Book 

 Site last updated at 7:20am EST on          
 
 # of new Visitors since May 2009       Hit Counter by Digits   
 # of repeat Visitors since March 2010  New article on co-dependency

Criteria for BPD per DSM-IV-TR:
(Must meet 5 of these 9 criteria) 

1) Abandonment fears
2) Intense, unstable    
     relationships  
3) Identity disturbance
4) Psychotic-like perceptual
     distortions
5) Suicidal and/or self-injury 
6) Emotional instability
7) Emptiness 
8) Anger 
9) Impulsivity

                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                             

                                                                                                                                     


Book for those with addictions and BPD. Written by website author. Click "book".
 

 

 

  
        
            
 

          Borderline Personality Disorder 

Awareness can save lives.  Pass this website forward.
Designed & Researched by Amy L. Allison of Odyssey Design


              


           
 

 

 

 Topics Covered
 (See full Site-Map)

A Word from the Author   
Addictions
see Recovery & Addictions
Amygdala Info   
Blogs    
Books   1-29-14
Books 
**Press Release**  
BPD's & Families
Causes of BPD   

Characteristics of BPD    
Comments from BPD's
 
Complications of BPD  

Compulsion    
Contact 
Crisis  
Discussions by BPD's & Non's
DBT   
DBT- Therapists 
DBT Facilities     
DBT Skills    
Distress Tolerance 
see DBT Skills
Dual Diagnoses
     2-10-14
EMDR
Emotion Regulation 
see DBT Skills
Function of Anger
General Information     2-22-14
Genetics  
Help for the non-BPD's
How BPD Impacts Employment
Impulsivity   
Interactive Forums
Interpersonal Effectiveness see DBT Skills
Marsha Linehan PhD  
 
Media on BPD  
Medical Journal of CA
Medications Often Used  
 
Mentalization      
Mindfulness   
Movies about BPD
Oxytocin     
Personal Blog  
Professionals & BPD
Proven Fact 
Published Article
Radical Acceptance
see DBT Skills
Recklessness
Recovery & Addictions 
 2-10-14
Relationship Recovery
Reducing Severity of BPD
Schema Therapy **
Shadow of BPD   
SIB Self-Injurious Behavior
Special Thanks  

Statistics      
Stigma of Mental Illness
Stress
Success of Recovery
Suicide  
3-6-14
Support Groups for BPD's 
Technical Articles
Treatments
&      
   
 
Alternative Help 

Treatment Centers   
Videos  

Writing of BPD's & Non's

Zen
Living with BPD   
Conclusion
Living in Recovery    
For Lay-Persons        
 
For Professionals   
 
 
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     HURT             HOPE  



"Who then can so softly bind up the wound of another as he who has felt the same wound himself." -- Thomas Jefferson
 
______________________

Online Treatment:  it exists.  I have no experience or opinion about this.  Here is a link You might read  this website  to obtain more information, so you may make an informed decision about trying this.  Please.

______________________


"Education is not the filling of a bucket, but the lighting of a fire."  W.B. Yeats
 

    A Webquest for Understanding this Disorder                                               
                 Site Created by Odyssey Design Copyright © 2009-2014  All Rights Reserved                                                                                           Terms & Conditions


        S
tatement of Purpose:  To increase mental health professionals' and society's awareness of the internal horror experienced by people suffering with Borderline Personality Disorder, and treatments for their recoveries. Borderlines diagnosed with the disorder represent half of those who suffer.   The remainder of the people are those who experience the pain, insanity, and self-doubt  that result from being in a relationship with a BPD. The site is for both groups, as well as for professionals, to a lesser degree.
This webquest's main purpose is to give you free information; hopefully this will assist you in making wise decisions and taking positive actions.
              
       The intent is not to dazzle you with a flashy website.  I have not
received payment from anyone for publishing this website.    After reading the book Stop Walking on Eggshells  along with my significant other, a psychiatrist told us without treatment for BPD "people often die from it"... with a suicide rate of 1 in 10 attempts.  This disorder can cause immense wreckage, and there is an  overwhelming denial of how much destruction it can truly cause. 

        The need for researching and designing a website of this topic came to me in May of 2009;  this website's main objective is to educate others on all facets of this  personality disorder - diagnosis, treatment, medication, therapies, misconceptions, the patients, their families, the therapists, the psychiatrists, the stigmas, to name a few.  
A lot of websites about medical issues  are often either an overview, with a synopsis of information, or they may examine one issue in depth.   I have attempted to cover almost all issues encountered with BPD in a little more detail.  I have searched the internet for BPD resources, new information and new treatments;  and I have expanded this site  on a  daily basis.  In recent months, I have tried to include the date (hi-lited in yellow) that a topic or a page was added
or the topic was expanded, to alert you to additions to the site. 

       Please bookmark this site.
  It is user-friendly.  Many, many links will take you away from this website, because of the volume of related topics.  You may return to this site by just hitting your "Back" button on your browser.  I encourage you to bookmark other links, away from this site, you find interesting so that you may return to them later.  I have combed through the internet searches (so you do not have to) to bring you the most current information published--  to create a BPD portal, so to speak.   My goal has been to provide you with 'one stop' where you may learn all about the disorder, and with the help of a professional, determine your next  action, as a BPD or as the family.   What I have learned in researching this baffling disorder, I pass on to you.  I hope that you will do the same for others.

      I am encouraged by the number of new people viewing this website, and the repeat visits - the word is getting out about BPD.   Please, just pass it forward.  My responsibility to you is to pass on all the information that I can compile.  In Google searches of Amy Allison on Borderline Personality Disorder Webquest search yields this website
38 out of the first 54 search results.  This can change from time to time.

      I was perplexed by how few professionals and treatment centers there are that are DBT-certified to treat this disorder;  more are needed to address the growing numbers of people who are diagnosed with this disorder.  As I have researched this topic for a year, and been in DBT for almost 8 years, I have discovered that there are many, many therapies that are being accepted and widely used to treat BPD, with amazing success! I also am aware of how professionals limit the number of BPD clients on their caseloads, due to the exhausting nature of professionally treating someone with this disorder.  I understand their reluctance in treating clients with BPD.  It is a thankless, grueling, and draining experience, so I've read.  I can imagine.

    
Many  resources exist for people with BPD, as well as for their families, spouses, parents, partners, friends, or children  (all called Non-BPD's).  If you are in a relationship where scenarios with this person have evolved from being a bit off-balanced to a gruesome horror movie - or living with a certain someone feels as though you are creeping through a field of land-mines (with the possibility being blown to bits at any moment), or you live your life as if you are existing in a burning Hell, you possibly could be dealing with a person with BPD. 

    Have you seen the movies "Fatal Attraction" and "Girl, Interrupted"?  Do yourself a favor, rent one or both of these movies and watch them.  Yes, they will make you very uneasy.   Maybe YOU can relate to those portrayed, and wish to learn more about why your life isn't working.  Please, don't hide under a rock, or drown yourself in alcohol, drugs or food, sex, gambling or look the other way, or hope it will go away.  Trust me, it won't.  As it is heard in AA meetings:  "If you don't think you have a drinking problem, then why are you sitting in this meeting?"   What made you examine this site?  I assure you, it is not as entertaining as some, but you will have a pretty good grasp about the disorder when you leave it (but hopefully to return later.)

     
I will add something to note:  this website has A LOT of information for the non-BPD's as well.  Non-BPD's are those who live with or deal with a loved-one, friend, spouse, employer who has this disorder of BPD.  Please see "Help for the non-BPD's" on the sidebar in the upper left-hand of this page. 

    
You are visiting this site because someone, or you, have felt that there was a reason for all the trauma-drama in your life;  or the topic interests you. Or you may be a professional.  They care.  We care.  I care.  I have lived it.  I have been to OZ.  I hope you consider seeking some help.        
                       Start with this website.  It's risk-free and FREE.

                              The good news is - BPD is treatable. 
          Your pain brought you here;  Hope and Help in this website
               
will keep you coming back.   But--Keep coming back.

 

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Thanks to the internet and Google, I am able to get new information on this subject of BPD as it is uploaded to the internet by whomever.  I receive an immediate notification.  Anything newsworthy, I add it to this site.  It pays to be a geek sometimes. 

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 Refresh Often

This website is
going on
5 years old!
Started in May 2009
 

new birthday clipart image: clip art illustration of a birthday cake with pink frosting and the number 5 and five candles

 

 




 

ANYONE CAN HAVE
   THIS DISORDER

Quality inspector looking over his work

An executive
Your boss

Young children

This is when it begins.

Signing contracts

Some members within a work-group

A sportsman

Click to view

Two_people_talking : Two talking women. Girls secrets.   Vector

Maybe you  Maybe me

70% are female, 30% are male. These %'s are changing-more males are diagnosed.

Family portrait

Provided by website-hit-counters.com

Note:   An underlined word is a link, and may be clicked on, and it will take you to another webpage, or elsewhere in this site.   Clicking "Top" in the site will take you to the top of this website. All pictures and "smilies" have messages (hold your mouse arrow over the picture -read message in yellow box)

 

DID YOU KNOW? Robert Schloesser and colleagues at the National Institute of Health (NIMH)  found that an environment filled with enriching activities could lift your mood.  Experiments in mice showed that enriching activity helped them to generate new neuronal (brain cell) growth...including cells and pathways in the brain. It has been concluded that you can alter your mood by engaging in activity.


 "Refresh" Often  

This website is
going on
3 years old!
Started in May 2009




52.2 % of those suffering borderline personality disorder are addicted to internet use.  That's what the studies say.

 

 General Information      
      
(10-15-13)

 Definition & Characteristics 
Distinction Between Bi-Polar and BPD     
(10-15-13)
BPD and spirituality relationship examined    (5-10-13)
Psychiatry is failing those with personality disorders  (12-12-12) 
More controversial discussions on personality disorders  (12-12-12)
Some backup info on personality disorders in general  
(9-14-11)
Characteristics of Borderline Personality Disorder
Vital Information
  (a "must-see" video when you reach the end of your rope) (5-21-10)
SAMHSA-Substance Abuse and Mental Health Services Admin. 
(9-25-11)
Nat'l Alliance on Mental Illness
defines BPD, includes statistics  (7-20-09)

The many faces of BPD: a NAMI pamphlet   (7-20-09)
A.J. Mahari on BPD  (7-9-09)
What is Borderline Personality Disorder?
Pictorial Diagram of BPD
Test Yourself for BPD    (9-28-09)
Personality Disorder Test (a real test)
Mayo Clinic's contribution to research on BPD
 


In 2008, the U.S. House of Representatives passed a resolution naming May "Borderline Personality Disorder Awareness Month."  Every year.  YAY!
 


Genetics    (Partial Cause of BPD) 

Discussion of the Amygdala   (2-21-11)
BPD's have slight brain abnormalities.                                                               
Brain Findings       (9-26-09)                                           
BPD and Chromosome 9   (Rev. 2-21-11) 
New research findings
BPD: A Perception Disorder? 
Dr. Brooks King-Casas     (7-23-09)  
  
Excerpt:  "It's different because it's not a lesion (or injury to the brain) but it is a difference in perceiving information that comes from an interaction." That is the area where people with borderline personality disorder have the most problem.  * is BPD a Perception Disorder?"
 


Environment    (Partial Cause of BPD)     (5-16-13)
Multigenerational
 Transmission of BPD to Their Children  (5-16-13)
Is BPD Preventable?    (5-21-12)
Causes of BPD - Can Invalidating Environments Be Changed? (2-12-12)
"People who suffer from BPD, in part, grew up in an invalidating environment".

BPD and Abuse as Children   
(5-30-10)

 


Borderlines in the Media      (8-21-11)

Moammar al-Qaddafi  
(8-21-11)
Amy Winehouse, and her death
Missouri Swim-Team casualty

Founder of DBT treatment
Brandon Marshall of Miami Dolphins has BPD 
 (8-1-11)

 


Problems & Misconceptions   (2-22-14)

BPD:  A disorder or an excuse for bad behavior
 
  (2-22-14)    
Is BPD a disorder with a Spiritual Solution?     (6-8-10)                                
BPD May Be Mis-Diagnosed
Testimonial - Mis-diagnosed as Borderline?
Dual Diagnoses: what this means      (6-13-10)
Borderline & other Personality Disorders
BPD & PTSD
BPD and the function of Anger      (9-10-09)
Exorcisms & Mental Illness       under investigation at present
BPD & Demonic Possession     
under investigation at present
 


Solutions                                                                     
Stories of Hope  YES!   (7-9-09)
Treatment Centers  (6-13-10)
     (see also DBT section)
 


Legalities                                                                  
THE LEGAL SYSTEM AND BPD   Breaking news!    (9-24-09)  
Top        

...or all sorts of emotions
can overcome a
Borderline in a short
period of time....usually
without warning.

"A Borderline has no emotional skin."

A Borderline is beat up by their own emotions.

 


Movies / Music Depicting Borderline Behavior 

Movies (whose main characters have BPD)
Thirteen [2003]  One of the closest depictions of BPD

Fatal Attraction - Glenn Close  [1987]
Girl, Interrupted -
Winona Ryder  [1999] 

Songs  (relevant for their lyrics)     
"Unwell" by Matchbox 20  [2008]
"Borderline" by Madonna [1984], depicts emotions of this disorder  

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This is how the Borderline feels - constantly bombarded by their brains

The ball is like
the BPD's emotions

(Smilies "talk". Mouse-over means place your mouse over the smilies and hold it there until the message appears.)


 

Videos     Medical Opinions & BPD Patients   *Some are lengthy.  View when relaxed and have the time.  Make popcorn.  Have Kleenex handy.
  

"Back from the Edge"  actual BPD's & families speak of their experiences from different perspectives.  (2-21-12)   48 min. Very worthwhile!
NEABPD (National Education Alliance for BPD): Conference April 2-3, 2011
   Speaker: Dr. Marsha Linehan  (video length over 2 hours, in 2 parts)
   updated (5-19-11)

Another video 
(9:00 minutes)    (7-29-10)
Video on BPD  (10:47 minutes)  (7-6-10)
Back from the Edge video - Stories of Recovery   (48:10 minutes)  (5-26-10) 

Randi Kreger video     (10-24-09)

An overview of BPD  (8 minutes)
What a Borderline experiences    (3 minutes)
A.J. Mahari video  
"Understanding vs. Being Understood"  (7-11-09)
Conversation with a Doctor & Borderline (3.5 minutes)
Being a Borderline  (4 minutes)
An in-depth video of the disorder  (23 minutes)
Self-Harm - why happens to Borderlines   (4 minutes)
Dr. Rhoda
Hahn    (6 minutes)  (7-10-09)
Being Borderline is
eternal Hell
    (4 minutes)    (7-13-09)

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Tip: if the videos scroll too fast to read all the words on a page, push the sideways triangle (right under the video on the far left), and it will turn into a "=".  This will pause the video. When you are  ready to continue, press the "=" & the video will start up. 

.Don't try to argue with one. You cannot win. They will every time.


Their cruel words can make you cry.


Loving a Borderline can be very frustrating


Moods will change on a dime.


You can see the storm clouds coming!
 

There can be good times too!


You can get caught up in circular arguments. Watch out!


Borderlines have a lot of emotional pain.


They love, they fight. Confusing.

And just when you think you have it all figured out...

 

We need to increase public awareness about BPD.  It can be fatal.

I cannot stress this enough. Educate yourself.

Welcome, you have come to the right place if BPD is somewhere in your life.

This research shows that BPD patients are not able to use those parts of the brain that healthy people use to help regulate their emotions.

SOURCE:
Medical News Today

Sept. 2009

The public and patients want to learn more about this condition, and more doctors want to treat it.

SOURCE: SouthCoastToday.com
Oct. 2009

The significance of the colors of the rainbow used in this site is one of Hope


 

Treatments      
  
(7-21-11)           

When a person with BPD allows themselves to be treated (denial is often part of the disorder), treatment generally consists of medications and therapy.  “Up until now, existing therapies for BPD have proven to lead to only partial recovery or have only been able to reduce self-harming behaviors.”  That has been rapidly changing with the introduction of new therapies.

Medications, (see listing) which are often successfully used to reduce depression, dampen emotional ups and downs, and put the brakes on excessive impulsivity. Antidepressants can help with depression, while mood stabilizers such as Depakote, Tegretol, or Lithium can help with mood swings. Selective Serotonin Re-uptake Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil may help control impulsivity, as may Effexor, a related antidepressant. Buspar and Cymbalta are used to relieve discomfort associated with BPD.  Tegretol may be helpful for controlling excessive anger and irritability.  Many medications are used to treat the symptoms and discomforts of BPD.  Here is a website that gives a large basis for financial assistance and lost-cost medications for those without health insurance.

