by emotion or 'drowning' in it. 2. The stigma from within the medical profession It frustrates me when people assume that all medical professionals are compassionate and non-judgemental by default. Some are, but others are far from it. Sometimes people look at me in disbelief when I recount my experiences of awful treatment by mental health professionals. (Note: I have also had some *amazing* care too). 3. Just how difficult it is There are days when I am in so much emotional pain that I think almost constantly about suicide. Some days, everything hurts and I feel I can't go on. To pick myself up after each episode, each fear of abandonment and urge to self-harm is, well, exhausting. 4. The shame and embarrassment If only people could know how ashamed I have felt when I have been in crisis. Sitting in an A&E corridor waiting hours for yet another psychiatric evaluation and texting my friends to tell them where I am because I don't know how I will survive this pain alone. Seeing my messages left on 'read' because 1. they are too scared of what to say and 2. they need space from me for their own wellbeing. I can only describe the depth of this shame as lying in a pool of my own vomit. 5. The trauma of BPD I haven't heard anyone else talk about this, but I feel traumatised by my own experiences of suicidality, self-harm and periods of depression. I have painful memories of the things I have been through & carrying that around has been (although it is getting easier). I have nightmares very easily too and have done since I was a child. * What things do you wish people knew about your BPD?

[TW: This post talks about suicidal thoughts in detail, so please take care.] I deal with my suicidal thoughts in three ways by looking at them from the perspectives of the past, the future and, lastly, the present. 1. Past Like a lot of people with a diagnosis of BPD, things have happened to me in the past that have been difficult. I went through years of deep psychological pain during which I had no understanding and no way of coping. I translated things that hurt me into self-neglect and self-cruelty because I didn't know what else to do. When I feel suicidal nowadays, I try to remember that these distressing thoughts emerge from a place of pain. Knowing this can (sometimes) make it easier to be compassionate, rather than cruel, to myself. 2. Future When I feel suicidal, I do my best to think of something that I am looking forward to. It seems strange to look forwards with hope when I feel suicidal, because this is kind of the opposite of what feeling suicidal is (feeling no hope?). However, nowadays when I feel suicidal, I know that there will be a time when I won't feel like this and I will be able to enjoy drinking a cup of coffee, or chatting with a friend or stroking a dog. This is huge for me, because it means I am now able to look beyond my present emotional state and imagine feeling something else. I never used to be able to do this, and I am not suggesting that it would be right for others to do this. Another thing I do is try to remember my long-term goals when I feel suicidal. This also seems counterintuitive because to be suicidal is to imagine no future. However, for some reason, I am now able to do this. Because I am in the (sadly) privileged position of having the right mental health support, my main life goal right now is emotional stability. I know that acting on my suicidal thoughts would be counterproductive to this goal and remembering this encourages me to breathe through the painful thoughts rather than acting on impulse. 3. Present When I feel suicidal, I know that it is time to whip out my DBT mindfulness skills. This doesn't mean that I sit down and mediate or stare at flowers! I feel far too agitated to do such things when I am having suicidal thoughts. What I mean is, I try to observe, notice and then describe my thoughts as per the core DBT mindfulness skill. I try to do this without judgement. I try to say to myself: 'I notice I am having thoughts that I am so unlovable that I should die', 'I am observing the thought that I am worthless' or 'I am having repeated thoughts about death'. This represents my attempt to get distance between myself and my thoughts. After that I usually try use more DBT skills alongside, usually self-soothe, distract or improve the moment. Often this means playing Animal Crossing or trying to watch something on TV. * If you are reading this and you think that it sounds impossible, please know that I haven't always been as able to deal with suicidal thoughts as I am now. In the past, when my suicidal thoughts have been particularly strong, they have left me feeling completely unable to cope. This means that I have had multiple trips to A&E in crisis, even literally crying on the hospital floor. Not knowing how to cope with suicidal thoughts has left me behaving in ways that are chaotic and out-of-control such as hurting myself in the middle of conversations because I was so distressed I didn't know what else to do. Since starting DBT, I have been able to learn ways of coping with painful feelings and distressing thoughts. Furthermore, my therapist is helping me understand why I feel, think and behave as I do. This is making a hugely positive difference to me because I can start to look at myself with less self-blame, self-neglect and cruelty and instead view myself with more compassion. My suicidal thoughts seem to emerge from a place when I become overwhelmed and my critical voice takes over. The challenge is to bring in a self-compassionate voice and that, for me at least, is the biggest challenge of all... I also want to acknowledge that everyone experiences suicidal thoughts in different ways. Some people don't find suicidal thoughts scary like me-- everyone is different. * Do you have any tips for dealing with suicidal thoughts?

