Holy $h!t such a busy day. Non stop non stop rush rush rush. Met a cute guy though. And he’s from my alma mater. I actually found myself appreciating a nicely constructed male backside today. This is so not my style. Girls, yes. Guys? Not so much. But lemme tell you, he had a nice booty. So you’re probably wondering what this has to do with today’s schema. Absolutely nothing.
On that note. Today I’m talking about the Vulnerability to Harm or Illness Schema.
Vulnerability to Harm or Illness
Typical Presentation of the Schema
These people live their lives believing that catastrophe is about to strike at any moment. They are convinced that something terrible is going to happen to them that is beyond their control. They will suddenly be struck with a medical illness; there will be a natural disaster; they will become victims of crime; they will get into a terrible accident; they will lose all their money; or they will have a nervous breakdown and go crazy. The predominant emotion is anxiety, ranging from low-level dread to full blown panic attacks. These patients are not afraid of handling everyday situations, like patients who have Dependence schemas’ rather, they are afraid of catastrophic events.
Most of these patients rely on avoidance or overcompensation to cope with the schema. They become phobic, restrict their lives, take tranquilizers, engage in magical thinking, perform compulsive rituals, or rely on “safety signals,” such as a person they trust, a bottle of water, or tranquilizers. All of these behaviors have the goal of stopping the bad thing from happening.
This strikes me as very OCD and Paranoid PD, not that it can’t present in other personality disorders or even those without. Again, this is not a schema I relate to very well. While yes, I do have massive panic and anxiety attacks, it’s usually triggered by a real situation or perceived threat (which ok, may not be strictly real). Meh, even that isn’t strictly true because I have an anxiety disorder and I’m very familiar with that constant low level of dread, but this is due to other schema triggers I believe. And I do have the fear that I’ll just have a nervous breakdown and go crazy, but let’s face it, that isn’t exactly irrational. I think my point here is, there’s a difference between having panic/anxiety attacks for different reasons, and having panic/anxiety attacks because you think a meteor is going to spontaneously crash through the atmosphere and land on your house. One is not necessarily this schema, the other is.
Heh, in fact, I have a tendency to live like the world IS about to end and I want to do everything I can. Or if the world is going to end then there’s nothing I can do about it, I’m going to go out with my own kind of bang.
Goals of Treatment
The goals of treatment are to get patients to lower their estimations of the likelihood of catastrophic events and to raise their evaluations of their ability to cope. Ideally, patients come to recognize that their fears are greatly exaggerated and, even if a catastrophe did occur, they would be able to deal with it adequately. The ultimate goal of treatment is to convince patients to stop avoiding and overcompensating for the schema, and to face most of the situations they fear.
Strategies Emphasized in Treatment
Patients explore the childhood origins of the schema and trace its pattern through their lives. They count the costs of the schema. Patients explore the changes they would make in their current lives if they were not overly afraid. It is important to spend time building motivation to change. The patient should stay focused on the long-term negative consequences of living a phobic lifestyle, such as lost opportunities for fun and self-exploration; and on the positive benefits of moving more freely in the world, such as a richer, fuller life.
It’s important to do both cognitive and behavioral work to overcome this schema.
Patients counter their exaggerated perceptions of danger. Challenging catastrophic thoughts – or ‘decatastrophizing” – helps them manage panic attacks and other anxiety symptoms. Cognitive strategies also build motivation by highlighting the advantages of changing.
Behaviorally it’s important to face the situations that are feared by undergoing gradual and graduated exposure to phobic situations in homework (try to face it on paper before you face it in real life): Picture entering specific phobic situations and, with the assistance of the “healthy Adult” coping well. Anxiety management techniques such as breathing exercises, meditation, and flash cards help patients cope with the exposure as they go through them.
Reassurance is important. It’s necessary for a person to know that they will be able to cope in a healthy way.
This sounds easier than it is. It’s been my experience that when you have an irrational fear, you pretty much know it’s irrational. However that doesn’t change how you feel or think or act. So just having someone tell you that what you’re doing is irrational is not going to change anything. And the longer you’ve done a particular coping strategy, the harder it’s going to be to undo all that habit and reform new, healthier, habits. However, that’s what time is for. You take the time. You work on it little by little with someone you can trust.
I think this is a problem that a lot of nuero-typical people have with the personality disordered. They think that since we’ve been told a better way, have had our problems pointed out, that it’s easy for us to change. Because their brains work in a fundamentally different way they just do not understand that we cannot always follow the path from point A to point B. We have monsters hiding down some paths that they can’t see.
Special Problems with This Schema
The greatest problem is that people with this schema are too afraid to stop avoiding and overcompensating. They resist giving up their protections against the anxiety of the schema. As we mentioned earlier, mode work can help patients strengthen the healthy part of them that yearns for a fuller life.
I can relate to this. I’ve mentioned before how I’m afraid to ‘lose’ my Borderline Personality Disorder, my depression, my anxiety…. It’s such an ingrained part of me that the prospect of living without something that I’ve had my entire life is just, foreign. I can’t wrap my head around it, and it’s scary. However I’m also not the kind of person that’s afraid to try new things. So I keep doing what I’m doing to get healthier, despite these irrational fears that I’ll lose a part of myself by healing. Being who I’ve always been is comfortable in it’s own dysfunctional kind of way. I don’t want to lose who I am. However, I think this is a faulty way of looking at it. I won’t be losing myself. I will always be me. I’ll just be me in a different stage of growth. Maybe it would help to look at all these coping mechanisms and faulty habits as skills or tools. You grow up learning how to use a certain tool a certain way. It’s not until years later that you realize you’ve been using it wrong, or there are better ways of utilizing that skill. It can be impossible to recognize the problem if it’s what you’ve always known. It’s not until you have someone that knows how to properly use the tool and can show you that there really is a better way of going about doing the work, that you finally can see a different way. It’s upgrading your toolbox. Toss out the broken screwdriver and trade up for the power drill.
Something like that.
*Schema Therapy: A Practitioner’s Guide – Young, Klosko, Weishaar