Therapy, especially cognitive-behavioral therapy. The major problems are finding a qualified therapist and getting the BPD into therapy. Researcher Marsha Linehan’s cognitive-behavioral method of treatment, called Dialectical Behavior Therapy (DBT), has been shown in empirical research to help BPD patients experience less anger, less self-mutilation, and fewer inpatient psychiatric stays than patients who received other forms of treatment. Other newer and effective treatments are below as well.
  High Risk, High Gain intervention is something to consider.  (7-21-11)


Effective Therapy  makes a difference reducing the severity of BPD
  (9-26-09)
What Works in Therapy     
(3-14-10)

  (6-24-11)

Dr. Marsha Linehan   Linked page devoted to Dr. Linehan      
Faculty of
Univ. of Washington & Founder of DBT
"DBT IS A LIFE ENHANCEMENT PROGRAM, NOT A SUICIDE PREVENTION PROGRAM."  MML

Dialectical Behavior Therapy (DBT)

          
Everything you need to know about DBT and more
Therapists trained in DBT by State
DBT Skills  
(7-16-11)
DBT reduces self-injurious behavior.  Read article.  (9-24-09)
DBT's "Half-Smile"  video (younger Borderlines will love this)  (5-18-10)
P.L.E.A.S.E.   a DBT skill
DBT Self-Help   (5-16-10)
Use of Dialectical Behavior Therapy in a Small Community



Mindfulness-Based Cognitive Therapy (MBCT)

A
ccepting Criticism Mindfully as a Borderline   (5-26-12)
Mindfulness & BPD (5-19-11)

What is it?   Zen and Mindfulness    (7-19-09)
More about Mindfulness   (5-16-10)

An in-depth look at Mindfulness, MBCT & Thich Nhat Hanh 
(5-26-10)



Transference-Focused Psychotherapy (TFP)
 
TFP gaining ground on DBT Therapy?   (3-3-10)
Personality Disorders Institute;     Transference-Focused Psychotherapy 



Mentalization-Based Therapy
   
Mentalization Based Therapy   (1-7-10)
Mentalization: A Patient's Guide



Schema Therapy 
  (Successful treatment getting more recognition)
Schema therapy integrates elements of cognitive therapy, behavior therapy, object relations, and Gestalt therapy into one approach to treatment.
 
What's Your Schema?
Test
formulated by Jeffrey E. Young (on Oprah's site!)
Schema Therapy discussed in depth


 BASE - BPD Awareness, Skills & Empowerment 
(BASE encompasses use of DBT with other therapies/rationales)



Systems Training for Emotional Predictability & Problem Solving (STEPPS)

About STEPPS  
(6-16-11)
Effective program  for reducing the intensity of BPD
STEPPS    (6-25-09)



EMDR   what is it?  (8-25-09)
EMDR is a treatment that helps "reprogram" the brain  and to get at the source of the trauma that caused the patient to deal with it, and whom developed  over-loaded, mis-firing mental and emotional processes that became what comprises the characteristics of a person with Borderline.

More about EMDR from Dr. Francine Shapiro, founder.    (9-1-09)

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Alternative Treatments         (9-7-11)

Blog on alternative suggestions

FOR THE
NON-BPDS


This Page is for ALL Who are in Relationships with a Borderline....this page can help you SAVE YOURSELF.

For Non-BPD's      An entire page for you*   
                                                                                               
                         
      This entire page has been exclusively devoted to the persons who deal directly with a Borderline, both personally, in business, in public, at their job, or anywhere else that you deal with people on a close basis.
*Click the following link: Where can you get help?   (Page created on 8-3-09)

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Support & Interactive Forums for BPD's

A very good website to go to and set up membership is Psych Central. By clicking on this link, I have taken you to the page on Borderline. You may go back to the "Home" tab, sign-up for free membership, and have access to daily chats on different topics, viewing all the members on PC, be in contact with psychiatrists, blogging capabilities and much more.  Psych Central is a very comprehensive tool for augmenting your treatment for BPD.

Another source is on-line groups for Borderlines:  Some are   
NEABPD Recovery Resources - many, many links 
(3-25-12)
BPD Support Tumblr  
Express yourself here    (10-13-09)
BPD About.com
 (10-13-09
Yahoo Angry Heart Group    

Florida Borderline Personality Disorder Assn.
BPD Resource Center
 
Behavioral Resource & Therapy Clinics comprehensive site  
(10-13-09
)

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          Read all about BPD in DSM4, if you can understand the jargon.

Articles about BPD (Technical  )  

(12-3-09)  Article by author of this website
I have been emailing (individually) therapists from around the world about this website on BPD that you are reading.  I have received numerous replies back!  Now THAT has generated excitement with myself.  One therapist had me write an article about my own journey with BPD, and she put it on her website.  Here is the link to my article there.   I invite you to read it.  

Evolution of BPD   (6-9-09)
Personality Disorders and Social Phobias

* May need to register FOR FREE to view some articles from BMI Journal.
      
  

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 A very good book.
"Minds on the Edge"

 

 

 



~ A great book of introduction

Books                                                                              

(11-16-11)   "Prepare for the Harvest by Amy L. Allison, Borderline. 
                                                                                                    
She is also the author of  this website.  Newly released in hard-copy on Lulu Press website, and in ebook format on Smashwords. A 366-day meditation book for those with addictions AND BPD.  Press release on 11-1-2011  


"The Weather House"   by Laporte & Fraser     Dr. Lise Laporte and           Dr. Ronald Fraser wrote a children's book for those dealing with parents who have Borderline Personality Disorder.  View the video about this wonderful tool for children.   (1-29-14) 


"The Essential Family Guide to Borderline Personality Disorder"  by Randi Kreger  New tools and techniques to stop walking on eggshells in dealing with someone with BPD. (She also co-authored "Stop Walking on Eggshells") see below.   (5-4-13)


"Radical Acceptance"   by Tara Brach, PhD. Written in 2003, the book stresses the importance of incorporating Buddhist mindfulness meditation in our daily lives.  This is of paramount importance to the BPD.   (3-25-12)


"Let Me Make It Good" by Jane Wanklin  Written in 1997, the book is a first-hand life experience of a person with BPD. Recommended in an email from a therapist in Ontario, Canada. 


"One Way Ticket to Kansas" by Ozzie Tinman.  See the page for the Non-BPD's, for more explanation about all the references to "The Wizard of Oz" and BPD.   (11-22-09)


"Borderline Personality Disorder for Dummies" Charles H. Elliott, Laura L. Smith
Yes, it's for real! 
(10-30-09)


"Get Me Out of Here by Rachel Reiland      (9-15-09)
This book was touted by a non-BPD as being an excellent book by a recovering Borderline.  It tells the journey of a Borderline's recovery.  An excellent book, so I am told.  One of the best written by a Borderline.
 


(more books on page for Non-BPD's, page on Melody Beattie and found throughout site)


"Minds on the Edge" by John Cloud   A discussion of Borderline was featured in an article in TIME magazine dated January 19, 2009 in an article by the same title "Minds on the Edge".  Click the link to take you to this article.  It has been emailed as a recommendation to get this into stock.  This book can be purchased at bookstores or on Amazon.


"Stop Walking on Eggshells" by Paul Mason & Randi Kreger
"Stop Walking On Eggshells Workbook"
 by Randi Kreger   (7-17-09)
"The Essential Family Guide to Borderline Personality  Disorder"
 
by Randi Kreger
 New Tools & Techniques to Stop Walking on Eggshells 
 (7-20-09)


 


"I Hate You Don't Leave Me"   by Jerold J. Kreisman is a great starting point for those who want to better understand BPD. It was one of the first books written for the lay person. It assumes a very low existing baseline of knowledge, without patronizing the reader.
 


"The Handbook of Mentalization" by Jon G. Allen/Peter Fonagy  (7-14-09)
"Psychotherapy for Borderline Personality Disorder-
          Mentalization Based Treatment"  
by Anthony Bateman/Peter Fonagy   
"What Works for Whom?"
by Peter Fonagy   (entire book online!)  (7-14-09)

For more books for BPD's AND Non-BPD's, go to this link.  (8-4-09)

 

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Stig-ma: a symbol of disgrace or infamy.

 

Stigma of Mental Illness & BPD 

Stigma Lingers  (3-23-11)
Coming Out of the Psycho Closet  (9-29-10)
Stigma of Mental Illness  video  
(7-19-10)
Stigma and History of BPD   (2-10-10)
Mayo Clinic's article on this topic
Reducing Mental Illness Stigma
Diminishing the Stigma
Stigma of Borderline Personality Disorder held by PROFESSIONALS  
 

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Comments from Borderline Patients 

Click here  (Patients Speak Out)   (9-24-13)
Stories by Older Borderlines

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  Site Created by   Odyssey Design
Copyright © 2009-2014
Odyssey Design

-- All Rights Reserved

In Relationship with a Borderline

Recovery 101
Relationship Evolutionary Stages    (10-26-09)
The Stages of Discovery for Family Members    
(10-26-09)
Tami Green has made it her business to help others
Recovery Is Possible 
True Story of One Borderline   (7-23-09)
 


 


 


 

Blogs About BPD    (4-24-12)


The Experience Project website   
(2-3-12)
BPD
blog
New York Times BPD blog
Anonymous Blog of a real-life Borderline as it happens 
I have gotten permission to follow  a BPD's Journey of Recovery in a personal blog on Blogger.com. 
(4-24-12)

    

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For
the
Professionals

For
the
Professionals

 

For
the

Professionals

 

For
the

Professionals


 

 

 

 


[Success in Recovery]

NEW YORK (Reuters Health) - For those suffering from borderline personality disorder, friends and a job may be harder to secure than symptom relief, according to a new study.

"There's been this idea that if people had fewer symptoms of the disorder, then they would naturally evolve socially and vocationally," lead researcher Mary Zanarini of McLean Hospital in Belmont, Massachusetts told Reuters Health. "That does not seem to be true."

So Zanarini and her colleagues followed 290 people with borderline personality disorder, 93 percent of the patients had at least one 2-year break from the symptoms of the disorder during the 10 years, and 86 percent had at least one 4-year symptom-free period. Once achieved, symptoms rarely returned.

However, only about 50 percent of patients achieved full recovery, which was defined as a reprieve from symptoms lasting at least 2 years, plus good social and vocational functioning. Of those that did reach this mark, about a third later redeveloped symptoms, or once again struggled socially or with their job.

By Lynne Peeples


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A short page has been directed at those therapists who have not been trained in Borderline treatments, or currently do not handle Borderlines in their caseload.  The discussions below touch on pertinent topics (in the way of linked-to information), and is hopefully helpful, nonetheless. 

LINKS FOR PROFESSIONALS

The Journal of the California Alliance for the Mentally Ill   (7-16-09)
This is an 84-page document published by the above organization.   Be sure to set the "viewing %" at 100% for easier reading, both while on your computer screen, or if you should print it out. 
It can be printed for you use distribution to clients or other interested persons.  This is not a recent article, but highly informative.  Below are findings for various components of BPD.

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A Matter of Personality
- From borderline to narcissism   
by David M. Allen, M.D.
Why Does the Predominant Treatment Paradigm for Borderline Personality Disorder Neglect Family Dynamics?  What is invalidation and what role does it play? Published on February 11, 2012 by David M. Allen, M.D. in "A Matter of Personality".

Marsha Linehan is the creator of what is currently the most prominent psychotherapy paradigm used to treat Borderline Personality Disorder (BPD). Her Dialectical Behavior Therapy  (DBT) is often said to be the most "empirically-validated" of all such psychotherapy treatments. Actually, DBT is only "empirically validated" mostly for the treatment of one symptom of BPD called parasuicidality. But I digress. 

Dr. Linehan's theory of the cause of BPD, for which she cited no actual scientific evidence when she first described it (although there has been some since), is called the "biosocial model."  BPD, she believes, is created primarily by two factors.  The first is  the patient's genetic tendency to become emotionally dysregulated. Individuals with the disorder are highly reactive. They respond quickly and very strongly to environmental events and are slow to recover from this "dysregulated" state. 

Whether the tendency towards becoming emotionally dysregulated is something purely genetic in origin or is the result of environmental factors in genetically-vulnerable individuals is an open question.  Clearly both genes and environment contribute to most personality traits, but how much of each is required?  I will mention some evidence for the answer to this question later in this post. 

The second causal factor in the genesis of BPD, according to Linehan, is what she refers to as an invalidating environment. 

Invalidation, as used in psychology, is not merely people disagreeing with something that another person said. It is rather a process in which individuals communicate to another person that the opinions and emotions of that person are meaningless, irrational, selfish, uncaring, stupid, most likely insane, and wrong, wrong, wrong. 

Invalidators let it be known directly or indirectly that their target's views and feelings do not count for anything to anybody at any time or in any way. In some families, the invalidation becomes extreme, leading to physical abuse and even murder. However, invalidation can also be accomplished by verbal manipulations that invalidate in ways both subtle and confusing.  

Dr. Linehan wrote only briefly in her book (Cognitive-Behavioral Treatment of Borderline Personality Disorder) about which environment she is talking about as being invalidating (page 56-59), and she barely mentions it in her talks and videos.  It is the family environment in which the person grew up.  Really, what else could it be?  Of course, your spouse and friends can also invalidate you, but why would you choose to fall in with an unpleasant group like that if you were not already accustomed to this sort of treatment?   

When it comes to DBT, however, most of the energy in the psychotherapy treatment described by Dr. Linehan is directed at helping the patients accept themselves as they are, without much said about how they got that way in the first place, combined with teaching patients other skills that are helpful in reducing their emotional reactivity.  These are referred to sometimes as self-soothing skills, and are presumed by many DBT therapists to be something that patients with the disorder just never learned. 

I sometimes give my patients with BPD handouts which describe these skills from Dr. Linehan's Skills Training Manual.  I usually find that patients have already tried at least some of these techniques on themselves without having had any instruction at all.  That makes me wonder if perhaps their apparent lack of knowledge about the techniques in some interpersonal environments actually reflects a strong, fear-induced desire not to use such skills, rather than an actual absence of them. 

In her book, Dr. Linehan does say that she focuses on the patient's interpersonal skills later in the therapy process.  She even mentions that family therapy might be included.  Mentions it once or twice.  The first time on page 420 of her book.   She does not say anything about what that family therapy might entail.

If an invalidating environment is one of two main causes of the disorder as she theorizes, how come she does not address this very much in her treatment plan?

A few months ago, a story in the New York Times about Dr. Linehan possibly shed some light on this question.  Dr. Linehan admits that when she was younger, she "attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on." She added, "I felt totally empty, like the Tin Man."  Self injurious behavior and feeling empty are two of the hallmark symptoms of BPD.  Did she have the disorder?  According to the article at least, BPD is a diagnosis "that she would have given her young self." 

I have only personally met Dr. Linehan once very briefly, and she was perfectly appropriate and personable.  However, I had heard the occasional rumor from other researchers that she has a little bit of the BPD in her.  

So why has she so studiously avoided family dynamics in her treatment paradigm when an "invalidating environment" is fully half of her theory about the cause of borderline personality disorder?   And why would she include an invalidating environment in her theory if she, as someone who has struggled with the disorder, had not been invalidated herself?  If her theory is true, she of all people would have experienced that. 

The Times article does describe her family a bit, but there does not seem to be a whole lot of dysfunction in the description:  

          "Her childhood, in Tulsa, Okla., provided few clues. An excellent student from early on, a natural on the piano, she was the third of six children of an oilman and his wife, an outgoing woman who juggled child care with the Junior League and Tulsa social events. People who knew the Linehans at that time remember that their precocious third child was often in trouble at home, and Dr. Linehan recalls feeling deeply inadequate compared with her attractive and accomplished siblings. But whatever currents of distress ran under the surface, no one took much notice until she was bedridden with headaches in her senior year of high school.  Her younger sister, Aline Haynes, said: "This was Tulsa in the 1960s, and I don't think my parents had any idea what to do with Marsha. No one really knew what mental illness was."  

This description makes it sound as if she were just mentally ill for some unknown reason, and that that was the whole explanation for her behavior, does it not?  She just somehow acquired a messed up brain.  But that would only be half of her DBT theory, and a problematic part of the theory at that.   

In one study by researcher extraordinaire Andrew Chanen and others, adolescents who presented for the very first time with BPD did not show the volume reductions previously observed in parts of the brain's limbic system in many samples of adults with BPD (the hippocampus and amygdala)  - two of the MRI findings of adult BPD brains considered to be the most significant. They did, however, show small changes in one other part of the brain compared to controls.  (Psychiatry Research: Neuroimaging 163 [2008] 116-125). 

This finding could mean that some of the brain phenomena that may create high emotional reactivity arise primarily from the effects of some other factor or factors.  An effect, not a first cause. What factors might they be?  An environmental factor?  I would suspect so.  Perhaps the invalidating environment? 

So, again, why does Dr. Linehan relegate changing family behavior to what is basically a footnote in her treatment text?  Of course I have no way of knowing the answer to this question in her case. 