There are some days when everything hurts. Marsha Linehan, the psychologist who created Dialectical Behaviour Therapy, wrote that people with borderline personality disorder are 'similar to people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.' Today this was my experience. I felt as raw as an open wound. I felt brittle like I could crack into a thousand pieces. It was as though everyone around me had the power to wound me: a brief word said by a colleague, a passing glance from a stranger, a text from a friend all felt like they could pierce into me. I had to try really hard today to get distance between my thoughts and the actual situation occurring in front of me. I had to use mindfulness to notice that the agonising memories from the past were no longer my present reality. I had to challenge my thoughts: 'Yes, I just made a mistake. No, that does not mean I am terrible at my job'. Today showed me how far I have come. I have felt vulnerable today, but it has not interfered with my routine. I have not spent hours crying. I think that being able to notice my thought without judging them is the key difference. I never used to be able to do that: they used to strangle me. During therapy tonight, I cried quite a bit. Mostly because I talked about how happy and relieved I feel to have survived all of those years. I spent many years fearing that I would not survive this pain. Now that I feel safe, maybe I mourn all those years I longed for this feeling of safety? There have been so many days where all I have felt is pain. Maybe you are going through one of these days right now? Today was not quite one of those days for me. This is because I now (mostly) know how to take the pain, welcome it, accept it- and then make some room for pleasure and warmth too. Does everything hurt for you right now? I want to hold onto hope for you that things can get better for you. Feel free to share your experiences... Reference Linehan Marsha, Armstrong HE, Suarez A, Allmon D, Heard HL., 'Cognitive- behavioral treatment of chronically parasuicidal borderline patients', Arch Gen Psychiatry 1991;48(12):1060-4.

When I was first diagnosed with Borderline Personality Disorder, I had no confidence in my ability to have a happy relationship. If you have this diagnosis, then you will more than likely have heard the many damaging and hurtful myths such as 'people with BPD are incapable of relationships' or 'people with BPD are impossible to love'. Stigma like this, combined with the crushing emotional abuse that I went through, made me wonder whether I would ever have a happy, stable relationship. I completely lost confidence in myself; I believed that I was too problematic and too emotional to be lovable. Fast forward a few years...and I am now in a really happy, stable and loving relationship. I have been with my amazing boyfriend for over a year now and have shown myself that, in spite of the stigma and my doubts, that I am completely capable of having a happy relationship. Yes, I have a diagnosis of borderline personality disorder. Yes, I struggle, sometimes a lot. There are times when I fear abandonment, feel panicky and worthless, but nonetheless I am in a happy, stable and loving relationship. I wanted to share some of the reasons behind why my relationship works and demonstrate that people with a diagnosis of BPD *can* be happy in romantic relationships. 1. The other person This for me is the most important thing. No amount of therapy or coping skills could make my relationship happy if I was with someone who wasn't a good fit for me. I believe that I need to be with someone who is extra caring, kind, understanding, patient, affectionate, supportive and open-minded. 2. Acceptance of me as I am I used to think that I could only be in a happy relationship if I no longer met the criteria for a BPD diagnosis. I want to get better at managing my emotions, but I don't feel that I *have* to get to a place where my emotions are better regulated in order to have a happy relationship. In my relationship, I am accepted and valued as I am now, not who I will be after another year of DBT, or on a new medication, or when my emotions are more regulated. 3. Warmth and consistency Because fear of abandonment is such a core part of BPD, I need to know where I stand in a relationship. There are times when I fear abandonment and although I am working towards reassuring myself more and more, I need to know that I can ask for reassurance from time to time too. 4. Non-judgement In my relationship, I can say when I feel upset or when I am getting distressed. If I couldn't do this, my relationship wouldn't work. I have been belittled, laughed at, criticised and invalidated so much in the past that I need to be with someone who respects my feelings, my past and present experiences and is really kind to me when I feel vulnerable. 5. Understanding of a BPD diagnosis Life with BPD can be hard. Many people with this diagnosis have been through trauma of all kinds. Lots of people have been stigmatised, discriminated against. There can be many barriers to support and care. Waiting lists. Lack of specialist help. Stereotyping. I think being with someone who is aware of these things is hugely helpful. I used to feel that it was impossible for me to ever be happy in a relationship. I now realise that this belief was a result of stigma, emotional abuse and not having support. People with BPD can have happy relationships. What are your experiences? I would love to hear what you think!

