Navigating the Intersection of Perimenopause and Women's Sexuality: A Comprehensive Exploration
In the realm of women's health, perimenopause stands as a significant transitional phase that often goes overlooked in discussions surrounding sexuality. While the physiological changes during menopause are widely acknowledged, the nuances of perimenopause, the period leading up to menopause, and its impact on women's sexuality deserve profound exploration. This article delves into the multifaceted relationship between perimenopause and women's sexuality, shedding light on the physiological, psychological, and socio-cultural factors at play.
Understanding Perimenopause
Perimenopause, commonly referred to as the menopausal transition, typically begins in a woman's 40s but can start in her 30s or even earlier. It is characterized by fluctuating hormone levels, specifically declining estrogen levels, which herald the eventual cessation of menstrual cycles. This phase can last for several years before menopause, marked by the absence of menstruation for twelve consecutive months.
Physiological Impact on Sexuality
The hormonal fluctuations inherent in perimenopause can significantly influence a woman's sexuality. Estrogen, a key player in female sexual health, declines during this phase, leading to various physiological changes. Vaginal dryness, decreased lubrication, and thinning of vaginal tissues are common occurrences, which can result in discomfort or pain during intercourse, thus affecting sexual desire and satisfaction.
Moreover, declining estrogen levels may contribute to decreased blood flow to the pelvic region, potentially leading to reduced genital sensation and arousal. These physiological changes can challenge women's perceptions of their sexual selves and hinder their ability to engage in sexual activities with the same ease and enjoyment as before.
Psychological and Emotional Dimensions
Beyond the physical realm, perimenopause can also evoke psychological and emotional shifts that reverberate through a woman's sexuality. Fluctuating hormone levels can manifest in mood swings, irritability, anxiety, and depression, all of which can impact one's libido and overall sexual well-being.
Additionally, navigating the societal expectations and stereotypes surrounding menopause can exacerbate feelings of insecurity and self-doubt. The cultural silence and stigma surrounding menopausal sexuality can leave women feeling isolated and invalidated in their experiences, further complicating their journey through perimenopause.
Relationship Dynamics
The impact of perimenopause on women's sexuality extends beyond individual experiences to influence intimate relationships. Communication and understanding between partners become paramount as couples navigate the changes occurring within and between them. Open dialogue about desires, concerns, and adaptations can foster mutual support and strengthen the emotional connection, mitigating potential challenges posed by perimenopausal shifts.
Exploring Solutions and Support
Despite the myriad challenges posed by perimenopause, there are various strategies and resources available to support women in reclaiming and nurturing their sexual well-being:
Hormone Replacement Therapy (HRT): HRT, which involves supplementing the body with estrogen and, sometimes, progesterone, can alleviate many of the physiological symptoms associated with perimenopause, including vaginal dryness and discomfort during intercourse.
Lubricants and Moisturizers: Over-the-counter lubricants and vaginal moisturizers can provide relief from vaginal dryness and enhance comfort during sexual activity.
Pelvic Floor Exercises: Pelvic floor exercises, such as Kegels, can strengthen the muscles supporting the pelvic organs, potentially improving bladder control and enhancing sexual function.
Counseling and Therapy: Seeking support from a therapist or counselor trained in sexual health can provide women with a safe space to explore their feelings, address psychological concerns, and learn coping strategies to navigate the challenges of perimenopause.
Education and Advocacy: Empowering women with knowledge about perimenopause and its impact on sexuality is essential in challenging societal taboos and fostering a culture of openness and acceptance. Education campaigns, support groups, and online forums can serve as valuable resources for women seeking information and solidarity.
Perimenopause represents a pivotal juncture in a woman's life journey, marked by profound physiological, psychological, and socio-cultural changes. By acknowledging and addressing the complexities of perimenopausal sexuality, we can empower women to embrace this transformative phase with resilience and confidence. Through education, support, and advocacy, we can cultivate a more inclusive and understanding discourse surrounding menopausal health and sexuality, ensuring that every woman feels seen, heard, and validated in her experiences.
References:
Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B., ... & Thurston, R. C. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531-539.
Dennerstein, L., Lehert, P., Burger, H., & Dudley, E. (2007). Factors affecting sexual functioning of women in the mid-life years. Climacteric, 10(4), 253-262.