With my patients who do not want to look too closely at their family dynamics, however, the reason why is crystal clear.  They are very protective of their families, even if they complain unceasingly about them.  They really do not want anyone to think badly of their family members, so they tend to keep the skeletons in the family closet to themselves, at least at first. 

(In cases where they do try to make their family members look bad, as some patients with BPD do, they often do so in a way which makes the listener doubt their truthfulness or their ability to remember things correctly.  In other words, they do so in a way in which they invalidate themselves).  

Maybe if you just ignore a big and recurring family problem, it will go away.  Not.

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Mentalization-Based Treatment – a Patient’s Guide (MBT)


I’ve got borderline personality disorder. I’ve got all sorts of other things – a dog, two jobs and a strange itch on my shin. But I’m only having psychotherapy for my BPD. And it’s not any old psychotherapy. It’s a relatively new, designer therapy, with the Americanish title of Mentalization Based Treatment. (Or the even more American version – Mentalization etc.) This information piece is about MBT, written in the hope that it will be helpful for other people fortunate enough to be offered or currently having MBT. 

I’ve written elsewhere about my having BPD – if you’re interested, you can find it on a website www.brightplace.org.uk/starbpd.html. So I won’t ramble on about it here, other than to say that of the nine qualifying conditions, my five are bunched around mood swings and self-harm. (The whole thing about qualifying conditions feels a bit like the entry conditions for the Euro. But easier to understand and without spawning quirky breakaway political parties.)
 

What is MBT? 

MBT is a type of psychotherapy created to treat people with borderline personality disorder. It’s also been found to be useful for people with other types of mental illness. As the name suggests, it centres on the concept of ‘mentalisation’. I struggled to understand what exactly this is, which could be further evidence of my need for this therapy or just that I’m a bit dim. But I finally grasped that it’s very straightforward. Mentalization is simply about recognising what’s going on in our own heads and what might be going on in other people’s heads.
 

So what’s the big deal? Surely we’re all pretty in touch with what we’re thinking and feeling, and have got as good a chance as anyone else of guessing what others are doing? Er, no. Unfortunately those of us with BPD are unlikely to be top scorers in the Minds’ Awareness League. Not great at accurately identifying what’s happening in our own minds and even less likely to correctly work out what’s in other people’s minds. Especially if we’re feeling stressed out.

 

And there’s an even more fundamental problem here. When we’re feeling crap, we’re likely to shut down (or at best tone down) our ability to ‘mentalise’. Thinking becomes a real effort, and reasoned thinking about thinking nearly impossible. Certainly for me, when things are tough I often self-harm specifically to avoid thinking, as that’s too painful. Self-harming gives us something very concrete to focus on, which links with another aspect of BPD. Apparently, if we’ve got BPD we tend to find it easier to believe things that we can see rather than imagining what might have led to a particular situation. (No money under the pillow, definitely no tooth fairy.)

 

MBT is intended both to help us sharpen up our ability to mentalise and to be willing to use it, especially when we’re feeling intense emotions. For example, in a session the therapist might ask us to consider what the other person in a difficult situation might have been thinking, and help us move past our initial assumption, especially if it’s a really negative one.

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What’s the difference between ‘mentalising’ and thinking, and why can mentalising sometimes be better?

 

Thinking is thinking. Mentalising is thinking about thinking and feeling, our own and other people’s. Obviously it’s often best just to get on and have thoughts. About whether Borat is the funniest film ever made or a shocking and trashy piece of sexist and racist rubbish. About whether there’s something we can do as a non-punitive alternative to self-harming.

 

I’ve found it helpful looking at mentalising from the perspective of people with autism. Perhaps it’s because I’ve struggled to understand quite what mentalisation is about that it’s been useful to me to consider a group of people with a totally different disability to mine. People with autism live very much in the here and now. They have been described as having no ‘theory of mind’, as most are unaware of their own thinking processes and have even less recognition that other people think or have feelings. Clearly people with autism think. (An inordinate amount of the time, it seems, about Thomas the Tank Engine, at least when they’re kids.) But it’s a very automatic experience, and reflecting on their own thoughts just doesn’t arise. And the way they see the world is such that although they may notice the manifestation of others’ thoughts and feelings, for example they can see that someone is smiling or hear them shouting, they don’t connect that with the emotions that produce those observable responses. People with autism find it almost impossible to imagine themselves ‘in someone else’s shoes’.

 

For those of us with BPD rather than autism, mentalising is an acquirable skill, and one which can give us valuable extra perspective on a situation. For example, if I’m planning to take an overdose, just thinking about it tends to take me along a route which lets me confirm this is the ‘right’ thing to do. But if I have to mentalise, I have to look at my thinking. It’s hard for me to do this without concluding that I’m not thinking straight. That my thoughts and feelings about the overdose are caused by feeling seriously crap and that I should at least try to hold off any decision til I’m feeling more settled.

 

And if I then move on to thinking about others’ thoughts and feelings, it takes me to the painful place of knowing how traumatised my friends are if they find out that I’ve taken an overdose. Let alone the impact on them if the next overdose turns out to be fatal.

 

None of this mentalising necessarily stops me from taking self-damaging action but it at least gives my self-protective side a decent shot at introducing some logic to the situation. 

 
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What’s It Like Having MBT?

 

You might expect that a therapy with mentalisation at its heart would involve the therapist endlessly asking “And what was in your mind? And what was in their mind?” But, luckily, this hasn’t happened. It’s all much more nuanced than that. Similarly, although the approach is very non-directive, when I ask for advice or need help in practical problem-solving with something I’m wrestling with, my psychiatrist will often respond in a ‘normal’ way and help me out.

 

I had cognitive behavioural therapy with a psychologist before I ended up being sectioned. At that stage, I was taken on by a personality disorder unit as an outpatient and have had MBT weekly with a psychiatrist for about 18 months. Both types of therapy feel very similar, despite the psychologist and psychiatrist being very different types of people. Both approaches have felt supportive, non-judgmental and focused on what I’m thinking. I’ve been able to see issues, especially painful ones, from a different perspective and to understand what might be fuelling the tough stuff. Both have made me feel like I’m setting the agenda about what we talk about and that I can say anything, however embarrassing or ridiculous I feel it is. And I know that the self-protective part of me, which tries to resist my self-destructive tendencies, gets crucial reinforcement.

 

The most noticeable difference in style is that my psychiatrist has very ‘high boundaries’, so I know almost nothing about him and his life, other than what I can pick up from clues around his office. (He either rides a motorbike or is excessively worried about getting a head injury when driving his car.)

 

Perhaps the most tangible difference I experience is that I’ve only once self-harmed after a session with the psychiatrist whereas I used to do so regularly after my previous sessions. This really puzzled me til I read a couple of books about MBT. These made me realise that while the MBT sessions feel quite normal and ‘spontaneous’, they’re carefully designed to be at a level of intensity, or intrusiveness, that I can comfortably cope with. (This relates back to the business about us closing off if things become too painful.) This doesn’t mean that I’m never moved outside my comfort zone – most sessions we cover things which make me cry. But somehow, overall I don’t end up feeling completely jangled or bursting with feelings I don’t know how to or don’t want to deal with.


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Does It Work?

 

Well, I’ve been able to survive 18 months of pretty consistent suicidal feelings and still be around to write this. And studies have shown that it certainly works for a lot of, but not all, patients. One very reassuring thing is that it’s been designed as a result of careful research into both the causes of BPD and the impact of MBT. I don’t really understand all the stuff about how BPD develops, but it goes something like this.

 

If mothers have problems connecting well with their babies, they respond differently to other mothers. One thing that the research shows is that when the babies are really upset, these mothers don’t calm the babies in a way that helps the babies to ‘understand’ or learn what’s their own distress and what’s the mother’s. It’s a bit like the baby’s distress is magnified and bounced back at the little thing rather than being soothed and dissolved by the mother. As well as emotional mishaps like this, it’s been found that many people who develop BPD often have early experiences of abuse or neglect by parents. These things lead to many of us being unable to soothe ourselves in ways that are conventional, or not self-destructive, again reinforcing our tendencies to self-harm.

 

Another central proposition of MBT is that when we’re babies and our mothers aren’t able to comfort us in an effective way, we sort of bung onto our mother the parts of ourselves we can’t cope with. This results later on in life with us coping particularly badly with the loss of someone close to us, partly because we might have ‘assigned over’ to them the painful parts of ourselves. This contributes in a rather complicated way to our tendencies to self-harm and be suicidal, apparently to feel re-connected to the outsourced part of ourselves.

 

The quality of ‘attachment’ in our earliest years continues to affect how we feel and think right through our lives, and if they’ve got off to a bad start we’ll have difficulties with other close relationships. Including potentially the one with our therapist.

 

The MBT therapist, then, will be very aware of this and will be careful that we don’t just slot back into a pattern of feeling overwhelmed by intensely painful feelings which make us close off thinking, especially about our own and the therapist’s thoughts. Feeling understood by someone we trust (the therapist), is a sound place to be able to move into a calmer, safer way of coping with difficult stuff.

 

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More Information About MBT

 

If you want to know and understand more about MBT… unfortunately there isn’t much information out there. And what there is has been written for therapists rather than patients. The most accessible of this limited literature is Mentalization Based Therapy for Borderline Personality Disorder by Bateman and Fonagy. I’ve only been able to find one thing on the Internet, a press release from the Royal College of Psychiatrists which provides a clear but brief explanation of its effectiveness: http://www.rcpsych.ac.uk/pressparliament/pressreleasearchive/pr748.aspx

 

There’s much more written about the obscurely titled Dialectical Behaviour Therapy. So it’s time for those of us getting MBT to start writing as well as reading about it.

 

For further information on Mentalization Based Therapy Training led by Prof. Anthony Bateman and Prof Peter Fonagy -- 
                                                  see
http://www.annafreudcentre.org/short_course_mbt.htm
 

Back to Mentalization-Based Therapy                  
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Recent Research Findings        (8-27-10)

New evidence and a study of 5,496 twins in the Netherlands, Belgium and Australia drew the conclusion that 42 percent of variation in BPD features was attributable to genetic influences and 58 percent was attributable to environmental influences.  There is more of a link to genetics of the disorder than previously thought.

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all, individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71% of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental
stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgment in choosing partners and lifestyles.

NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain-imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings.  

Back to General Information

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Holidays or any major interruption to a Borderline's daily patterns can be disruptive and disconcerting.  11-26-09

Stress and the Borderline    2-2-13

Does BPD Have a Spiritual Solution?   by Clive Green    (6-8-10)

Borderline Personality Disorder is a mental disorder that requires the adjustment of individuals and their loved ones. It requires that their loved ones learn how to avoid them when in hyper-hysteric fits and it requires that the individuals with the disorder learn to avoid their family when they are tempted to do them emotional harm. In time, the solution of problem avoidance isn't enough, however. Inevitably the sufferers need to tell someone of how badly they wish they could die or destroy everyone who doesn't totally adore them.

These kind of hysterics are not a matter of mere drama or pretense, they demand to be expressed and if the sufferers fail to express them they are sure that they will just die. Of course, the reality is much different than the illusion that these individuals create in their mind. The reality is that the people suffering from BPD have disconnected with their wise mind, their real mind.

They have gotten to a point where they have a hard time believing there is anything to the world around them except what their intellectual mind or their emotional mind tells them there is. The reality is that when they get stuck into one of these modes of thought as is true most of the time, they will either turn their friends off with manic attempts to share every bit of intellectual information that they find interesting. This will send the friends away because it is just too boring for the friend to endure. The other tactic that the BPDs will use is to share whatever they are feeling at the precise intensity that they are feeling it.

This usually frightens friends or family away unless they have learned to deal with it. The case of the BPD sufferer is that they are damned if they do and damned if they don't. So, as the cruelty of this disorder is made clear the ethical mind is challenged to ask, how could this be? How could God allow this suffering? Of course, God has little to do with it. God, in fact is the one who is able to heal the entire illusion, because especially with this type of suffering, illusion is the best word to describe what it is. The pains and frustrations that lead the sufferer to push into one of these extremes (emotion or intellectualism) is the same dysfunction that everyone experiences in the ego-bound mind except it is magnified for the BPD sufferer.

The result is contrary to what might appear obvious that the BPD has an easier time releasing ego and accepting God. So, the question is there a spiritual solution to BPD, is somewhat misleading. Perhaps a better question would be, what is BPD a spiritual solution for? The answer to that of course is that BPD is the spiritual solution for the illusion of ego-bound time. It is a guidance system in the same way that the two buffers of a bowling alley is a guidance system. They teach the BPD to shoot at the middle and avoid the comfortable edges.

The middle where intellect and emotion meld into a powerful unit is the perfect place for all who live in this time-bound reality, because this middle area teaches the soul that it is always connected to well-being while always being connected to the illusion of time and space. The spiritual truth of this reality is that we are all paradoxes walking around as if we aren't paradoxes. The existence of this paradox is something that constantly pushes people into either psychosis or more commonly, neuroses. The BPD sufferer is never able to get lost in the apparently comfortable world of neurosis and is also never able to flee into the secure insecurity of psychosis.

Rather, they are constantly tied to the pain of the borderline, until they free themselves from ego - the one source of their apparent suffering. There are therapies available that can help the individual to develop their mindfulness and release the disabling aspects of BPD.

Back to Problems

The Etiology of BPD     by A.J. Mahari

I will be outlining the etiology of BPD - its causes. I know that no one has the definitive answer about exactly what one thing or combination of things makes up the root causes of BPD. I, do, however, based upon my own experience, have some fairly strong feelings about this.

Many put forth that the causes of BPD are still not well understood, and it is likely that a number of factors are involved in its development. I can partially agree with that. It is the causative factors of anything that may, in fact, be biological that I have difficulty with along with the amount of medication being thrust upon borderlines.

One biological theory purports that traumatic experiences in early childhood may cause the hippocampus to atrophy which is thought to cause structural brain changes in individuals with BPD. I don't know. I would say though that isn't it just as likely that the effects of trauma on the brain that can cause changes in brain development are the result of the early childhood emotional and psychological trauma and not some genetic mutation in those with BPD. Further to this, I've had many professionals I've asked tell me that they believe that traditional psychotherapy can positively impact trauma-induced changes in the brain and build lasting changes that can address any such damage -- so why the big push with medication?

I think what needs to be focused on most is that there are likely a number of factors rather than coming down so strong on the side of the biological argument.

I've had BPD and recovered from it. I had some neurological testing done when I was borderline and I don't have any atrophy or any such process in the hippocampus of my brain. That is not to say that some haven’t obviously had that result but is that really what causes BPD or is it a coincidence? I wonder.

It is further theorized by many that this dysfunction in the limbic system of the brain may explain some of the emotional dysregulation which is inherent in BPD. That may well be, but, do we need medication to control that or can we learn new ways of thinking and believing that re-route the neurons in our brains and make the necessary adjustments or changes needed to recover?

I would assert that how one thinks and what causes the cognitive distortions and polarized way of thinking in those with BPD is far more responsible for emotional dysregulation then some physical problem in one's brain. I believe most BPD responses to stress and to relational difficulties have their main genesis in the core wound of abandonment.

I have written a 253 page ebook called, The Legacy of Abandonment in BPD - An examination of the core wound of abandonment and Borderline Personality Disorder that is a follow up to my first ebook, The Abandoned Pain of Borderline Personality Disorder which is a detailed history, from the inside out, as someone who has been there and recovered from BPD, of how and why the abandoned pain of those with BPD keeps them stuck in the agonizing and seemingly mystifying suffering of Borderline Personality Disorder. This ebook is also a precursor to the ebook that followed it, The Shadows and Echoes of Self - The False Self That Arises Out of the Core Wound of Abandonment In BPD Each ebook is available separately or all 3 can be purchased together with or without audio programs as well. The core wound of abandonment is traumatic enough to perhaps cause some changes on a biological level. What I take issue with though as the biological theories are put forth is that there are not contained in those theories, or articles, the reality that many are recovering from BPD and that DBT Skills Training Schema Therapy and Cognitive Behavioral Therapy along with psychotherapy - talk therapy - can and will (in most cases) address the organization of thoughts based upon reactionary protective instinctual behavior while under the stress of the trauma to the point where one can change the way they think and more or less reverse the damage and/or manage their way out of BPD.

© A.J. Mahari 2006

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The Use of Dialectical Behavior Therapy in a Small Community Health Setting      by Leah Jaquith, Ph.D., Washington County Community Mental Health Services

Washington County Community Mental Health Services is a small (1,400 client) full-service community mental health center located in rural Ohio. Washington County is one of a handful of single MHAR boards in the state. We have never been successful in getting a mental health levy passed and thus always struggle to provide maximum service for minimum dollars.