[This post mentions self-harm and suicidal thoughts. I also write about trauma, including sexual trauma, so please take care] For years, every time I went to a yoga class I would cry. There was something about lying down on the yoga mat, next to other people and listening to the teacher's gentle instructions that inevitably brought me to tears. At the end of each class, with everyone lying on the floor for a relaxation posture, I would ache with an enormous sadness. As the teacher told me to 'let go', 'relax your body', 'take time to rest', a blue-whale sized swelling of grief would rise inside me. Lying there on the mat, I couldn't hold back my tears. Although I wanted to practise yoga, I only went to classes sporadically because I knew that they would activate strong and painful emotions in me. I tried different styles of yoga, as well as many teachers over the years, but I had this same difficulty across the classes. I think it would be easy for people to tell me that this sadness during yoga is something to be embraced rather than avoided; that it is a 'healthy release' or 'to feel it is to heal it'. The difficulty for me however, is that my emotions can be so strong and painful that they have been completely overwhelming for me. As a result of not being able to cope with my emotions, I have ended up self-harming and in crisis more times than I have been able to count. This can mean that feeling immense sadness during a yoga class was not a 'helpful' experience for me. Instead, it could leave me so distressed than on leaving classes I have had to call Samaritans because I am so anxious and upset that I don't know how I will make it home safely. It also made me feel disconnected from everyone else in the class when I already felt isolated by my BPD. * Now that I have completed a year of DBT (Dialectical Behaviour Therapy), I am able to manage my intense emotions well enough to go to yoga classes. When the emotions rise up in me, I am able (most of the time!) to attend to them as my therapist has shown me. In fact, about a month into starting DBT, I began going to yoga and I have regularly ever since. Yoga is one of my favourite things to do and I have always loved exercise involving balance, stamina and flexibility. Now that I'm in a place where my body and mind feel safe enough to practice yoga, I am able to reap its rewards: less tension in my body, enjoyment and a feeling of improved health. I think that until I knew how to manage my borderline personality disorder and my intense emotions, I was not able to bear hearing the teachers saying kind and calming things. Yoga teachers tends to say things like 'be kind to yourself', 'give your body what it needs', 'let yourself relax'. Hearing these things activated harsh thoughts within me about being unworthy and being deserving of punishment. It was very hard for me to be a person who self-harmed, as well as a person who did yoga. Secondly, yoga classes made me aware of how starved I felt of affection, physical touch, warmth and intimacy. I felt grief during yoga for all those moments I had longed to feel safe, nurtured and cared for. There is a well-established link between people who have a diagnosis of borderline personality disorder and those who have experienced trauma of all kinds. I am aware that just as trauma-informed approaches to mental health care are growing, so are trauma-informed approaches to yoga. Furthermore, many people with a diagnosis of BPD have been through sexual trauma. As yoga is deeply invested in the question of what it means to inhabit your body, I believe trauma-informed yoga, as well as free and lower-cost classes, could play an important role in making yoga safe and accessible for people who have experienced trauma. Although yoga can feel instinctively safe and calming for many people, for others it could activate traumatic experiences; an unexpected touch from the teacher, certain postures that feel exposing and so on. Forgive the pun, but because yoga is so flexible I believe it can be adapted to all needs. I know, for example, that there are yoga teachers who specialise in teaching for children with additional needs, those with physical disabilities, autism and cancer. What are your experiences with yoga? Have you ever found it distressing? Has it helped you? I would love to hear from you.

*This post mentions self-harm and suicidal thoughts* I am writing this from the middle of a wave of extremely uncomfortable emotions. I feel the emotional equivalent of wanting to physically throw up. I have a grim concoction of disgusted, ashamed, angry, alone and upset churning inside of me. I am having thoughts of self-harm because I want to 'rid' myself of this intense unease I feel. Instead of hurting myself like I used to in the past, I am doing what I have been learning to do in therapy: 'sit with' the painful emotions, rather than acting on them. In terms of DBT skills, this is called 'riding the wave'. The theory is that an emotion is like a wave; its intensity will rise then reach its highest peak, and after that will it will fall like a wave reaching shore. I am streaming a piece of music that lasts twenty minutes long and I have told myself to wait until that finishes before making any decisions or doing anything. I have the urges to self-harm, but I am going to ride this storm out. Reflecting on why I feel this way, I can see that these difficult emotions have been activated by a few things that have been happening around me. One of these things is to do with with texting and not getting replies from specific people. This is something that can trigger feelings of shame and worthlessness in me. The other thing that has triggered me is to do with something that is happening in the life of someone close to me. I easily take on the emotions of others around me. I am going to do a meditation on one of my apps now and I hope that will help me to accept my emotions and possibly even soothe them. Because I feel helpless and desperate, my urge is to send lots of texts- apologising and expressing how ashamed I feel. But I must wait until this wave passes before I make any decisions. It is painful, but it will pass. Useful book about DBT with lots of detail: DBT Skills Training Handouts and Worksheets by Marsha M. Linehan. Guilford Press; 2nd edition (9 Dec. 2014).