Guthrie, J. R., Dennerstein, L., Taffe, J. R., Lehert, P., Burger, H. G., & The Melbourne Women's Midlife Health Project. (2004). Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women. Obstetrics & Gynecology, 104(1), 132-140.
North American Menopause Society. (2015). The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause, 14(3), 355-369.
Resilience: Restoration Vs. Tolerance
by Lauren Dummit, LMFT, CST, CSAT-S
Many people have different interpretations of the word “resilience.” Pychcentral.com defines it, “When faced with a tragedy, natural disaster, health concern, relationship, work, or school problem, resilience is how well a person can adapt to the events in their life. A person with good resilience can bounce back more quickly and with less stress than someone with less developed resilience.”
A common assumption is that resilience means the ability to push through, to endure. There seems to be a collective misunderstanding of what it means to be resilient. As a result, many people, especially in American culture, are experiencing the detrimental impacts of overworking. Societal norms have seemed to take on an attitude of “the more pain, the more gain.” The tendency is to use the mind, or the neocortex, which is involved with logic, reason, planning, and decision-making, to override the body’s needs. The body, the sensations, and one’s sense of intuition are all part of the limbic system. This part of the brain is much more primitive than the neocortex. It is where the seat of wisdom lies. Current American culture values productivity above all else, urging its citizens to strive for praise and approval for pushing through, toughing it out, and working harder despite the cues from one’s body that may signal hunger or the need to rest, sleep, etc. Many people today have adopted the belief that this is what is necessary to be successful.
Those who work out tend to understand that to build muscle one’s body requires a period of recovery. For example, lifting weights creates small tears in the muscles. Given proper time to recover, these small tears increase muscle mass. However, these small tears can only lead to injury without adequate recovery time. Our nervous system operates under similar needs. If one truly desires to cultivate success and resilience, he or she cannot overlook the importance of a sufficient recovery period. Otherwise, we are putting our health and safety on the line. (https://doi.org/10.1080/001401399185487)
Just because one is not actively working does not mean that he is resting. It is prevalent for the average person to struggle to fall asleep due to an inability to let go of thoughts related to work or everyday stressors. In addition, people often get stuck in a state of sympathetic hyperarousal when they are perpetually checking their phones for updates. The nervous system is continually striving for homeostasis. The harder it must work to get there by down-regulating sympathetic activation, the higher the allostatic load. This means that more energy is being used, translating to an increase in burn-out, costing American companies $62 billion annually in lost productivity. (https://www.sciencedaily.com/releases/2011/09/110901093653.htm).
Just recently Norway released the results of a study, indicating that 7.8% of Norwegians meet diagnostic criteria for workaholism. Researchers quote a definition of workaholism as “being overly concerned about work, driven by an uncontrollable work motivation, and investing so much time and effort to work that it impairs other important life areas.” (https://www.emerald.com/insight/content/doi/10.1108/JMP-05-2013-0143/full/html)
This seems to be the current trend in American culture as well. Americans seem to value productivity and success above many other core values. Advances in technology have extended working hours and availability, obstructing adequate cognitive recovery and resulting in significant healthcare costs and turnover costs for employers.
From an early age, the messages one receives about resilience are often misleading. Often, parents praise and reward depleting efforts, such as commending their child for staying up and completing homework until the wee hours, which is a massive distortion of what resilience actually means. A resilient individual is a well-rested one. When one is exhausted, he travels to school or work, putting the safety of everyone on the road at risk with his impaired driving; he does not have the cognitive resources to perform on tests or class assignments; he has lower self-control with his peers and/or colleagues; at home, he is moody with his parents, partner, or other family members. Overwork and exhaustion are the opposite of resilience. The younger these patterns are ingrained, the more laborious they are to break.
Ironically, people often deprive themselves of a good night’s sleep in the name of work and productivity. Due to the overstimulation of the sympathetic nervous system, they might struggle to access enough of the parasympathetic nervous system, which is responsible for calming them and even being able to fall asleep. However, lack of sleep leads to moodiness, fatigue, irritability, depressed mood, difficulty learning new concepts, inability to focus, lowered frustration tolerance, and forgetfulness. (https://www.medicalnewstoday.com/articles/307334)
When the body is out of synch from overworking, many mental and physical resources are wasted just trying to return to homeostasis. Resilience is not just about accessing one’s inner strength and perseverance to keep moving forward; it’s also about honoring the organism's needs for rest and recovery in between spurts of productivity and action.