As our agency was developing programming to meet the needs of the community we began implementing treatment for individuals diagnosed with borderline personality disorder based on Marsha Linehan’s Dialectical Behavior Therapy model. One of the reasons I was interested in the DBT model was because I had seen it used so successfully in community mental health in New Hampshire and because its principles were so consistent with those of the Recovery Model promoted by the Ohio Department of Mental Health. DBT, like Recovery, places the emphasis on the individual being allowed to take responsibility for the direction of their mental health treatment and for decision-making in their lives. DBT is an amalgam of cognitive-behavior therapy which includes a variety of coping skills, validation of the individual’s emotional experience and coaching to help the individual make choices that are adaptive rather than self-destructive or self-defeating.

DBT assumes that individuals with borderline personality disorder have in common an inability to effectively regulate their emotions. This high sensitivity to negative emotional stimuli and an intense response to such feelings often leads to attempts to escape the negative emotions that are maladaptive. Such responses share the characteristic of their representing an often-desperate attempt to escape the negative emotional state. Substance abuse, self-mutilation, overeating, engaging in risky behaviors such as sexual encounters, stealing, speeding in cars and making suicidal gestures are all common responses to the negative emotional experience. And while these activities can provide immediate distraction or relief, overall they solve nothing and often leave the individual with more difficulty than before they engaged in these escaping behaviors.

DBT represents an attempt to offer individuals with the diagnosis of borderline personality disorder the opportunity to learn new ways to tolerate emotional pain, make decisions that lead to productive, problem-solving activity and to receive validation for the emotional pain that has driven the maladaptive behaviors. In essence we offer the opportunity to substitute the non-productive behavior with an understanding of triggers for their behavior and a repertoire of productive alternatives.

The structure of DBT at our clinic is dictated to some degree by our size and financial limitations. We run two introduction-to-DBT concepts groups per week for women. We have three DBT groups that familiarize women with the DBT concepts and skills of mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. These groups meet for two hours each week. In addition, all group members must have individual therapy that is based on DBT principles. DBT group members are encouraged to practice and document the success or problems they encounter in using their skills in their day-to-day lives. They are supported in their emotional expression of distress but often confronted, sometimes in an ironic or humorous manner, about their tendency to catastrophize. They are encouraged to think of skills to use to help them tolerate the emotional distress. When DBT group members make a suicidal threat or gesture (called parasuicidal gestures by Linehan), individuals are frequently not hospitalized after they are declared medically stable. Instead, they are reminded of the principles of DBT, which suggest that learning to tolerate the discomfort is key in developing more adaptive responses to stress and to their recovery. In group, they are free to question techniques or skills, describe skills they used or had difficulty with and work on skills sheets that offer new concepts or skills. Larger agencies often have distinct DBT teams who do only DBT with a certain group of clients. In our small agency we do DBT as a part of the other work we do. However, we are committed to the concepts and make sure that the availability for coaching is honored. I believe that it is essential to remove the need for these women to do something “dramatic” to get attention. Quite the contrary, we want to support their desire to learn and we make coaching an easy and routine thing for them to request and receive.

Easy access to support, clear and well-maintained boundaries and lots of encouragement and information about feelings are all aspects of DBT that make it successful in helping women with emotional dysregulation challenges. All women in the DBT groups are able to make phone calls during the day and up to 9 P.M. in the evening (through the crisis line) to their group facilitator or their DBT individual therapist. The phone calls have constraints: no discussion of suicidal plans or activity. The call focuses on the coaching aspect of the DBT program where the individual is helped to understand what she is feeling, what may have triggered these feelings and a review of skills that the individual has indicated have been helpful to relieve these feelings in the past.

Our success with DBT programming has led us to expand and we now have a DBT group for men and are in the process of developing one for teenage girls with emotion regulation challenges. We have partnered with the local developmental disabilities board and their contract providers to adapt DBT principles for dually diagnosed individuals (DD/MH) we share. This partnership has been generally successful and has led to our providing trainings to DD staff regarding the use of coping skills with other DBT clients and in fostering more adaptive responses in our shared clients.

We are fortunate in that the hospitals with whom we work (Appalachian Behavioral Healthcare and Marietta Memorial Hospital) have been open to learning about DBT and DBT interventions. In order for clients who typically have been admitted to the hospital to learn to tolerate some emotional discomfort and to be encouraged to use skills to do so, they cannot continually be admitted to psychiatric hospitals. The DBT model suggests that if an individual has made a parasuicidal gesture (e.g., scratched wrists, taken pills) that they be medically stabilized and returned to the community with appropriate supports (crisis appointment, case management, coaching in skills, attempt to follow the “chain” that led to their emotional upset). As you might imagine, this feels quite risky to emergency room personnel and those unfamiliar with DBT principles. However, the psychiatrists at both hospitals have been supportive of our interventions and have helped pave the way for us to work closely with emergency room personnel in this area as well.

Overall, the implementation of DBT programming and the institutionalization of DBT principles has led to a reduction in hospitalization, parasuicidal gestures and to reports of increased satisfaction with their lives in our DBT group members. The most gratifying result comes when our DBT members report that they have successfully managed a situation that in the past would have overwhelmed them.

Like any program, DBT relies on the individual’s desire to change. This program requires lots of participation on the part of our members. The two greatest challenges we face are engaging individuals who do not believe they can or are ready to change and move toward recovery, and working with individuals who are still actively misusing substances such as alcohol or street /prescription drugs. As long as they can numb themselves or escape with the substance, the attractiveness of learning skills to tolerate emotional distress is diminished.

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BORDERLINE CHARACTERISTICS     (From Marsha Linehan’s book & internet)            

1. Shifts in mood lasting only a few hours.
2. Anger that is inappropriate, intense or uncontrollable.
3. Self-destructive acts: self-mutilation or suicidal threats and gestures.
4. Self-damaging impulsive behaviors are alcohol & drug abuse, compulsive  
    spending, gambling, eating disorders, shoplifting, reckless driving,
    compulsive sexual behavior, food addiction.
5. Marked, persistent identity disturbance shown by uncertainty in at least two       
    areas:  self-image, sexual orientation, career choice, friendships, values.
6. Chronic feelings of emptiness or boredom.
7. Unstable, chaotic intense relationships characterized by splitting.
8. Frantic efforts to avoid real or imagined abandonment.
9. Stress-related paranoid ideation or severe dissociative symptoms.

  • Splitting: the self and others are viewed as "all good" or "all bad."
  • Alternating clinging and distancing behaviors.
  • Great difficulty trusting people and themselves.
  • Sensitivity to criticism or rejection.
  • Feeling of "needing" someone else to survive.
  • Heavy need for affection and reassurance.
  • Some people with BPD may have an unusually high degree of interpersonal sensitivity, insight and empathy.
  • 36% of us will attempt suicide who meet all 9 criteria of Borderline.
    9% of us will attempt suicide who meet 5-7 of criteria for Borderline.
    8 out of 100 suicide attempts of Borderlines are fatal; higher with dual diagnoses and/or coupled with other addictions.
    75% of Borderlines are self-harming (does not include any of suicide stats).

·    Additional addition issues, usually present in BPD patients, should be treated by a therapist versed in experience in recovery issues, most notably in the sexual & food addictions and substance abuse. Group therapy and supportive 12-step programs are available and important tools for recovery from most addictive behaviors.

·     Substance abusers (including drugs, porn, alcoholic, narcotics, food) along with BPD have a higher % of suicidal behaviors than patients with only BPD (9-35%) or only substance abuse  (7%)…more like 16-42% or more.

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  Statistics for Borderline Personality Disorder          


STATS & FACTS
  
(10-23-12)

All Mental Illness Stats: Global/General Facts & Numbers
 
(from NAMI magazine)

1 in 4 adults experiences a mental health disorder in a given year.
1 in 17 adults lives with a serious mental illness.
1 in 10 children lives with a serious mental/emotional disorder.
According to 2004 World Health Report, major depressive disorder is the leading cause of disability in the U.S. /Canada between 15-44.
Anxiety disorders frequently co-0ccur with depression or addiction disorders.
One half of all lifetime cases of mental illness begin by age 14, 3/4 by 24.
Adults living with serious mental illness die 25 years earlier than other Americans.
Suicide is the 11th leading cause of death in the U.S.
75% of youth in juvenile justice systems have at least one mental disorder.


STATS & FACTS   Updated (6-9-11)

The Suicide Rate for Borderlines is 60 times that of the general population. 
 


STATS & FACTS    from the New England Journal of Medicine website 
    
Borderline Personality Disorder  

Posted by Abigail Place • May 27th, 2011
The latest article in our Clinical Practice series, Borderline Personality Disorder, reviews the characteristic features of borderline personality disorder, evidence to indicate genetic and environmental factors in pathogenesis, and effective treatment strategies.

BPD is present in about 6% of primary care patients and persons in community-based samples and in 15 to 20% of patients in psychiatric hospitals and outpatient clinics. In clinical settings, about 75% of persons with the disorder are women, although this percentage is lower in community-based samples.

Clinical Pearls
• How can BPD be recognized?   Recurrent suicidal threats or acts in combination with fears of abandonment are by themselves strongly indicative of the diagnosis. The most distinctive characteristics of patients with BPD are their hypersensitivity to rejection and their fearful preoccupation with expected abandonment.

• What is the prognosis for patients with BPD?   While BPD has long been considered a chronic and largely untreatable disorder, more recent data indicate a high remission rate (about 45% by 2 years and 85% by 10 years), as defined by meeting fewer than two criteria for at least 12 months, and a low relapse rate (about 15%). In other respects, however, the prognosis remains discouraging. The suicide rate is about 8 to 10%, with a particularly high proportion of young women. Moreover, even after remission, most patients with BPD have severe functional impairment, with only about 25% of patients with full-time employment and about 40% receiving disability payments after 10 years.

Morning Report Questions 
Q: What is the primary method for treating BPD?   A: Psychotherapy is the primary method for treating BPD. Randomized trials involving patients with BPD support the efficacy of several forms of psychotherapy. The best studied of these methods is dialectical behavior therapy.

Q: Is there a role for pharmacotherapy for patients with BPD?   A: Selective serotonin-reuptake inhibitors and other antidepressants are frequently prescribed to patients with BPD, but in randomized trials such drugs have little if any benefit over placebo. In such trials, benefits for patients with BPD have been shown for atypical antipsychotic agents (e.g., olanzapine) and mood stabilizers (e.g., lamotrigine), particularly for reducing impulsivity and aggression. However, these effects are typically modest, and side effects are common.


UPDATED STATISTICS
    (7-13-10)      


Borderline Personality Disorder affects 2 out of 50 people, or roughly 4% of the population, which is 10.8 million people in the United States.  A whopping 70% of those with BPD also abuse alcohol, drugs, food, sex, gambling or some other addictive practice.  Borderlines diagnosed are 3% female, and 1% of male, but more males are being diagnosed, and the proportions are changing.  There are approximately 14 million alcoholics in this country, and 3 million of them are recovering in Alcoholics Anonymous.  Seven (7) million alcoholics have psychiatric disorders;  and of those - 1.8 million people are inflicted with alcoholism and Borderline Personality Disorder (or 26%). 

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UPDATED STATISTICS AND FINDINGS
    (5-21-10)

May Is Borderline Personality Disorder Awareness Month        Thu, 20 May 2010
from ArticleClover.com  website


Borderline Personality Disorder (BPD) is an illness often stemming from a history of childhood trauma. Disrupted family relationships, abandonment, sexual abuse and poor communication within the family are risk factors for this devastating disorder. It is estimated that 5.9% of the general public struggles with this. People with BPD have very unstable moods, swinging from rage to joy and love to hate in the blink of an eye. They also have problems with impulse control. These factors set the stage for very intense, chaotic relationships in both the teen years and into adulthood.

People with Borderline Personality Disorder view themselves as victims, accepting little responsibility for the problems in their own lives and feel helpless to change. They commonly see situations as either good or bad, with no middle ground. These people also resist being alone and are extremely afraid of being disregarded by those close to them, which may lead them to mistakenly interpret someone's behavior as abandonment. Depression, anxiety and feelings of emptiness further complicate the situation. Sadly, people with BPD long for human connection; however, their wild mood swings and extremely impulsive behaviors create tension in their relationships.

Impulsiveness has been known to lead to financial problems, shoplifting, excessive risk taking, and health problems, including eating disorders and substance abuse. Self-mutilation, such as cutting, scratching or overdosing are also common in these patients.

Those suffering from this disorder are often resistant to treatment, which puts their chances for normal interaction at risk. BPD affects more women than men and is seen more often in psychiatric patients who have been hospitalized. Medication to stabilize mood swings and to lessen the symptoms of depression is one facet of treatment. Because authority figures trigger resistance in people with BPD, group therapy may be a more successful route than individualized therapy. In group therapy, peers are able to provide support, give encouragement and are viewed as equals by the patient.

This disease makes up 20% of all in-patient psychiatric hospitalizations and 11% of out-patient psychiatric treatment programs. One out of 10 people with BPD will ultimately commit suicide, which is the most shocking statistic of all.

Loved ones and family members trying to support someone with BPD may be depressed themselves. Guilt and helplessness in the face of this illness result in isolation and a deep sense of despair. Three-quarters of family members participating in one online support group reported themselves as being in therapy to handle their own feelings about Borderline Personality Disorder.


 Updated Statistics    (10-16-09)

BPD affects roughly 10 million Americans, more than 75% of whom are women. 10% of all mental health outpatients and 20% of inpatients are thought to have the disorder, which is characterized by extreme mood swings, impulsive behavior, self-injuring acts and suicide ideation as some of its many symptoms.


      Out of 1,000 people

  • approximately 40 people are diagnosed or undiagnosed Borderlines. 

  • Of those 40, 28 will attempt suicide one or more times. 

  • Of those 28, 3 will be successful

  • 0.3% of the general population will die a suicide death due to Borderline Personality Disorder.

    Statistics for Alcoholics only 
    from various sources

  • only 7% of alcoholics who get sober, stay sober

  • 7-10% commit suicide

  • those with long-term sobriety, have 5x the probability of death from
    alcoholism.

  • Cause of Death:  disease  73%, accident 11%, suicide/homicide  7%. 

          Statistics for Eating Disorders only   from many sources 

          There are 4 categories:  Anorexia, Bulimia, (combinations of the 2),   
          Binge Eating Disorder, Food Addition.

  • 82% of binge eating/food addicts are effectively treated by DBT/Cognitive therapy.

  • 10%  mortality rate directly from one of the disorders above.

  • Average relapse probability is 30%.

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THE CAUSES OF BPD      written by a treatment facility

The individual suffering with Borderline Personality Disorder typically has a history of pathological family experiences involving possible physical, sexual or/and emotional abuse, certain patterns of over-involvement between parent and child, abandonment by a parent, inconsistent and unstable attachment patterns, poor emotional support, neglect, hostility and lack of communication within family environment. An ‘invalidating environment’ in childhood has also been significantly linked to Borderline Personality Disorder whereupon the child’s emotional experiences, feelings and expressions are consistently dismissed, belittled, minimized, criticized or ignored. When this occurs consistently throughout a child’s emotional development, there can be a thwarting of the development of the child’s emotional self and ability to know, understand and regulate what they are feeling. This disruption to their affective regulation system and identity occurs because the invalidating environment tells them that their most private and innate experience is wrong and over time there is a conflict set up where the individual begins to not trust what they are feeling and their self experience becomes increasingly distorted.

The expression of feeling is one of the most personal and intrinsic parts of one’s core self, who one is, how one defines themselves and how they communicate their sense of self and the world to others, and when a child does not have their feelings mirrored back to them in order for them to learn what they are feeling, but rather they are invalidated, criticized or rejected, it follows that there is a base denial of one’s self and identity. The child learns that their internal experience is wrong and inappropriate and the true self becomes increasingly corroded and disorganized as the psyche constructs defenses to deal with and tolerate their environment, often internalizing the invalidation and patterns of abuse, leading them to often feel like they are crazy, even if they are functioning normally. This leads these individuals to often develop difficulties with impulse control due to lacking the ability to regulate their emotions and due to a fragmented sense of self.

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Bullying and borderline personality disorder: a missing link   
from preventionaction.org website    (4-6-13)

Bullying and borderline personality disorder: a missing link 04 April 2013 Children abused by adults are known to be at increased risk of developing the serious and persistent mental illness known as borderline personality-disorder (BPD). New research suggests that bullying and victimization by other children during the elementary school years should be acknowledged as another important risk factor.

Psychologists in Britain, Germany and the United States base their conclusions on an analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) which has followed the development of more than 6,000 mothers and children in south west England since pregnancy in the early 1990s.

After comparing the results of diagnostic interviews with the children when aged 11 with reports of bullying gathered when they were aged 8 and 10, they conclude that intentional harm inflicted by peers is a significant precursor of BPD symptoms – although it could be a “marker” for the increased level of risk, rather than a direct cause.

Dieter Wolke of Warwick University and his colleagues note that BPD is a chronic psychiatric condition estimated to affect between 0.7 per cent and 5.9 per cent of the adult population. Its characteristics include poor mood and impulse control, unstable and intense personal relationships, and severe difficulty trusting the actions or motives of others.

