What are some ways to get over the fears of trusting others? I suffer from depression and borderline personality disorder. I have issues with being around people I don't know because I am afraid I will say or do the wrong thing. Do you have any coping skills or suggestions?

Both depression and borderline personality disorder (BPD) can cause difficulties with interpersonal relationships. Feeling low or empty can lead people to withdraw from social situations. If, because of illness, you have spent long periods of time unable to work, sustain relationships, or even get out of the house, you may fail to develop reliable social skills or lose the social skills you used to have. A good analogy would: be after breaking a leg, walking is difficult even when the cast comes off because the leg muscles are weak from disuse. Similarly, it may be hard to know how to interact with others, even when you are feeling better, if you have suffered from depression and BPD for a long time. Relationships are more complicated when a person has suffered from emotional or sexual abuse, both of which are common in people with depression or BPD. So it’s not surprising—-and not your fault-—that you sometimes feel uncomfortable around others if you suffer from depression and BPD.

Continuing the broken leg analogy, after the cast comes off, you might need physical therapy to build strength before you walk again. Similarly, specific kinds of psychotherapy can re-build social skills. Types of psychotherapy that have been shown to help individuals with depression and BPD include cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT). Examples of strategies used in these therapies include: 1) Exposure (CBT): the more you avoid situations you’re afraid of, the more difficult it will be ultimately to face them. If social situations make you anxious, you can develop skills to help you manage your anxiety more effectively such as controlling or counter-acting fearful thoughts. You can then push youself to try situations that provoke mild anxiety and practice your new skills. In CBT, your therapist might ask you to put yourself initially in lower-stress social interactions such as joining an on-line chat group or engaging in “pleasantries” with store clerks. Mastering these experiences will prepare you for more complicated situations such as (eventually) asking someone on a date or participating in a job interview. 2) Social skills (IPT): IPT focuses on the two-way relationship between mood and interpersonal relationships. In IPT, the therapist will help you with role-playing and/or coaching to help you find better ways to manage difficult interpersonal situations. You can learn to improve eye contact, better understand non-verbal cues, practice empathic listening, and develop strategies for asking effectively for things. You’ll practice these skills in “easy” situations before trying them in more difficult ones. 3) Emotion Regulation (DBT): With both depression and BPD, unstable mood can interfere with social functioning. DBT helps develop skills like mindfulness to current emotions, labeling and identifying emotions, and tolerating negative emotions without acting impulsively. Improved mood stability can help you to manage more stressful or challenging interpersonal situations.

About the Doc

About the Doc

Holly A. Swartz, M.D. is a psychiatrist and researcher at the University of Pittsburgh School of Medicine and the Western Psychiatric Institute and Clinic. Her research and clinical interests include understanding the role of psychosocial treatments in improving outcomes for individuals with mood disorders. She is also interested in helping to reduce the impact of mood disorders on families across generations.

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