Authors Jim Loehr and Tony Schwartz proclaim that the value of a recovery period rises in proportion to the amount of work required of us. (Loehr, J. E., & Schwartz, T. 2003). Marshaling all of one’s internal resources to keep pushing forward to counteract a low arousal level can be referred to as “upregulation.” Maintaining a consistent state of upregulation is energy-consuming. The more one depletes his energy, the more effort is necessary to restore a state of balance.
The solution is not so simple as just deciding to slow down. It necessitates a much more conscious effort to access one’s internal resources. Internal recovery refers to the more brief interludes of relaxation that one is able to interject into their typical schedule, such as short, pre-planned or even spontaneous breaks, by shifting attention or changing to other work tasks when the mental or physical resources required for the initial task are temporarily depleted or exhausted.
External recovery refers to actions that take place outside of work, such as during one’s free time or vacation time. The brain requires a pause from mental stimulation. It is also necessary to allow the nervous system to experience a respite from sympathetic activation. Otherwise, one’s allostatic load gets too high, leading to toxic levels of cortisol in the system, which then, in turn, results in further health problems.
Stress triggers particular holding and bracing patterns in the body, which use great energy to maintain. In order to conserve energy and resources, the organism will begin to shut down other systems, such as the immune system, the reproductive system (decrease in libido, sexual dysfunction, irregular periods, etc.), the digestive system (constipation, irritable bowel syndrome, diarrhea, bloating, stomach pain, etc.), or the muscle-skeletal system (pain in the muscles, bones, or joints, etc.) among other crucial systems within the body. In addition, when the body is braced or tense, one often does not get proper blood flow and oxygen delivered to certain areas of the body. When cells do not get adequate nourishment, they die. The brain needs a rest as much as our bodies do. One cannot discount the connection between the brain and the body. Therefore, both need adequate rest and time for recovery.
Allowing for both internal and external recovery periods is imperative to one’s mental, emotional, and physical health and well-being. There are various measures one can take to self-impose some boundaries. For example, there are apps like Offtime or Unplugged, which generate tech-free zones by tactically planning automatic airplane modes on one’s cell phone. Other solutions may include consciously deciding to take a mental break every so often (60-120 minutes) to recharge one’s resources.
Many people often take for granted the human need for social interaction and for cultivating a sense of community, which results in more and more people spending their lunch breaks eating at their desks or even in their cars. However, is a lunch break recuperative if one spends it compulsively working? It can be much more vital to commit to using one’s downtime as a recess from cognitive overload, instead allowing oneself the leisure and pleasure of social engagement. Connecting with others activates the parasympathetic nervous system, which is necessary for one’s capacity to digest food.
Many people become self-sacrificing in the name of productivity, perhaps even deprivational. However, it is crucial for one’s overall sense of health and well-being that he or she practices self-care, which may mean taking full advantage of one’s paid time off from work, using it to rest and recharge, which, in turn, generally boosts one’s efficiency. Another option may be to carve out a window of time each day or even one full day of the week to commit to doing nothing but activities that are regenerating, such as journaling, napping, practicing yoga, meditating, spending time in nature, watching movies, laughing, having sex, etc.
Anything that someone is too hard on eventually breaks down or gets worn out. The body and mind are no different. To build resilience, it is helpful to maintain an autonomic nervous system that operates within one’s window of Tolerance. The Window of Tolerance is the nervous system’s comfortable, functional, social state. Threats result in hyperarousal, fight or flight, and hypo arousal, freeze, immobility. Someone with a dysregulated nervous system has a very small window of tolerance. They may have a Faux Window of Tolerance, where they manage to function despite being under physiological stress.
When one is chronically operating outside of his or her window of tolerance, deluding themselves that they are functioning well, he or she is just operating from what Kathy Kain and Stephen Terrell refer to as the Faux Window of Tolerance in their book, Nurturing Resilience: helping clients move forward from developmental trauma. They explain that when one is functioning from the Faux Window of Tolerance, any additional stressors may push them over the edge, leading to the collapse or breakdown of various systems within the body because their capacity for resilience is already compromised.
Resilience does not mean one does not get activated in response to stressors. However, it measures how well one can cope with stressors. By accessing both internal and external resources, one can teach his or her nervous system to remain regulated. The resilient individual exhibits an increased capacity to contain the activation created by the stressor. Containment does not necessarily mean disinhibition and downregulation. It refers to expansion in one’s Window of Tolerance, the amount one can tolerate and integrate. If there is a deficiency in internal containment, more external containment is needed.