Threats, rumors and lies

Existing studies have linked BPD to childhood experiences of physical and sexual abuse, neglect and exposure to domestic violence. In addition, bullying or “peer victimization” in childhood has been associated with the emergence of psychotic symptoms and suicidal thoughts as well as adverse neurobiological changes in the brain.

This makes it all the more surprising that potential links with BPD have not been investigated before and that this study is, so far as the authors know, the first to use longitudinal data to explore the connection.

Wolke and his colleagues not only analyzed data collected from children in the ALSPAC survey, but also interviews with parents and teachers about victimization when the children were as young as 4. Information gathered on the children’s home life, well-being and IQ was taken into account to rule out other possible explanations for the link between bullying and BPD symptoms, including sexual abuse and harsh, maladaptive parenting.

The association between BPD and different types of bullying was investigated by making a distinction between “overt victimization” where victims are physically hurt or threatened and “relational victimization” involving exclusion from play by peers or the circulation of rumors and lies. The researchers also examined “dosage”, considering whether bullying was reportedly chronic or severe.

Pinpointing lessons for prevention

The results showed that any experience of peer bullying in primary (elementary) school was significantly linked to the emergence of BPD symptoms in children under 12. This association was strong and remained so even after controlling the data for other, potentially “confounding”, explanations.

The study also found that the risk of developing symptoms increased among children who had experienced chronic bullying or a combination of “overt” and “relational” victimization. For children who said they were victims of both types of bullying the odds of BPD symptoms were increased seven times compared with children who were not bullied. For children who reported being bullied at age 8 and again at age 10, the odds 5.5 times greater than for those who had never been victimized.

Turning to potential explanations, the researchers highlight the capacity for bullying to work its way “under the skin” of its victims, both psychologically and functionally. However, they also recognize that children who get bullied tend to have fewer friends anyway and are often more withdrawn, physically weaker, and more easily upset than their peers. Their victimization could, consequently, be a “marker” within a developmental risk factor model for BPD, rather than an actual cause.

The development of BPD, as with other mental health disorders, is a complex matter. It is not, however, difficult to see why this latest study – soundly based in data from a major longitudinal study – holds important implications for prevention.

At a universal “whole school” level, it underlines the value of applying structured, evidence-based strategies that prevent victimization and facilitate swift and effective action when bullying occurs. But it also points to the need for clinicians working with children who already exhibit significant mental health problems to be alert to the links between BPD and bullying by peers.

As the authors of the new study suggest, professionals in child and adolescent mental health should be routinely asking children and young people about victimization – and be properly trained to deal with the answers.

*********

Reference: Wolke, D., Schreier, A., Zanarini, M. C., & Winsper, C. (2012). Bullied by peers in childhood and borderline personality symptoms at 11 years of age: A prospective study. Journal of Child Psychology and Psychiatry, 53(8), pp 846-855.


Tuesday, 31 May 2011     (6-1-11)
Press Release: Royal Australian and NZ College of Psychiatrists
Psychiatry Congress highlights

The Royal Australian and New Zealand College of Psychiatrists’ Congress runs until 2 June 2011 at the Darwin Convention Centre. The Congress brings together mental health experts in a diverse range of areas across cultures and age groups. Here are some highlights from today’s program; the full program is available at http://www.ranzcp2011.com/congress-program/.

How childhood trauma changes the brain
The brain structure of children exposed to chronic trauma and neglect develops differently to those children raised in secure, healthy, environments. Drawing from emerging research and clinical experience this presentation will examine how exposure to chronic childhood stress and terror results in a brain hard wired toward a persistently altered stress response. “Children who have suffered early trauma, abuse and neglect commonly have multiple persistent issues including poor emotional regulation, increased anxiety, poor problem solving and impaired social relationships. If left untreated these symptoms can compound to further social and health disadvantage in adulthood,” said author of this review Dr Anja Kriegeskotten.

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Invalidation:  What Is Invalidation?

  • Negates or dismisses behavior independent of the actual validity of the behavior.
  • To weaken, to nullify, to cancel, to reject, to dismiss
     

    What are examples of invalidating responses?

    1. Reject self-description as inaccurate
    You just passed a difficult math test. You said that you feel like Einstein. Your dad says, “You don’t know what you are talking about.”

    2. Reject a normal response.
    You are really into watching your favorite show and don’t feel like doing your chores.Your mom says, “He doesn’t want to do his chores because kids are just brats.”

    3. Reject response to events as incorrect or ineffective.
    Your favorite teacher yelled at you today and you just told your sister what happened. She said, “That’s stupid to feel that way. She’s just a teacher.”

    4. Dismiss or disregard.
    Your beloved dog just was hit by a car.  Your brother says, “Oh well, stuff happens.”

    5. Directly criticize or punish.
    You are at your grandpa’s birthday party.  Grandma cut the cake and you are passing out the cake.  You accidentally drop a one of the plates. Grandma says, “You idiot. You don’t need birthday cake if you just smear it all over my floor.”

    6. Reject and link responses to socially unacceptable characteristics.
    You are helping your grandpa in the garage.  One of the bigger tools just fell on your fingers. Your grandpa says, “Crying means you are weak. Suck it up.”

    How does invalidation impact us?

    1. Confusion about self: learns not to trust self and relies on social environment for the correct response.

    2. Problems regulating emotions: Ignores or withholds emotions or is extremely emotional.

    3. Oversimplification: Highly sensitive to failure, perfectionism, and forms unrealistic goals.

    4. Responses to and view of the world are not accurate.

    5. Look to others to tell you how to do things.

    Back to Environment

  •  
     

     

    The following is from Dr. Shapiro's website under the link, "What is EMDR?" Dr. Francine Shapiro is founder of EMDR Therapy.

    "Eye Movement Desensitization and Reprocessing" (EMDR) is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2.

    EMDR is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.

    During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.

    Eight Phases of Treatment

    The 1st phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

    During 2nd phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

    In phases 3-6, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

    After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Although eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

    In phase 7, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

    The next session begins with phase 8, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

    After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures.

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    Back to EMDR

    P.L.E.A.S.E.    (9-24-09)
     

    PL stands for treating “PhysicaL Illness.” Make sure that your children are up to date on all their vaccinations and teach your children to wash their hands often. If your child shows symptoms of illness talk to your doctor as soon as possible and keep them home from school.

    E stands for balanced “Eating.” Try to get your children to eat as many fruits, vegetables and healthy grains as possible. This will give them the mental and physical energy to be productive throughout the day and less likely to cause behavioral disruptions. Take advantage of the schools reduced lunches and introduce your children to the farmers market for the wide variety of fresh fruits and vegetables the season brings.

    A is for “Avoiding mood altering drugs.” Watch the amount of caffeine your children are consuming and limit the amount of sugars that they eat.

    S is for balanced “Sleep.” Help your children get into a regular bedtime routine. This is a perfect time to start a family ritual such as bedtime stories and reading together.

    Finally, E is for “Exercise.” There are many ways to keep your child active throughout the school year. Take advantage of the many after school programs in our area. Other community organizations and centers give children an opportunity to meet others and learn social skills. Be active with your children and model good exercise habits. Limit TV and video game time for your children and be creative with spending more family time together perhaps playing a game instead. The more balanced these skills are the better prepared your family will be for every day.

    Back to DBT
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     Mount Sinai researchers have found that real-time brain imaging suggests that patients with Borderline Personality Disorder (BPD) are physically unable to activate neurological networks that can help regulate emotion. The findings, by Harold W. Koenigsberg, MD, Professor of Psychiatry at Mount Sinai School of Medicine, were presented at the 11th International Congress of the International Society for the Study of Personality Disorders (ISSPD), held August 21-23, 2009 at The Mount Sinai Medical Center in New York. The research will also be published in the journal Biological Psychiatry.

    Using functional magnetic resonance imaging (MRI), Dr. Koenigsberg observed how the brains of people with BPD reacted to social and emotional stimuli. He found that when people with BPD attempted to control and reduce their reactions to disturbing emotional scenes, the anterior cingulated cortex and intraparetical sulci areas of the brain that are active in healthy people under the same conditions remained inactive in the BPD patients.

    "This research shows that BPD patients are not able to use those parts of the brain that healthy people use to help regulate their emotions," said Dr. Koenigsberg. "This may explain why their emotional reactions are so extreme.

    Gene function and serotonin levels may also be contributing factors in BPD, according to research findings also presented at the ISSPD Congress by Larry Siever, MD, Professor of Psychiatry and Director of the Special Evaluation Program for Mood and Personality Disorders at Mount Sinai School of Medicine. Dr. Siever's research demonstrates how genes related to serotonin and neuropeptides in the brain may be altered in serious personality disorders such as BPD.

    Dr. Siever's neuro-imaging research suggests that a gene that controls production of a critical enzyme for the synthesis of serotonin, a brain chemical that modulates emotions and aggression, may be altered leading to reduced synthesis of serotonin in people with BPD and may be associated with increased aggression. This variant of gene may also be associated with reduced frontal lobe activation in the brain.

    These studies were part of the 11th International Congress of the International Society for the Study of Personality Disorders, which took place August 21 - 23, 2009 at The Mount Sinai Medical Center in New York.

    Return to General Info
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    REDUCING THE SEVERITY OF BPD        (10-12-09)
    By SHARI ROAN,   LOS ANGELES TIMES

    The primary treatments for borderline personality disorder are behavioral strategies, such as dialectical behavioral therapy, which University of Washington psychologist Marsha Linehan devised almost two decades ago.

    In this approach, the patients acknowledge that they have damaged their relationships while learning to regulate their emotions and change their most destructive behaviors. It takes time and effort.

    "It's very active. It's not talk therapy," Linehan says. Instead of just talking about the fact that she is always arguing with people, for example, the patient has to try to find something to agree on with someone she is arguing with.

    There are other successful therapies, such as mentalization-based therapy, which focuses on observing one's own emotions and those of other people in order to understand the effect of emotions, and transference-focused therapy, which centers on helping the patient develop new skills that overcome the tendency to see everything in extremes.

    And studies show that these very specific behavioral therapies can reduce some of the most severe behaviors.

    A 2006 study in the Archives of General Psychiatry showed that suicidal patients who were randomized to dialectical behavior therapy were half as likely to make future suicide attempts compared to patients who were treated with more conventional therapies.

    A study published in May in the American Journal of Psychiatry showed that patients treated with mentalization-based therapy (MBT) had sustained improvements in their symptoms compared to patients undergoing conventional treatment.

    And research in the same journal, published in 2007, found that patients undergoing transference-focused therapies, dialectical behavior therapy and other supportive therapies showed improvements in depression, anxiety, daily functioning and social adjustment after one year of treatment.  (also look under the topic "STEPPS")


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    How a Borderline Personality Disorder Love Relationship Evolves
    Article: Adapted from Romeo's Bleeding by Roger Melton, M.A.

    Regardless of how a person with Borderline Personality Disorder alters and tailor her appearance and actions to please others, she often presents with a clear and characteristic personality pattern over time. This pattern usually evolves through three stages: The Vulnerable Seducer, The Clinger, and The Hater. This evolution may take months, and sometimes even years to cycle through. In the later periods, the personality often swings wildly back and forth from one phase to the next.

    Love: The Vulnerable Seducer Phase

    At first, a Borderline female may appear sweet, shy, vulnerable and "ambivalently in need of being rescued"; looking for her Knight in Shining Armor.

    In the beginning, you will feel a rapidly accelerating sense of compassion because she is a master at portraying herself as she "victim of love" and you are saving her. But listen closely to how she sees herself as a victim. As her peculiar emotional invasion advances upon you, you will hear how no one understands her - except you. Other people have been "insensitive." She has been betrayed, just when she starts trusting people. But there is something "special" about you, because "you really seem to know her."

    It is this intense way she has of bearing down on you emotionally that can feel very seductive. You will feel elevated, adored, idealized - almost worshiped, maybe even to the level of being uncomfortable. And you will feel that way quickly. It may seem like a great deal has happened between the two of you in a short period of time, because conversation is intense, her attention, and her eyes are so deeply focused on you.

    Here is a woman who may look like a dream come true. She not only seems to make you the center of her attention, but she even craves listening to your opinions, thoughts and ideas. It will seem like you have really found your heart's desire.

    Like many things that seems too good to be true, this is. This is borderline personality disorder.

    It will all seem so real because it is real in her mind. But what is in her mind it is not what you perceive to be happening.

    Love: The Clinger Phase

    Once she has successfully candied her hook with your adoration, she will weld it into place by “reeling in” your attention and concern. Her intense interest in you will subtly transform over time. She still appears to be interested in you, but no longer in what you are interested in. Her interest becomes your exclusive interest in her. This is when you start to notice “something”. Your thoughts, feelings and ideas fascinate her, but more so when they focus on her. You can tell when this happens because you can feel her "perk-up" emotionally whenever your attention focuses upon her feelings and issues. Those moments can emotionally hook your compassion more deeply into her, because that is when she will treat you well - tenderly.

    It’s often here, you begin to confuse your empathy with love, and you believe you're in love with her. Especially if your instinct is strong and rescuing is at the heart of your "code." Following that code results in the most common excuse I hear as a therapist, as to why many men stay with borderline women, ".... But I love her!" Adult love is built on mutual interest, care and respect - not on one-way emotional rescues. And mothering is for kids. Not grown men.

    But, if like King Priam, you do fall prey to this Trojan Horse and let her inside your city gates, the first Berserker to leave the horse will be the devious Clinger. A master at strengthening her control through empathy, she is brilliant at eliciting sympathy and identifying those most likely to provide it-like the steady-tempered and tenderhearted.

    The world ails her. Physical complaints are common. Her back hurts. Her head aches. Peculiar pains of all sorts come and go like invisible, malignant companions. If you track their appearance, though, you may see a pattern of occurrence connected to the waning or waxing of your attentions. Her complaints are ways of saying, "don't leave me. Save me!" And Her maladies are not simply physical. Her feelings ail her too.

    She is depressed or anxious, detached and indifferent or vulnerable and hypersensitive. She can swing from elated agitation to mournful gloom at the blink of an eye. Watching the erratic changes in her moods is like tracking the needle on a Richter-scale chart at the site of an active volcano, and you never know which flick of the needle will predict the big explosion.

    But after every emotional Vesuvius she pleads for your mercy. And if she has imbedded her guilt-hooks deep enough into your conscientious nature, you will stay around and continue tracking this volcanic earthquake, caught in the illusion that you can discover how to stop Vesuvius before she blows again. But, in reality, staying around this cauldron of emotional unpredictability is pointless. Every effort to understand or help this type of woman is an excruciatingly pointless exercise in emotional rescue.

    It is like you are a Coast Guard cutter and she is a drowning woman. But she drowns in a peculiar way. Every time you pull her out of the turbulent sea, feed her warm tea and biscuits, wrap her in a comfy blanket and tell her everything is okay, she suddenly jumps overboard and starts pleading for help again. And, no matter how many times you rush to the emotional - rescue, she still keeps jumping back into trouble. It is this repeating, endlessly frustrating pattern which should confirm to you that you are involved with a Borderline Personality Disorder. No matter how effective you are at helping her, nothing is ever enough. No physical, financial or emotional assistance ever seems to make any lasting difference. It's like pouring the best of your self into a galactic-sized Psychological Black Hole of bottomless emotional hunger. And if you keep pouring it in long enough, one-day you'll fall right down that hole yourself. There will be nothing left of you but your own shadow, just as it falls through her predatory "event horizon." But before that happens, other signs will reveal her true colors.

    Sex will be incredible. She will be instinctually tuned in to reading your needs. It will seem wonderful - for a while.

    The intensity of her erotic passion can sweep you away, but her motive is double-edged. One side of it comes from the instinctually built-in, turbulent emotionality of her disorder. Intensity is her trump-card.

    But the other side of her is driven by an equally instinctually and concentrated need to control you. The sexual experiences, while imposing, are motivated from a desire to dominate you, not please you. Her erotic intensity will be there in a cunning way tailored so you will not readily perceive it.

    “I love you” means – “I need you to love me”. “That was the best ever for me” means – tell me “it was the best ever for you”. Show me that I have you.

    Love: The Hater Phase

    Once a Borderline Controller has succeeded and is in control, the Hater appears. This hateful part of her may have emerged before, but you probably will not see it in full, acidic bloom until she feels she has achieved a firm hold on your conscience and compassion. But when that part makes it's first appearance, rage is how it breaks into your life.

    What gives this rage its characteristically borderline flavor is that it is very difficult for someone witnessing it to know what triggered it in reality. But that is its primary identifying clue: the actual rage-trigger is difficult for you to see. But in the Borderline's mind it always seems to be very clear. To her, there is always a cause. And the cause is always you. Whether it is the tone of your voice, how you think, how you feel, dress, move or breathe - or "the way you're looking at me," - she will always justify her rage by blaming you for "having to hurt her."