*This post mentions self-harm so please take care* There are many (possibly infinite!) ways to do DBT skills and most, if not all, DBT skills can be personalised in some way. For example, I am a huge Harry Potter fan and I have been able to customise quote a few of the skills to fit around my love of the boy wizard. I also love nature and have also found numerous ways to tailor my skills to that too. Mindfulness: Observe & Describe I do this skill lots when I am walking or travelling, especially when I have said good-bye to a person or have left a social event. This is because at these times I tend to ruminate on what I have said or done which tends to activate a lot of anxiety and embarrassment. I observe what I can see- hedges, trees, houses- and I look for the details such as the texture of bricks, the colour of a leaf or the pattern of squashed petals on the pavement. I also try to become aware of what each of my senses are taking in. I then try to put words to it and describe my experience: 'I can smell petrol', 'I can hear a dog barking' or 'I can see a man in a blue coat carrying an umbrella'. Self-soothe One of the ways I do self-soothe is by lying down and listening to my Harry Potter audiobook. I try to absorb the plot, the descriptions and the characters and submerse myself into the familiar story as much as possible. I even listen to the music when I am getting ready for bed; it relaxes me. I also do self-soothe by watching nature programmes such as David Attenborough's Blue Planet or Planet Earth. Animals calm me for some reason. Animal Crossing is also a really helpful tool for me. One Thing At A Time I do this skill at work when I am overwhelmed. It becomes a bit of a motto for me and I say to myself: 'one thing at a time'. I make a tick list that I go through step-by-step. I then try to focus all of my attention on the task at hand, a bit like when Harry is looking for the golden snitch. He is not thinking about anything else, all of his attention is honed in on one thing only. Opposite Action The emotion that troubles me the most is shame. Shame usually makes me want to hide from the people I fear are going to reject me. It also often makes me want to self-harm. Therefore for me opposite action almost always involves *not* hiding away and instead joining in with the people I fear are rejecting or judging me. Opposite action for shame looks like me leaving my bedroom and daring myself to go downstairs to hang out with my friends or family. *** I need to say that doing DBT skills is not always easy. If you have a diagnosis of BPD, you will probably know how it feels to have emotions so strong that they leave you sobbing on the floor, screaming, acting on impulse and feeling completely out of control. Needless to say, doing skills when your emotions are on full-volume is extremely hard. When I am having strong urges to self-harm for example, it's usually because I want to punish myself for something I feel ashamed. So naturally the last thing I feel like doing is the DBT skill self-soothe! This year I have managed to master a lot of DBT skills. The learning process has been made possible by my lovely and very thoughtful and skilled therapist. A lot of it has been trial and error, as well as taking some risks to find out which skills work (or don't work!) in which situations. Have you tailored any skills to your life? Do you have any favourite skills? Which ones do you most frequently use? I would love to know! Useful book about DBT with lots of detail: DBT Skills Training Handouts and Worksheets by Marsha M. Linehan. Guilford Press; 2nd edition (9 Dec. 2014).

I am in the best place I have ever been with my BPD. I have an understanding of what works for me and what doesn't. I have supportive relationships and an amazing therapist. I am almost a year into DBT (Dialectical Behaviour Therapy) and I have learnt how to use skills to help me cope with overwhelming emotions and distressing thoughts. Lately I have been spending time in my one-to-one therapy sessions looking into my past and finding out why some things trigger me and activate a strong desire to self-punish and self-criticise. The aim of looking at my past alongside doing DBT skills is to help me understand why I feel, think and act in such ways and to have more compassion for myself. Although I am in the best place that I have ever been emotionally, Christmas still feels daunting for me. I love Christmas and there are lots of aspects that I find enjoyable. However, it is also a time of high stress. For one, I am surrounded by lots of people who tend to be quite excitable. I also can't help but feel under pressure with gift giving and making sure that I am being suitably cheery. Most importantly however, Christmas can be hard for me because of the memories. In the past I have had several crises during Christmas time that have seen me in and out of A&E. I have had Christmases since then that have been shadowed by traumatic memories of previous festive seasons when I felt isolated and bleak. This Christmas, I feel more able to cope with my BPD than ever. As a result, I have hope for the future. I can imagine myself living a life where I am no longer revolving through the A&E doors in and out of crisis. Although there may be times this Christmas when I feel overwhelmed, I am sure I'm going to be able to use DBT skills in order to get through those painful moments. Being able to use skills, combined with the reassurance that my BPD is now less distressing than ever, means that I feel I will be able to enjoy Christmas this year. More than anything, this is because this year I have what I haven't had since early childhood: a feeling of safety.