References
Browse journals by subject. (n.d.). Retrieved from https://doi.org/10.1080/001401399185487
A study shows that insomnia costs the US workforce $63.2 billion a year in lost productivity. (2011, September 2). Retrieved from https://www.sciencedaily.com/releases/2011/09/110901093653.htm
Kain, K. L., Levine, P. A., & Terrell, S. J. (2018). Nurturing resilience: helping clients move forward from developmental trauma. Berkeley, CA: North Atlantic Books.
Kathleen Davis, F. N. P. (2018, January 25). Sleep deprivation: Causes, symptoms, and treatment. Retrieved from https://www.medicalnewstoday.com/articles/307334
Loehr, J. E., & Schwartz, T. (2003). The power of full engagement: managing energy, not time, is the key to performance, health, and happiness. Crow’s Nest, N.S.W.: Allen & Unwin.
Psychometric assessment of workaholism measures. (n.d.). Retrieved from https://www.emerald.com/insight/content/doi/10.1108/JMP-05-2013-0143/full/html
Bottoms Up: A Journey from Despair to Freedom Through Service
by Lauren Dummit, LMFT, CST, CSAT-S
Like many my story of recovery started with a spiritual, emotional, and physical bottom, a moment of incomprehensible demoralization. I couldn’t look at anyone in the eye or stand to look at myself in the mirror. I was in so much shame and hopelessness that I stood outside the doors, stalking this 12-step meeting because I was too afraid to go in. To quote my first sponsor, “I may not have been thinking much of myself, but I was all I thought about.” All day and night I meditated on my resentments, my regrets, my lost relationships, all the pain I had caused others, how many people were disappointed in me or thought I was crazy, my broken heart, how much trouble I was in, or fears and the future paralyzed me, what people would think of me, getting fired, the list went on. Self-deprecating thoughts dominated my consciousness.
Within the first few days of joining the meetings, this man, whom I knew had been old friends with my dad, approached me and asked if he could talk to me. I thought I was going to die of embarrassment and shame. I didn’t want to be linked to my family; I should say I didn’t want him to see my family as connected to me. I was so worried about him discovering that my family wasn’t perfect or that my dad had a daughter who was such a screw-up. But the words he said to me, words I will never forget, were precisely what I needed to hear in that very moment. His words saved my life.
He told me that he had heard about me and had heard about what I had done during my “bottom,” which had been the lowest, darkest point in my life up until then. As he continued to talk, with that light-hearted smile on his face, my whole body got hot, and my limbs became rigid; I thought my knees would give out. I was so embarrassed I wanted to jump out of my skin. But, as he went on, I slowly realized he was not trying to shame me; he was just trying to show me empathy by sharing the experience of his own spiritual bottom, which involved having hit someone with his car. At the same time, he was drunk and high and killing them, which was far worse than what I had done.
I felt like I had swallowed a grapefruit as I tried to get the words out when he asked how I felt. I responded that I hated myself, that I felt like a monster and just wanted to die. He just hugged me, smiled this knowing smile, and laughed, “Ok, well you’ve got to let that go. You are just stuck in yourself. When you are stuck in self, you can’t be of service to others.” He explained that perhaps everything that had led me here to this very moment in my life had happened for a reason. Maybe I was “meant” to use this experience to help others. He assured me, “I know you don’t feel like it right now, but one day, you will look back on this event and think it’s the best thing that ever happened to you and feel so grateful for your experience. That’s what happened to me.”
He told me how once he surrendered to his Higher Power and humbly dedicated the rest of his life to serving others, he slowly started to heal from the shame and intense self-hatred he once felt. He moved from being completely self-centered to other-centered. He laughed again, “I just try not to think about myself too much.” He encouraged me to get into action immediately, pick up a broom right now, sweep, give up my seat to a newcomer, take commitments, offer to do chores for my mother, call someone struggling, etc. He promised me that if I just filled my mind with thoughts of how and who I could help, I would start to feel better.
That night, as I sat on the couch in my parent’s home after they had gone to bed, thinking about the complete lack of meaning and purpose in my life, just praying to die, my mom came down, seeming so worried and sad to see me so distraught but with so much love and peace in her face. When I shared how I was feeling, she sat down next to me and responded, “You know, if God put you here for no other purpose, no other purpose at all, then perhaps it was just to spread kindness to someone else, to try to make someone else’s day better.”