    Rage reactions are also unpredictable and unexpected. They happen when you least expect it. And they can become extremely dangerous. It all serves to break you down over time. Your self esteem melts away. You change and alter your behavior in hopes of returning to the “Clinger Stage”. And periodically you will, but only to cycle back to the hater when you least expect it, possibly on her birthday, or your anniversary.

    Borderline Personality Disorder is a serious mental illness.

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    Love When You have Borderline Personality Disorder...

    Some partners of people with BPD worry the relationship was just a game, that their SO was using them and felt nothing for them. That’s not true.

    I am a recovering BP.

    Before, when I was in a relationship, my feelings felt genuine. I didn’t have a conscious ulterior motive. There was an authentic connection; and while it may have been unhealthy and for the wrong reasons, it was, in my mind, real.

    I acted as if I was in love because I thought I was.

    The bond that occurred in the beginning of a relationship was incredible: there was a deep (false) sense of knowing the other person intimately, intuitively. He became my whole world and it was wonderful, rapturous. When my boyfriends left – and they invariably left – that world was annihilated; everything fell to ashes.

    The breakup that led to my hard-won recovery from BPD left me literally slumped on the floor, crushed in spirit, feeling as if there was no meaning in my life.

    I was close to killing myself - too defeated and broken to even move. The saddest thing about the situation was that I was the cause of my pain, yet had little idea then that it was due to my own behavior.

    So yes, the love is “real”, but only in the sense of how it feels to the person with BPD: the feelings seem real, they feel like love.

    But it’s not love because it’s based on need rather than on true caring and intimacy, which is the real love we all deserve.   ~Oceanheart

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    The Five Stages of Discovery for Family Members elsewhere in site
    Paul Mason. MS, CPC, and Randi Kreger, Excerpt from "Stop Walking on Eggshells"

    A Family Members Discovery and Reaction to Borderline Personality Disorder

    People who love someone with Borderline Personality Disorder seem to go through similar stages in their discovery and learning about the disorder and the recovery of their own lives. The longer the relationship has lasted, the longer each stage seems to take. Although these stages are listed in the general order in which people go experience them, most people move back and forth among the different stages.

    Confusion Stage
    This generally occurs before a diagnosis of Borderline Personality Disorder is known. Family members struggle to understand why Borderlines sometimes behave in ways that seem to make no sense. They look for solutions that seem elusive, blame themselves, or resign themselves to living in chaos. Even after learning about BPD, it can take family members (sometimes referred to as "non-BPD's) weeks or months to really comprehend on an intellectual level how the Borderline Person is personally affected by this complex disorder. It can take even longer to absorb the information on an emotional level.

    Outer-Directed Stage - Focuses on the Person with BPD
    In this stage, non-BPD's turn their attention toward the person with the disorder, urging them to seek professional help, attempting to get them to change, and trying their best not to trigger problematic behavior. People at this stage usually learn all they can about BPD in an effort to understand and empathize with the person they care about. It can take family members a long time to acknowledge feelings of anger and grief--especially when the Borderline Person is a parent or child. Anger is an extremely common reaction, even though most family members understand on an intellectual level that Borderline Personality Disorder is not the borderline's fault. Yet because anger seems to be an inappropriate response to a situation that may be beyond the borderline's control, family members often suppress their anger and instead experience depression, hopelessness, and guilt. The chief tasks for family members in this stage include acknowledging and dealing with their own emotions, letting the Borderline Person take responsibility for their own actions, and giving up the fantasy that the Borderline Person will behave as the family members would like them to.

    Inner-Directed Stage - Focus on Ones Self
    Eventually, family members look inward and conduct an honest appraisal of themselves. It takes two people to have a relationship, and the goal for family members in this stage is to better understand their role in making the relationship what it now is. The objective here is not self-recrimination, but insight and self-discovery.

    Decision-Making Stage
    Armed with knowledge and insight, family members struggle to make decisions about the relationship. This stage can often take months or years. Family members in this stage need to clearly understand their own values, beliefs, expectations, and assumptions. For example, one man with a physically violent borderline wife came from a conservative family that strongly disapprove of divorce. His friends counseled him to separate from her, but he felt unable to do so because of his concern about how his family would react. You may find that your beliefs and values have served you well throughout your life. Or you may find that you inherited them from your family without determining whether or not they truly reflect who you are. Either way, it is important to be guided by your own values--not someone else's.

    Resolution Phase
    In this final stage, family members implement their decisions and live with them. Depending upon the type of relationship, some family members may, over time, change their minds many times and try different alternatives.

    When it comes to chosen relationships, we found that the Borderline Person's willingness to admit they had a problem and seek help was by far the determining factor as to whether the couple stayed together or not... If you are looking at this right now, know that you are not alone.

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    Brain Abnormalities Underlying Key Element Of Borderline Personality Disorder Identified    (8-27-10)

    ScienceDaily (Dec. 27, 2007) — Using new approaches, an interdisciplinary team of scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City has gained a view of activity in key brain areas associated with a core difficulty in patients with borderline personality disorder—shedding new light on this serious psychiatric condition.

    "In its early days yet, but the work is pinpointing functional differences in the neurobiology of healthy people versus individuals with the disorder as they attempt to control their behavior in a negative emotional context. Such initial insights can help provide a foundation for better, more targeted therapies down the line," explains lead researcher Dr. David A. Silbersweig, the Stephen P. Tobin and Dr. Arnold M. Cooper Professor of Psychiatry and Professor of Neurology at Weill Cornell Medical College, and attending psychiatrist and neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

    Borderline personality disorder is a devastating mental illness that affects between 1 to 2 percent of Americans, causing untold disruption of patients' lives and relationships. Nevertheless, its underlying biology is not very well understood. Hallmarks of the illness include impulsivity, emotional instability, interpersonal difficulties, and a preponderance of negative emotions such as anger—all of which may encourage or be associated with substance abuse, self-destructive behaviors and even suicide.

    "In this study, our collaborative team looked specifically at the nexus between negative emotions and impulsivity—the tendency of people with borderline personality disorder to 'act out' destructively in the presence of anger," Dr. Silbersweig explains. "Other studies have looked at either negative emotional states or this type of behavioral disinhibition. The two are closely connected, and we wanted to find out why. We therefore focused our experiments on the interaction between negative emotional states and behavioral inhibition."

    Advanced brain-scanning technologies developed by the research team made it possible to detect the brain areas of interest with greater sensitivity.

    "Previous work by our group and others had suggested that an area at the base of the brain within the ventromedial prefrontal cortex was key to people's ability to restrain behaviors in the presence of emotion," Dr. Silbersweig explains.

    Unfortunately, tracking activity in this brain region has been extremely difficult using functional MRI (fMRI). "Due to its particular location, you get a lot of signal loss," the researcher explains.

    However, the Weill Cornell team used a special fMRI activation probe that they developed to eliminate much of that interference. This paved the way for the study, which included 16 patients with borderline personality disorder and 14 healthy controls.

    The team also used a tailored fMRI neuropsychological approach to observe activity in the subjects' ventromedial prefrontal cortex as they performed what behavioral neuroscience researchers call "go/no go" tests.

    These rapid-fire tests require participants to press or withhold from pressing a button whenever they receive particular visual cues. In a twist from the usual approach, the performance of the task with negative words (related to borderline psychology) was contrasted with the performance of the task when using neutral words, to reveal how negative emotions affect the participants' ability to perform the task.

    As expected, negative emotional words caused participants with borderline personality disorder to have more difficulty with the task at hand and act more impulsively—ignoring visual cues to stop as they repeatedly pressed the button.

    But what was really interesting was what showed up on MRI.

    "We confirmed that discrete parts of the ventromedial prefrontal cortex—the subgenual anterior cingulate cortex and the medial orbitofrontal cortex areas—were relatively less active in patients versus controls," Dr. Silbersweig says. "These areas are thought to be key to facilitating behavioral inhibition under emotional circumstances, so if they are underperforming that could contribute to the disinhibition one so often sees with borderline personality disorder."

    At the same time, the research team observed heightened levels of activation during the tests in other areas of the patients' brains, including the amygdala, a locus for emotions such as anger and fear, and some of the brain's other limbic regions, which are linked to emotional processing.

    "In the frontal region and the amygdala, the degree to which the brain aberrations occurred was closely correlated to the degree with which patients with borderline personality disorder had clinical difficulty controlling their behavior, or had difficulty with negative emotion, respectively," Dr. Silbersweig notes.

    The study sheds light not only on borderline personality disorder, but on the mechanisms healthy individuals rely on to curb their tempers in the face of strong emotion.

    Still, patients struggling with borderline personality disorder stand to benefit most from this groundbreaking research. An accompanying journal commentary labels the study "rigorous" and "systematic," and one of the first to validate with neuroimaging what scientists had only been able to guess at before.

    "The more that this type of work gets done, the more people will understand that mental illness is not the patient's fault—that there are circuits in the brain that control these functions in humans and that these disorders are tied to fundamental disruptions in these circuits," Dr. Silbersweig says. "Our hope is that such insights will help erode the stigma surrounding psychiatric illness."


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    Borderline Personality Disorder Caused by Genetic Material on Chromosone 9 

     
     

    Recent research from the National Institute of Mental Health indicates that “genetic material on chromosome nine was linked to BPD features”. This research, while valuable, is misleading (more on that later). First, what is Borderline Personality Disorder? People who experience BPD are highly emotionally reactive and their moods, interpersonal relationships, self-image and behaviour are very unstable and irratic. Their black and white thinking patterns are reflected in their tendency to idealize others and then become extremely disillusioned with that same person due to acute abandonment fears. Self-harm, suicidal thoughts, eating disorders, and alcohol and drug abuse are some of the typical co-occuring difficulties. According to this new research, “genetic factors play a major role in individual differences of borderline personality disorder features in Western society”. What is not mentioned in the article is the fact that 40 to 71 percent of people diagnosed with BPD have been abused as children. The article also fails to mention that 75% of people diagnosed with BPD are female. While a number of factors may contribute to the development of BPD, the role of childhood physical, sexual and emotional abuse, and the fact that it is seen predominantly in women, is neither new or controversial and should be mentioned as part of the BPD context. Not mentioning these long established facts creates a false impression, and a misguided hope for a genetic cure. It also neglects the painful background experiences plaguing people who experience BPD and takes the focus off abuse prevention  and the need to support abuse victims who wish to come forward.

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    (5-19-11)

    The Brain and Emotional Intelligence: An Interview with Daniel Goleman  from Tricycle website

    The Brain and Emotional Intelligence: An Interview with Daniel Goleman

    I recently was blessed with the opportunity to talk with author, psychologist, and science journalist Daniel Goleman about his new book, The Brain and Emotional Intelligence: New Insights. Among Goleman's prolific body of work is the best-selling book Emotional Intelligence: Why It Can Matter More Than IQ, a subject that he has revisited and expanded upon in his newest offering.

    Tricycle: How does understanding the brain help us manage stress?

    Daniel Goleman: There are several ways that understanding some brain mechanics and having basic neural tools at hand can help us manage stress. First of all, we have to realize that there’s no escaping stress completely; this is the nature of life. Some of what's called samsara is what other people call “stress”. When we're stressed the part of the brain that takes over, the part that reacts the most, is the circuitry that was originally designed to manage threats—especially circuits that center on the amygdala, which is in the emotional centers of the brain.

    The amygdala is the trigger point for the fight, flight, or freeze response. When these circuits perceive a threat, they flood the body with stress hormones that do several things to prepare us for an emergency. Blood shunts away from the organs to the limbs; that’s the fight or flee. But the response is also cognitive—and, in modern life this is what matters most, it makes some shifts in how the mind functions. Attention tends to fixate on the thing that is bothering us, that’s stressing us, that we're worried about, that’s upsetting, frustrating, or angering us. That means that we don’t have as much attentional capacity left for whatever it is we're supposed to be doing or want to be doing. In addition, our memory reshuffles its hierarchy so that what's most relevant to the perceived threat is what comes to mind most easily—and what's deemed irrelevant is harder to bring to mind. That, again, makes it more difficult to get things done than we might want. Plus, we tend to fall back on over-learned responses, which are responses learned early in life—which can lead us to do or say things that we regret later. It is important to understand that the impulses that come to us when we're under stress—particularly if we get hijacked by it—are likely to lead us astray.

    It's extremely important to widen the gap between impulse and action; and that’s exactly what mindfulness does. This is one of the big advantages of mindfulness practice: it gives us a moment or two, hopefully, where we can change our relationship to our experience, not be caught in it and swept away by impulse, but rather to see that there's an opportunity here to make a different, better choice. I think that understanding the basic neural mechanisms involved is an aid to mindfulness because it tells us we don’t have to get swept away.

    Tricycle: Fascinating. It seems that it is through awareness that we have any choice at all, as opposed to just letting our reactions dictate everything we do.

    Daniel Goleman: Yes, exactly, the unconscious mind is completely happy to make all of our decisions for us, and to run us on “automatic,” through habitual sequences that roll on outside of our awareness—and so without our seeing that a choice was even there to be made. When we are mindless, so to speak, we're piloted through our day seemingly by whim, by pure habit. Mindfulness lets us step out of that rut and see that there's another road we could take and actually take that road. So it's a very powerful choice point in the mind.

    Tricycle: We have quite a capacity for autopilot, it seems.

    Daniel Goleman: Yes, exactly.

    Tricycle: So stress reactions and various difficulties are hardwired into the brain, so to speak. I'm curious—are ethics or morality hardwired into our brains as well?

    Daniel Goleman: There's some evolutionary thinking that there tend to be four or five universal dimensions of ethics and ethical choice, but no one is saying there’s some specific spot in the brain which is our ethical center. It’s certainly more diffuse than that.  The psychologist Jonathan Haidt proposes an evolutionary theory that there are five or so universal dimensions of ethics. He has written about how universal, for example, a sense of fairness seems to be, or the positive value of cleanliness and negativity of dirtiness, or a concern with larger meanings. So, it may be that our brain is designed to foster our thinking about such ethical concerns. I don’t know if you could say it's hardwired but I think the capacity for ethical concerns seems to be a universal brain function.

    Tricycle: How do you feel about all the time that we're spending online these days? How might this effect our brains?

    Daniel Goleman: I think it's an enormous experiment with our sense of community and our children. Evolution designed the human brain for face-to-face human contact, particularly our capacity for empathy, which, of course, is very strongly related to our sense of ethics. Empathy is the essential factor for compassion but online we may be disabling this. The social centers of the brain seem to act like an interpersonal radar attuning to the person we're with, and activating in our own brain what's going on with that person—their feelings, their intentions, their movements. Because we have this inner sense of what they're doing we don’t have to think about it; this is another automatic function.

    Tricycle: Like mirror neurons?

    Daniel Goleman: Mirror neurons are one of the main classes of neurons that have been discovered in the social brain—all of these social circuits together keep things operating smoothly during interactions. But when we're online there's no channel for our social brain to get feedback. The mirror neurons have nothing to read, and so we're operating in the dark. This may create, for example, a negativity bias to email, where the sender thinks the message is more positive than does the person who receives. This also means people are more likely to experience what's called “cyber-disinhibition” which means that, say, you're having a little bit of an emotional hijack and if you were face-to-face your social circuitry might tell you "Well, it would be better to say this than that." In other words, you might be artful about it. But online it has zero feedback; that’s the disinhibition which gives rise to what's called flaming. Flaming is when somebody's really agitated and they sit down and pound out a message all in caps, and they hit "send" and then immediately regret it; it's a classic online hijack. So, on the downside, there also may be some emotional numbing, some deadening of empathy, and all of that means that we may be fraying social connections as more and more interactions become virtual as on Facebook and less and less face-to-face. Then there is the big experiment that is perhaps the most troubling: kids are spending more and more time during childhood online. This changes the way we have always taught social and emotional skills in life, in day-to-day interactions. If kids are spending fewer hours of time together in person and more and more hours online we might be de-skilling entire generations in essentials for a full human life.

    Tricycle: Do you recommend any practices or activities that might help people living in this age develop their capacity for emotional intelligence?

    Daniel Goleman: The good news is that there are ways to cultivate emotional intelligence. But first remember that emotional intelligence is a set of human skills; it is not one monolithic ability. It includes self-awareness, it includes managing your emotions (or “self-regulation) which doesn’t mean suppressing emotions, but not letting your disturbing emotions get in the way of life and also marshalling your positive emotions and passions for a full life. Third is empathy, sensing how other people are feeling and a general social awareness, and fourth, putting that all together in social skill during interactions.

    I would say that there are many aspects of dharma practice that would facilitate different parts of emotional intelligence. Tonglen practice, for example, is explicitly attuning into the other person and I think that must strengthen empathy. I have yet to see the research study that shows that but I would bet that that’s what it would find. I also think that the ethical dimension of dharma practice is implemented by strengthening our self-regulation, and I think that meditation practice generally is a way to enhance self-awareness. So I can see many, many ways in which dharma practice itself could give a boost to different aspects of emotional intelligence.

    Tricycle: Can you talk about the relationship between motivation and emotion?

    Daniel Goleman: Motivations are drivers of positive emotion. When we do the things we are motivated to do, and some people are motivated to have strong connections with other people, those things will give us a kind of spontaneous high. Some people are motivated to strive incessantly for achievement, while some people are motivated to exert power by influencing other people, some for the better, some for the worse. So, I think that the relationship is that one is the driver of the other. Our motives determine what we enjoy. Our values, on the other hand, are a little different from our motivations. Our values are our sense of what we should do and what we should like and it's clearly best to be in a situation where our values are aligned with our motives. Many people are stuck in jobs they hate and it’s because of values say “well, you should be doing this” and their motives are somewhere else. Howard Gardner, who is at Harvard, has done research on what he calls "Good Work" which is work where people are fortunate enough to align their values, that is their sense of ethics, with their emotions, what engages them, and also what they're good at, their excellence. So when you align excellence and ethics and engagement, then you have a calling that you utterly love. It may or may not be a paid job, but it gives your life the most meaning and is most satisfying to you.

    Tricycle: Is that like self-actualization?

    Daniel Goleman: I would say that’s an ingredient in self-actualization and that self-actualized people find their way to that kind of work or calling.

    Tricycle: What in your research is exciting and interesting you at the moment? What are you hoping people get from your new book? In short, give me a snapshot of Daniel Goleman right now.

    Daniel Goleman: Well, the reason I did this digital book, The Brain and Emotional Intelligence, is that I don’t stop pursuing an area once I finished a book about it. I wrote Emotional Intelligence, Social Intelligence, and Working with Emotional Intelligence but I've continued to be interested in what science can reveal to us about our lives and particularly what the newly emerging brain science can reveal to us. My profession is as a science journalist; I was at The New York Times for a dozen years before Emotional Intelligence became a career in itself and I continue to try to harvest scientific findings that are kind of news we can use that have real applications to life. This is extremely satisfying to me to continue to share this with others who are interested by publishing a shorter book digitally and to do it quickly instead of setting aside three years of my life to do a conventional book. So, I'm very happy about this.

    Back to Genetics


    (2-21-11)
    Understanding the Amygdala in Simple Language
    by the Website Author


    Upon many hours of reading and researching the probable causes of Borderline Personality Disorder….I saw that there are two basic reasons for BPD:  Genetics and an Invalidating Environment in a family of origin. There are many theories as to what percentages are attached to each of the two causes.  This brief discussion on the Amygdala concerns the Genetics of what actually is anatomically  resides inside a BPD’s brain.

    The Amygdala (actually there are 2, so the Amygdalae) are small almond-shaped organs in the brain—a left amygdala and a right amygdala.  This area of the brain plays a major role in memory recall, responses to stimuli, and emotional regulation with the outcome of flight, fight, or freeze responses.  It is agreed upon that this organ is part of our instinctive and reactive brains.

    Stimulating the amygdala electrically (in studies) creates anxiety all the way to panic and fear.  Much information has tried to convince us that amygdala reaction will cause aggressive behavior.  This is not necessarily true.  The amygdala can produce a hyper-sensitivity to emotional arousal.   The amygdala will enable us to vividly remember a stressful event, because of the release of adrenaline.  Adrenaline will aid in highly accurate recall of a traumatic happening, and actually put the body into a similar physical state experienced as if the event was happening.  The feelings of the memory are thus stored along with the facts of the event.  Often times, panic and anxiety will cause the brain to jump to inaccurate conclusions of “what is.”  The brain then focuses on the possible threat or dangers of harm or death.

    Men’s RIGHT amygdala has a stronger connection to the brain, which keys off their external environment.  Women’s LEFT amygdala has a greater connection with the rest of their brain, and the focus is normally internal thought, not external environment.  It has  often been said that Borderline Personality Disorder could be “a perception disorder.”  And who does the internalizing of perceived imminent danger?  Women do.  That is why the largest percentage of Borderlines are female.  This has been the belief up to the most recent decade, but the numbers, percentages and identifiable diagnoses have changed.  A lot more men has been diagnosed with the disorder.  Also, the amygdala has been found to be smaller in people diagnosed with BPD.  This is a second component to the genetic cause of BPD.

    We have learned in more recent years through extensive studies, that the black and white reasons and criteria for BPD in either gender has become more grey in color.  The genetic causes of BPD in people, still has an identifiable physical component (the amygdala’s size and gender) along with the environment factor.  Women and men perceive things differently….even their invalidating childhood environments.   The point here is, this small pair of organs has a very prominent place in the discussion of the reason that BPD manifests itself in someone.

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    Experience Your Anger - Then Let it Go
    Individuals working through a borderline personality disorder relationship should be cautious not to spend excessive time and energy in the outer directed stage.

    Everyone passes through these stages in their own way, and anger is often a necessary release and part of the natural grieving process. But it is important not to indulge one's self or become consumed by anger to the exclusion of moving forward.  You must move past the anger if you desire to take control of your life. ~ Facing The Facts

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     Borderline Personality Disorder Label Creates Stigma by Elizabeth Bogod  

                                                                                                                                      (2-10-10)

    What's in a name? In the disability community this question is a hot topic. In fact, the use of negative language has proven time after time to be a major influence on individual and public attitudes towards people with disabilities and as Dahl asserts often constitutes "a major barrier for people with disabilities". However, despite progress being made to use less stigmatizing disability terms, psychiatry has not kept up with these changes. Borderline Personality Disorder, listed in the Axis II section of Diagnostic and Statistical Manual (DSM IV), is an example of one such term and the focus of this paper.

    The DSM IV defines BPD as "a pervasive pattern of instability of interpersonal relationships, self-image, and effects, and marked impulsivity beginning by early adulthood ...". The mental health disability causes extreme emotional vulnerability, an unstable sense of self, impulsiveness in potentially self-damaging behaviors (e.g., spending, sex, substance abuse, driving, eating, etc.), suicidal or self-mutilating behavior, chronic feelings of emptiness, intense anger or difficulty controlling anger, and periods of feeling removed from reality (dissociation).

    This paper will discuss the negative connotations of the term "BPD", examine the origin of the term, the effects it has on treatment and ways the term shapes both individual and public perception of people diagnosed with the disorder. In addition, the paper will explore whether or not the term is an acceptable use of language based on current terminology standards outlined in the government publication "Worthless or Wonderful". Finally, it will propose recommendations for changing the name and identify recent progress towards this goal.

    Origin

    The origin of the term "BPD" dates back to the early 1900's. At this time people with mental health disabilities were either categorized as neurotic or psychotic.  As it became increasingly clear to Dr. Stern (an early psychiatrist) that a growing patient body did not quite fit into these oversimplified diagnostic categories of the day, the term "borderline" was born. According to Dr. Stern's theory, such patient's teetered on the "borderline" between neuroses and psychoses. Although this theory went out of favor shortly after it was proposed, the "borderline" label stuck.

    Inaccuracy

    Dr. Leland Heller (M.D), an expert in BPD treatment, believes the BPD term is inaccurate and that the 'BPD' label "in and of itself is as if the whole person (and the personality) is flawed ...". He strongly objects to this implication because the most recent research on BPD indicates that the cause of the disorder is not a "flawed personality" but rather a biologically based brain disorder. He believes there is a dysfunction of the limbic system of the brain. Heller backs up his objection to the term with recent research on the biological components of BPD.

    Another study by Paul Soloff, M.D. and his associates found a connection between BPD and low level brain activity in the pre-frontal cortex. Using Positron Emission Tomography (PET) scans, researchers can measure glucose levels to detect brain activity Low glucose levels have been connected to deficiencies in serotonin, a naturally occurring chemical in the brain that helps regulate emotion. In this study, Soloff established two groups. The first group comprised of BPD patients, while the second group, served as the control group made up of participants with no history of mental illness. Subjects from both the BPD group and the control group were either given the serotonin-enhancing drug, Fenfluramine or a placebo. Under both conditions, researchers consistently observed higher level glucose activity in the frontal lobes of control participants than those in the BPD group.

    These biological explanations for BPD substantiate Heller's belief that BPD is in fact a biological disorder, and not just a personality flaw.

    Dr. Marsha Linehan, Ph.D., another leader in the field of Borderline Personality Disorder, proposes that the condition is a problem with emotional dysregulation. Linehan pioneered the development of Dialectical Behavioral Therapy (DBT), a well-recognized method of cognitive therapy in the treatment of BPD. Core to the success of this therapy, is the belief that BPD is a biological disorder characterized by heightened sensitivity to emotion and increased emotional intensity.

    Heller has suggested that name "Borderline Personality Disorder" be changed to a more accurate, less emotionally laden term. He has proposed the term "Dyslimbia" . To explain the term he breaks it down into two parts. The first part, "Dys" is the Greek for "disorder" while the second part, "limbia" refers to the limbic system of the brain. Put together the term refers to a biological disorder of the brain's limbic system. However, more research may be necessary to bring this term into general use. The advocacy organization, TARA - Treatment and Research Advancement Association, would like to see the name changed as well.

    "The name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma. We believe that BPD should be refrained onto a spectrum of its core components-impulsivity and emotional dysregulation."

    They believe that "Emotional Regulation Disorder" or "Emotional Dysregulation Disorder" have the most likely chance of being adopted by the American Psychiatric Association (APA).

    Dr. Joel Dvoskin (Ph.D.) seems to agree that something most be done to remove the stigma of the "BPD" diagnosis. He highlights the reality of what the "BPD" label does when applied to an individual. He stresses that "not all mental health diagnoses foster treatment" and goes on to identify BPD as a diagnosis that "hurts people very much". He dislikes the term because it so often results in sub-standard treatment of people diagnosed with the disorder. For example, mental health professionals often label undesired behaviors of BPD clients as "manipulative" and in need of punishment Yet, no matter how many times punishment is administered it has no effect on the so-called "manipulative behavior". So why persist in "treating" a patient's condition with the reward/punishment model when it clearly does not work? Dvoskin believes when such futile attempts fail, it is easier for the professional to blame the patient for lack of response to treatment or worse, fault the patient for a lack of moral fortitude than admit the professional's own shortcomings. In fairness, one should mention these patients are often regarded as "notoriously difficult to treat".  However, Dr. Dvoskin believes that one of the main reasons these clients are considered so difficult to treat is that mental health professionals take out their frustration on the patient, label their patients as purposely causing their own grief and blame their patients for not responding to treatment. He asserts "apparently the greatest sin a patient can commit is the sin of poor response to treatment...".

    The last area needing exploration is whether or not the term "Borderline Personality Disorder" meets currently held standards for proper language use in referring to people with mental illness. The report "Worthless or Wonderful" recommends that language which "suggests negative or judgmental connotations"  be changed to more objective terminology. As mentioned above, the term "Borderline Personality Disorder" suggests the judgmental connotation that the personality of the individual is flawed. Since personality is commonly viewed as the essence of who we are, the inference of a flawed personality is very insulting. Therefore, according to the latest recommendations on proper language use in referring to a persons with disabilities, the term BPD does not meet current standards.

    In light of the out-dated, out of favor theory used to develop the "borderline" label, the negative effect of this label on treatment and patients themselves, and the failing grade given to the BPD term based on recognized disability terminology standards, surely it is the duty of every professional to explore the inaccurarcy of the "BPD" label and its stigmatizing effect on those diagnosed. Needless to say, the people who are most affected by the stigma of the "BPD" label are those diagnosed with the disorder. Therefore, those diagnosed with "BPD" can also have a major influence on the use of the term by refusing to accept it. As "consumers" of mental health services, such individuals can empower themselves by speaking out about how they are affected by the "BPD" label and how it affects the mental health services they receive. Acting as their own mental health advocates, people diagnosed with BPD can make a difference to change public perception about their disorder and make services more adaptable to their needs.

    Now is the chance for people diagnosed with BPD, concerned community members and mental health professionals to speak out. TARA is encouraging people to use a copy of their form letter or write their own letter to the APA to express support for TARA's advocacy efforts (see Appendix). Through expressing these concerns, the APA will hear the voice of the people and hopefully, in the next publication of the DSM, do away with the stigmatizing "BPD" label altogether.


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    Despite Deeper Understanding of Mental Illness, Stigma Lingers
    By Whitney Blair Wyckoff   Sept. 17, 2010, NPR

    Even though most people understand that mental illness is caused by brain biology, it still carries a stigma.  Knowledge is power. And while some research suggests that emphasizing the science behind mental illness—that it’s a brain disorder and not a defect in character—could be powerful enough to help shake the stigma around the condition, a recent study in the American Journal of Psychiatry found that tactic isn’t paying off all that well.

    Other researchers have found that while more people understand that mental illness is caused by brain biology, it hasn’t necessarily translated into a decrease in stigmatization.  “We’re not saying that the ‘disease like any other’ line is going to fail, but it’s taken us as far as it's going to take us,” says Bernice A.  Pescosolido, lead author of the study and director of the Indiana Consortium for Mental Health Services Research.  Pescosolido and colleagues analyzed how people responded to questions about vignettes describing people living with schizophrenia, major depression and alcohol dependence.

    The data, from 1996 and 2006, came from General Social Survey.  Researchers found that 67 percent of the nearly 2,000 adults surveyed attributed major depression to neurobiological causes—up from 54 percent 10 years before.
    Looking at schizophrenia, 86 percent of those surveyed connected the disease with brain biology, which is 10 points higher than a decade earlier. And the same figure for alcohol dependence rose to 47 percent from 38 percent. Also, there was an across-the-board increase in those who recommended medical treatment for people living with mental illness. 

    However, there was no significant change in stigma indicators. For example, 62% indicated an unwillingness to work closely with someone with schizophrenia. And 74% said the same for people with alcohol dependence.  How come? Many people see mental illness as something that never goes away. “When you attach a feeling of permanence to this, then it justifies, in some ways, a person’s sense of ‘otherness’ or ‘less-than-humanness,’” Pescosolido says.  She adds, “There’s something about the mind that people have a different reaction to than body affliction.” 

    Pescosolido is currently researching how the stigma of mental illness in the U.S. compares to that in 17 other countries. She says she hopes the research will continue to shed light on how to address mental illness stigma.

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    Transference Focused Psychotherapy Explained in Human Terms  
    -With Dr. Frank Yeomans; as told by Tami Green and adapted from her article.  (3-3-10)

    Dr. Yeomans (Clinical Associate Professor of Psychiatry at the Weill Medical College of Cornell University) developed a special interest in treating Borderline patients during his residency in the early 80's. Though the (misguided) consensus at the time was that BPD patients were generally difficult, he felt they could be particularly rewarding to work with.

    Dr. Yeomans was asked how TFP differs from Dialectical Behavioral Therapy (DBT), the most well-known treatment option for BPD here in America, and he offered this example:

    "When a patient has a hard time getting a job, and tends to get anxious and angry, tends to feel she is being challenged, she responds in a hostile way. DBT will teach her to master the reactions, while TFP questions her perceptions and helps her distinguish between the internal and external reality.

    TFP helps sort out the internal perceptions that stem from childhood that may not match the external reality of today. It helps the patient question the way they think. In order to accomplish this, these therapists don't soothe their patients, so that a natural relationship is developed."

    In this way, feelings that would normally arise in the course of a relationship are felt during therapy so they can be thought about and discussed.

    Dr. Yeomans was asked "it is possible to assist someone in changing their internal view?"   He said, "by validating and then challenging. Get them to think. It may take months and years of going back and forth. As a therapist, you can introduce data into someone's mind so they can begin to entertain it, but it only lasts a while because it usually feels safer to return to the previously held position."

    When asked about actually changing the brain neurobiology, he offered some very exciting news: "There is more plasticity in the brain than once believed. The change happens through repetition, exposure and reflection." It would only make sense that to change our brain permanently would take a lot of time, then. However, life is not put on hold during therapy.

    As a matter of fact, engaging in the world is a very important requirement of the therapy. Repetitive bad outcomes of the past--such as failed relationships or jobs--can be turned around successfully by bringing the real-time challenges to the therapy where they can be discussed and worked through. And though two therapy sessions are held each week, more than that is discouraged, as it fosters a dependence upon the therapist that is unnecessary.

    He also discussed how TFP is a little controversial because of its' emphasis on the basic nature of the two sides of the human mind: the loving side (affinity and affection) as well as the competitive aggressive side.

    Dr. Yeomans continued by saying:

    "Our Mentalization (MBT) and DBT colleagues don't talk about innate aggressive drives, but even though these drives have been tamed in civilization, what do we do with them now? Part of TFP is integrating the aggression and mastering it."

    Speaking of this aggressive side and the need to integrate it, he added, "it was once thought that more women than men had BPD, but we now know that it is an equal percentage of each. It's just that more men with BPD show up in jail, not in the clinical community."

    He said that everyone has this aggressive side, not just those with BPD. TFP helps the patient to learn to stop and analyze reactions. There is, for example, nothing wrong with yelling and screaming if you chose to do it and control it and use the behavior effectively.