Perhaps it wasn’t coincidental that she would give me these simple words after the very similar message I had received from my dad’s old friend just that very morning. Since I felt so broken in that moment, I had no better plan, I was like a dog with my tail between my legs. I decided to trust this kind man and listen to my mother, one of the few people I knew would always have my back and love me unconditionally. If he could heal emotionally and spiritually, staying sober for 24 years after what he had done, so could I. I became willing to try whatever he suggested. I could do that. Maybe it didn’t have to be something grandiose. I could just spread kindness like my mother had suggested.
As I threw myself into service from that moment until now, I gradually became relieved from “the bondage of self.” My first sponsor kept reminding me that I had to do estimable acts if I wanted to build self-esteem. She was so wise. Throughout the years I have been in recovery, I have built a life around being of service. At times when I have wrestled with depression, my sponsor would remind me that I was spending too much time thinking of myself and would push me to call someone who was having a more challenging time than me. At times when I have struggled with social anxiety, I have reminded myself to just get into action, to find a way to be of service in some way, and to shift my focus to being “other-centered.”
Not only has this practice helped me build self-esteem, feel that I have a purpose, feel more connected to others, and heal relationships, but the loving energy that I put out comes back to me. Giving just feels good. This along with my daily gratitude lists has been the single most significant factor not only in my recovery but in my overall sense of happiness in life. I have no regrets because I know that everything that has happened in my life thus far has led me to where I am now. My experiences have had meaning. They have allowed me to grow spiritually so that I can help others. They have given me the ability to feel deep compassion. Today, I love my life because I feel more connected to you. I feel part of a whole, something bigger than myself.
The ego has an important function; it protects us and ensures our survival. It is a primitive defense mechanism that is driven by fear of not having enough or losing what we have. It is all about the “I.” The spiritual path is an evolved state in which we are motivated by what is in the best interest of the “we” instead of just the “I.” When we are solely self-focused, we isolate ourselves, becoming lonely and filled with fear. When we are other-focused, we can feel connected, in union with the natural flow of life.
Creating a peaceful life in recovery is about finding balance, which often occurs slowly over time. This requires us to develop healthy boundaries. When we are new in our recovery, we usually lack healthy boundaries and are accustomed to living in the extremes. So, we may take on too much, finding ourselves frantically busy or overwhelmed, which can provide a mechanism to avoid feeling our emotions, which can be addicting in and of itself.
While service is called “service” for a reason, meaning it is not always convenient for us, it is only truly “service” if it is given freely from the heart without expecting anything in return. If we give with expectations or resentment, it is more indicative of lacking healthy boundaries and may be a symptom of underlying codependence. Often addicts have been very selfish in their disease so being of service is about taking contrary action. However, for those who struggle with always putting other’s needs first at the expense of their own, taking contrary action may look very different.
The recovery journey is a process, and one’s growth often evolves gradually over time. Finding balance is frequently a process of trial and error as we discover what works for us. It is vital that we not only demonstrate love and tolerance for others along our path but that we also show love and compassion towards ourselves.
Survival skills
by Lauren Dummit, LMFT, CST, CSAT-S
Due to their similarities, coping mechanisms, or coping skills, are often confused and discussed synonymously with survival strategies or defense mechanisms. Both processes are activated in times of stress. Both methods decrease the arousal of negative emotions and either activate the nervous system or shut it down. While they are certainly related, they are not necessarily the same. The function of both processes is to adapt, yet the manner in which each does so can be quite distinct.
Often, when people have experienced developmental trauma, attachment trauma, or relational trauma in their families of origin, they develop certain defenses in order to adapt to their current environment or relationship so that they can survive. As a result, their personalities become formed around the survival strategy. Typically, the survival skills that they may have relied on in their childhoods were an adaptation, functioning to allow them to emotionally endure the intolerable pain of not having their needs met by their caregivers. Most frequently these strategies, which were so crucial to survival as children, are carried into adulthood and then no longer serve to benefit the individual, but, instead, they create dysfunction in his or her life and relationships, both with himself and others.
According to Dr. Aline LaPierre, Psy.D. and Dr. Lawrence Heller, PhD. there are five basic survival adaptation strategies, that are formulated in unity with one’s unmet needs. Dr. LaPierre, Psy.D., and Dr. Heller, Ph.D. who developed the Neuroaffective Relational Model (NARM) to restore connection and heal developmental trauma, discuss “five biologically based core needs that are essential to our physical and emotional well-being: the need for connection, trust, attunement, autonomy, and love-sexuality.” When these needs are unmet, “predictable psychological and physiological symptoms result: self-regulation, sense of self, and self-esteem become compromised. They postulate that most of the emotional issues and challenges can be traced back to early life developmental and shock trauma that compromise the development of one or more of the five core capacities. When one has developed the capacity to attend to his or her own core needs, he or she is able to experience self-regulation, internal organization, expansion, connection, and aliveness, which are all representative of physiological and psychological well-being.
When one’s biologically based core needs are not met in early life, the five adaptive survival styles, methods of coping with the disconnection, dysregulation, disorganization, and isolation from which the child suffers, are activated. Humans are created with the capacity to adapt to adverse experiences by detaching from distressing internal and external experiences and the anguish produced by not having our primary needs met. “Survival styles are adaptive strategies children use to protect the attachment relationship with parents…They adapt to their parents’ acceptance or rejection in order to maintain and maximize the attachment and love relationship.” These survival strategies get woven into their identity. Often, one’s personality develops around them, so they are carried into their adult life and relationships.
According to Dr. Aline LaPierre, Psy.D., and Dr. Lawrence Heller, Ph. D., these adaptation strategies are directly related to the core need that was not met. For example, when the need for connection is unmet, children give up their sense of feeling as if they have a right to be alive and take up space in the world, creating an innate sense of shame. They often disconnect in an attempt to make themselves unseen.
When caregivers do not attune to their child’s needs, the child is told that his or her needs do not matter. Children end up sacrificing their own needs, putting the needs of others, especially the caregivers’, before their own. They often become deprivational, feel underserved, and even feel guilty for having needs.
When the child cannot trust in his caregiver's relationship, he does not develop a sense of authenticity because he receives the implicit message that he must be who his caregivers expect him to be, or else the parent's love will be sacrificed. The child begins to feel that he is being used to keep the parent happy and satisfied.
Children are robbed of assertions of independence for fear of being abandoned or hurt when their need for autonomy is not met. They form a people-pleasing, placating personality. They often grow up to fear authority and then act out in covert, passive-aggressive expressions of rebellion or micro-aggressions due to their pent-up anger.
Those with the Love-Sexuality survival style grew up feeling that they had to be perfect or to perform and achieve in order to be loved. In childhood, their hearts were often broken by their parents (usually the opposite sex parent), who dismissed or rejected their loving feelings. They frequently grow up to be highly successful, energetic, and attractive. However, they rarely live up to their expectations of perfection, and deep down feel shame that they are never good enough. Their sense of self-worth is conditional, based on their performances.
According to Pia Mellody, an internationally renowned expert, author, and speaker on codependence, when children grow up in a dysfunctional family system, they learn to adapt to meet their needs by living in extremes. As they grow up, these adaptation strategies, or survival again become part of their ways of being in the world, affecting their perspectives and beliefs about the world around them and their relationships with themselves and others.
Pia Mellody discusses five core issues influenced by family dysfunction and in which children learn to live in the extremes. They are self-esteem, boundaries, dependency, reality, and moderation. When one has healthy self-esteem, he is able to validate himself from within. He does not feel better or worse than anyone else. An inflated or low self-esteem are opposite ends of the spectrum. One either feels the need to go one up, feeling superior to others, or to go one down, feeling less valuable than others.
Healthy boundaries mean that one can both set appropriate boundaries in relationships to keep himself safe or practice containment boundaries to protect others from inappropriate behavior. For example, if one is angry, he can choose to use his words to calmly communicate his feelings to the other instead of impulsively reacting to his aggressive impulses by hitting the other person. However, those living in the extremes either have no boundaries, damaged boundaries, loose boundaries, or have walls as boundaries, which impedes their ability to let people in and experience emotional intimacy and closeness.
People who have dependency issues either do not even know what their needs and wants are, or they may be overly dependent, needy, and clingy. On the other end of the spectrum, they may be anti-dependent, which means that they project a sense of not needing anything or anyone and that they are entirely self-reliant and self-competent. A more moderate option is to exhibit interdependence, meaning that the person is mainly independent but can also be vulnerable and ask for help when needed, acknowledging that we all have needs, some of which cannot be met by ourselves, such as affection.
Those who have grown up learning to live in extremes often have difficulty owning their own reality, meaning they struggle to experience their authentic selves and, therefore, to share that with others. This includes an awareness of how they look and how their bodies function, an understanding of what or how they think, consciousness of their emotions, and recognition of their behavior and how it affects others.
Lastly, people who have grown up in dysfunctional family homes often cannot express their realities moderately. They are frequently perceived as either out-of-control or overly controlled with their physical appearance (ie. being obese or severely underweight,) their thinking and opinions, their feelings, or their behavior. This usually stems from having their own caregivers model this immoderate behavior for them in childhood.
Defenses help the individual by distorting reality and coping strategies attempt to solve the problem, thus changing their reality. Miceli and Castelfranchi (2001) support this notion and add that “coping behaviors involve conscious modification of cognitive and emotional appraisals, which eventually modify the reactions to the stressful event rather than distort the perception of the event.” The individual has complete control of the coping strategies used. The individual can choose to stop a particular coping style and choose another approach. A choice of a specific coping strategy implies intent and full awareness of the behavior. On the other hand, defense mechanisms typically employ outside consciousness and understanding of the individual. One cannot intentionally choose to use another defense mechanism.
Coping is an integral part of the stress process. It is usually viewed as a complex set of processes that may moderate the influences of stressful life events on the individual’s physical and mental health. Healthy coping skills are made up of both internal and external resources. Internal resources are the skills, practices, and abilities that support an individual. Typically, they do not require the support or presence of another person or thing. Some examples include grounding exercises (ie. feeling one’s feet on the ground, the back against the chair, orienting themselves to time and space by naming five objects in the room, self-care practices (ie. getting enough sleep,) identifying and asserting one’s needs, self-regulation strategies (ie. breathing exercises, chanting, noting one’s internal sensations with curiosity,) and/or mindfulness exercises.
A regulated nervous system means that one is experiencing the feeling of being calm, relaxed, and generally comfortable in his body. Ideally, everyone would be able to maintain a regulated nervous system and return to equilibrium reasonably quickly after a stressor or trigger from the past. However, when people have experienced trauma, sometimes they get stuck in either a state of increased sympathetic activation or nervous system hyper-arousal, causing their heart rates to go up, anxiety, perhaps heat in their bodies, or parasympathetic activation, or hypo-arousal, resulting in a feeling of depression, lethargy, or possibly shut down.
If individuals mindfully listen to their external experience with curiosity, the nervous system can give them essential information about their levels of relaxation and dysregulation, which can be a valuable resource. When people can receive information from their bodies about their external sensations and experiences, it allows them to act on those signals in their best interests, putting self-care into action. When individuals notice when they are dysregulated, they can create the capacity to choose to return to feeling settled, which can be a precious life skill, allowing them to avoid feeling stuck on a rollercoaster of chronic dysregulation.
External resources, on the other hand, involve something or someone outside of oneself. Some examples are calling a friend, sponsor, or mentor, going to a 12-step meeting or therapy group, or going to yoga. It is most effective to utilize internal and external coping skills for maximum support. However, external resources are not always available, so knowing how to self-soothe and use only the resources within us is crucial.
Survival strategies serve a purpose; they keep one defended against pain. Therefore, the thought of giving them up can feel frightening and overwhelming. It is also highly challenging and takes a great deal of deep work in order to change these patterns that one has relied on for so many years and sometimes throughout one’s entire life. However, one must just weigh the function they serve against the dysfunction or limitations in one’s life and relationships to determine whether or not it is worth the journey.
References
Heller, L., & LaPierre, A. (2012). Healing developmental trauma: how early trauma affects self-regulation, self-image, and the capacity for relationship. Berkeley, CA: North Atlantic Books.
Lu, L., & Chen, C. S. (1996). Correlates of coping behaviours: Internal and external resources. Counselling Psychology Quarterly, 9(3), 297–307. doi: 10.1080/09515079608258709
Mellody, P., Miller, A. W., & Miller, J. K. (1989). Breaking Free: A Recovery Workbook for Facing Codependence: Harper & Row.
Miceli, M., & Castelfranchi, C. (2001). Further Distinctions Between Coping and Defense Mechanisms? Journal of Personality, 69(2), 287–296. doi: 10.1111/1467-6494.00146