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    What Borderline in a Parent Can Do to the Family Members, Especially the Children
         from
    http://mrstreasures.wordpress.com
     (5-26-12)


    St. Dymphna is the patron saint for emotional disturbance

    Veronica, a reader of my article “Mother’s Day and Borderline Personality Disorder: When your Mom is an Emotional Terrorist” articulated in her own words the pain

    “Thank-you for telling the real truth about how difficult it is and how utterly emotionally draining it is to have a mother with borderline personality disorder. There are so many articles that tiptoe around the truth and never tell how adult children of BPD’s are in constant terror from their mothers. This article was spot-on and I thank-you for giving a voice to all the adult children who are utterly confused and victims of this terrible illness that rips families and souls apart. I am an adult child victim as well and I could relate to EVERY sentence in this article.

    Veronica (2008, May 05)

    “When your Mom is an Emotional Terrorist” is about the plight of  children and their relationship with their Borderline mother.  They love her so much but being children, it is very hard for them to understand the difference between the illness and their mother’s behavior.  There seems to be no demarcation line that their mother is now being BORDERLINE.  The emotional outbursts are very unpredictable and scary for them.  Their world used to be very chaotic, their inner disturbances are acted out in other behaviors.

    It leads me to the question if we should protect the children of BPD mothers?  How will we do it?  Do we let them suffer their fate?

    The spouses of Borderlines are so engrossed with the partner’s never-ending problems that many children needs are emotionally neglected.  The spouses are suffering from Post Traumatic Stress Syndrome (PSTD) themselves and trying to make sense of their miseries. The children are suffering from Development Trauma Disorder (DTD) and possibly
    Reactive Attachment Disorder (RAD).

    A facade of normalcy is displayed to the outside world. But in reality, these children live in self-contained prison camps.  Some through genetic disposition end up being Borderline.  Some are able to make a drastic effort not to be Borderline.  But everyone in the process is traumatized.  BPD is a disorder that should not be taken lightly.  If you are in a BPD relationship and your partner is in denial, please protect your innocent children.  Each day in a BPD relationship is deadly for a child.  Think of your children.

    If you are interested to know more about DEVELOPMENT TRAUMA DISORDER and learn more about Borderline Personality Disorder, please visit the following articles:

    Development Trauma Disorder: The Next High Profile Mental Health Issue

    How to Spot a Girl with Borderline Personality Disorder

    The Scariest Aspect of Borderline Personality Disorder

    10 Tips to Handle a Difficult Ex:  Foster of Borderline Personality Disorder


    (More) Complications of BPD     from MedicineNet.com website    (4-19-11)

    What are borderline personality disorder complications?

    The presence of BPD can often worsen the course of another mental condition with which it occurs. For example, it tends to change the symptoms of posttraumatic stress disorder and to worsen depression.

    Individuals with BPD are at risk for self-mutilation, as well as for attempting or completing suicide. While both self-mutilating and suicidal behaviors seem to be associated with alleviating negative feelings, it is thought that self-mutilating behaviors are more an expression of anger, punishing oneself, distracting oneself, and eliciting more normal feelings. In contrast, suicide attempts are thought to be more often associated with feeling survivors will be better off for their death. People who engage in self-mutilation are more likely to commit suicide compared to those who do not self-mutilate.

    Although most individuals with a mental disorder do not engage in violent behavior, those who suffer from BPD have a somewhat increased risk for such behaviors. That risk is also increased for individuals who suffer from antisocial personality disorder, have previous history of violent behavior, frequent use of sedative medications, or experience several changes in their psychiatric medications in general.

    Complications of BPD also often involve families of the person with the disorder. For example, a parent with BPD is vulnerable to having depressive symptoms in their children.

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    Do Deficits in Mindfulness Underlie Borderline Personality Features and Core Difficulties?   (5-19-11)

    Posted on the 03 April 2011 by Michaelsweiss  From Biology Magazine Forums

    Do Deficits in Mindfulness Underlie Borderline Personality Features and Core Difficulties?
    Review of Study Published in the
    Journal of Personality Disorders


              Previous research includes several different models to identify the core mechanisms responsible for the diverse features associated with Borderline Personality Disorder.  This disorder presents with a variety of features that include ineffective interpersonal skills and emotion-regulation dysfunction.  Individuals diagnosed with Borderline Personality Disorder typically have issues related to awareness, attention, and self-acceptance.  Most previous research regularly associates mindfulness with the presentation of many of these issues; but there is limited research exploring the correlation between mindfulness and Borderline Personality Disorder symptoms.   The purpose of this study was to observe whether, in fact, mindfulness deficits underlie the broad areas of dysfunction commonly associated with the clinical features of this disorder.  To do this, the authors examined the relationship between mindfulness deficits and a diverse non-clinical sample that was representative of a wide range of Borderline Personality features.       

         The authors tested three main hypothesis based on the empirical evidence of previous research.  The first hypothesis was that there would be a negative association between mindfulness, and the core areas of dysfunction of Borderline Personality Disorder.  The second hypothesis predicted that the association between mindfulness and these clinical features would be statistically significant when controlling for neuroticism.  The final hypothesis was that mindfulness would be able to predict Borderline Personality Disorder features beyond its associations with the regular functioning of the features associated with this disorder.    

          The sample used for this study consisted of 342 undergraduate students who were currently enrolled in an introductory psychology course at the University of North Texas.  Mindfulness was measured using a fifteen item, Likert-type scale known as the Mindfulness Attention Awareness Scale.  This scale assesses several different traits that are characteristic of mindfulness including aspects of both attention and awareness.  Borderline Personality Disorder features were assessed using both self-report scales and written response items.  Neuroticism was also assessed due to its high correlation with Borderline Personality Disorder.  This was accomplished using a six item, likert-type scale that assessed the tendency towards negative emotions.      

            The results of this study indicate that mindfulness is positively correlated with interpersonal and emotional functioning, and negatively related to the dysfunctional emotional and interpersonal features associated with Borderline Personality Disorder.  Although weaker; the negative correlation with Borderline Personality Disorder remained statistically significant when controlling for neuroticism.  Analysis of data suggests that mindfulness significantly predicts Borderline Personality Disorder beyond the effects of features common to the disorder. This research suggests that the dysfunctional features of Borderline Personality Disorder may be explained by problems related to mindfulness combined with features of neuroticism.  Mindfulness was indicated as a main construct for explaining the primary areas of dysfunction common to Borderline Personality Disorder.  

                One limitation of this study was the use of undergraduate psychology students to comprise the sample.  This may indicate a limited ability to generalize results to clinical populations.  Another limitation is the inability to draw causal conclusions due to the correlational design of the study.  The relationship between mindfulness and neuroticism must be studied further in order to understand the direct effects of each variable on Borderline Personality Disorder features.           This study was meticulously designed and analyzed using strict data analysis procedures.  The major problem with this study is the inability to isolate all independent variables.  This is not a reflection of faulty methodology, but an indication of the complex clinical presentation of features related to this disorder.  This problem is most likely characteristic of all clinical studies that attempt to broadly examine Borderline Personality Disorder.     

           This study has broad implications for future research and clinical work.  I am interested in understanding how mindfulness meditation can be positively utilized in clinical application.  The relationship between mindfulness and Borderline Personality Disorder suggests that future research involving mindfulness meditation may be warranted.  It would be interesting to see if the introduction of mindfulness meditation would increase the efficacy of current therapeutic models.

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    (6-16-11)

    The STEPPS Group Treatment Program for Borderline Personality Disorder   directly from the steppsforbpd website; STEPPS is the Trademark of: N.S. Blum, N.E. Bartels, D. St. John, B. Pfohl, 2002. All rights reserved.
     

    Introduction to Training

    The Iowa program began in 1995, and is based on a systems approach to treatment of individuals with Borderline Personality Disordered (BPD) originally developed by Bartels and Crotty (1992). That program has subsequently been adapted and revised by Blum, St. John, and Pfohl (2002). The current program includes two phases--a 20-week Basic Skills group, and a one-year, twice-monthly advanced group program called STAIRWAYS. The combined program is identified by the acronym STEPPS, which stands for Systems Training for Emotional Predictability and Problem Solving.

    In this cognitive-behavioral, skills training approach, Borderline Personality Disorder (BPD) is characterized as a disorder of emotion and behavior regulation. The goal is to provide the person with BPD, other professionals treating them, and closely allied friends and family members with a common language to communicate clearly about the disorder and the skills used to manage it. Clients learn specific emotion and behavior management skills. Key professionals, friends, and family members whom clients identify as part of their “reinforcement team,” learn to reinforce and support the newly learned skills. This helps avoid the phenomenon of “splitting,” a process in which the person with BPD may externalize their internal conflict by appearing to draw others around them into taking sides against each other and arguing out the merits of differing perspectives and behaviors. Splitting, like other behaviors common in BPD, is viewed not as an intentional act of aggression, but as an automatic response to the emotional intensity and dysregulation which the client can learn to anticipate and replace with more effective behavior.

    Underlying this training approach is the assumption that at the core of BPD is an actual clinical entity, a disorder that might be characterized as a defect in the individual’s internal ability to regulate emotional intensity. As a result, the person with BPD is periodically overwhelmed by abnormally intense emotional upheavals that drive him or her to seek relief. Family studies suggest an underlying biologic vulnerability. The childhood history of the person with BPD often includes inconsistent emotional support or even abuse by important caregivers. In most cases there is a complex interplay between underlying vulnerability and the social environment. Identifying someone to “blame” for the disorder is usually counterproductive. We believe that individuals with BPD do not consciously choose to have this disorder and, with rare exceptions, parents and other important caregivers do not consciously choose to create an inconsistent and unsupportive childhood environment.

    Early in treatment, many of our clients view the term personality disorder as a code for, “it’s all your own fault.” The term borderline seems to imply that it is only a matter of time before they fall completely “over the edge.” For these reasons, clients often resist the label of BPD, even though they may readily acknowledge the behaviors. Bartels and Crotty have suggested the name Emotional Intensity Disorder as a more accurate description that clients find easier to understand and accept. We use both terms interchangeably. Regardless of the terminology, there are significant advantages to reframing one’s understanding of BPD as a disorder. Rather than viewing themselves as someone who is attempting to manipulate, is attention-seeking, or is sabotaging treatment, the trainees learn to view themselves as driven by the disorder to seek relief from a painful illness through desperate behaviors which are reinforced by negative and distorted thinking.

    The training is composed of three steps:

    Step 1 - Awareness Of Illness

    The first step for the client is to replace misconceptions about the BPD label with an awareness of the behaviors and feelings which define the disorder. Behaviors can be changed and feelings can be managed. Clients often begin with the belief that they are fatally flawed (for which they may alternately blame themselves or others) and that they deserve to suffer. The ability to entertain the notion that this is a legitimate illness and that the individual can learn specific skills to manage it is an important precursor to developing the capacity for change.

    Clients are provided with a printed handout listing the DSM-IV criteria for BPD and time is provided for trainees to acknowledge examples of the criteria in their own behavior (“owning” the illness). A second component is the concept of cognitive filters. Therapists may recognize the similarity to the concept of schemas described by Jeffrey Young (1999) in Cognitive Therapy for Personality Disorders – A Schema-Focused Approach. A questionnaire has been developed to allow trainees to identify their early maladaptive filters and to see the relationship between these filters, the DSM-IV criteria, and their subsequent patterns of feelings, thoughts, and behaviors.

    Step 2 - Emotion Management Skills Training

    We describe the five basic skills that aid the person with BPD in managing the cognitive and emotional effects of the illness. Combined with an understanding of how the illness works and recognizing the filters that have been triggered in a given situation, the skills assist the person with BPD in predicting the course of an episode, anticipating stressful situations in which the illness is aggravated, and building confidence in their ability to manage the illness.

    Step 3 - Behavior Management Skills Training

    There are eight behavior skills areas the person with BPD must work at mastering. As the BPD syndrome progresses through the disruptive interplay between the emotionally intense episodes and a social environment that becomes increasingly unempathic and unresponsive, many functional areas may begin to break down. Learning or relearning patterns of managing these functional areas helps the person with BPD to keep these areas under control during episodes.

    STEPPS Basic Skills Group Program

    The Basic Skills Program consists of 20 weekly meetings of two hours each. This includes a short break between the first and second hour. Each week is organized around a skill which is the focus of the session. Some skills require more than one weekly session to teach. The skills include:

    • Distancing • Communicating • Challenging • Distracting • Managing Problems • Setting Goal • Eating • Sleeping • Exercise • Leisure • Physical Health • Abuse Avoidance • Relationship Management

    For those groups whose meetings occur during the Holiday Season, we have included an optional unit (See Appendix) on managing emotional intensity during this time of the year.

    Outpatient Treatment - Classroom “Seminar” Format

    The training format is a weekly two-hour classroom experience with two trainers and 6-10 trainees. Trainees are supplied with a red notebook in which to keep their training materials. They are instructed to bring in the notebook to each session. They are strongly urged to share their notebook and the lesson materials with others in their system. By the end of the training, most clients view the red notebook as a resource they can turn to during difficult times.

    Rather than following a traditional group therapy model, sessions have the look and feel of a seminar. Clients sit at a conference table facing a board. Besides the use of the board and the printed materials, the training is facilitated by poetry, audio recordings of songs, art activities, and relaxation exercises. It is not unusual for clients to bring in materials, poems, and even art work they have created that reinforce the skills and themes of the meetings.

    A typical class session begins with trainees completing the Borderline Evaluation of Severity over Time (BEST) form, which allows them to rate the intensity of their thoughts, feelings, and behaviors over the past week. They keep track of their weekly score on a graph. This allows them to see the variability that is typical of BPD, and to note over time the decrease in the intensity of their emotional episodes and the increased use of the positive behaviors and skills being taught. The BEST can be used for data collection to evaluate the effectiveness of training. The data will allow monitoring of increases and decreases in self-abuse urges and behaviors, as well as emotional intensity, negative behaviors (e.g.,, substance abuse, eating-disordered behavior), and positive behaviors (e.g., choosing a positive activity, keeping appointments, etc.). This is followed by a brief relaxation/observation exercise. Scripts for some of the activities are written out and available in the handouts. Participants are encouraged to record the scripts (e.g., for progressive muscle relaxation and visualizations) to use outside of the sessions.

    The first half of each session is spent reviewing the Emotional Intensity Continuum, which operationalizes the concept of varying degrees of emotional intensity on a 1-5 scale. A 1 is feeling calm and relaxed, and 5 is feeling out of control, engaging in self-destructive impulses, angry outbursts, etc. Clients are expected to fill this out on a daily basis and to summarize the per cent of time spent at each level during the previous week. Clients often achieve a more balanced view of themselves through this self-rating. In addition, clients are often surprised to find that they do have significant periods of time when they are not at the highest level of emotional intensity.

    The authors gratefully acknowledge the contribution and creativity of Cynthia Claude-Rawson for her artistic conceptualization of the Emotional Intensity Continuum (please refer to week 1), and her illustrations and poems in the lesson on Eating Behaviors (week 15).

    A Skills Monitoring Card lists the skills being taught and allows trainees to indicate which skills they used in the previous week. As part of the family/caregiver education component, clients are encouraged to give an abbreviated version of this card to members of their reinforcement team. The previous week’s homework assignment(s) are reviewed and the remainder of the session is devoted to introducing the material for the current lesson. Participants are encouraged to read aloud the material being introduced

    With occasional exceptions, our clients take to this structured approach to emotional problem solving very well. On one occasion when a group leader was unexpectedly delayed about 20 minutes, she arrived to discover that the group had appointed one of the members to be the leader and the group was well into reviewing the Emotional Intensity Continuum for the group. In the advanced (STAIRWAYS) group, clients regularly request permission to conduct that portion of the session.

    While in a training session, a person with BPD may try to reframe their emotional experience in the context of or as a result of some personal or interpersonal problem. While there is an opportunity for clients to respond and share experiences relevant to the skills being taught, the structure does not allow the group to spend long periods of time focusing on a given group member who may be in crisis. One effect of the structured format is to model how to acknowledge problems and offer support while still imposing reasonable limits and boundaries on the scope of interaction so the main goal of the meeting is not lost. The group leaders must be prepared to re-reframe problems in the context of the disorder and filters. The rule to use is: focus on the disorder, not the content.

    The Systems Component of STEPPS

    Whether it is cause or effect, the individual coming to therapy is usually enmeshed in a system of relationships in which even concerned and well-intentioned friends and significant others respond to the individual with BPD in a manner that reinforces pathologic behavior. For example, the individual experiencing a perceptual distortion that others dislike him or her may become irritated and behave in ways that turns the distortion into a reality. This new reality then serves to reinforce the cognitive distortions and maladaptive behavior.

    For 20 weeks, the STEPPS group becomes a mini-system in which the trainee receives instruction on new ways of thinking and new behaviors. Trainees receive positive reinforcement in the form of support from group trainers and other group members. The new behaviors are designed to influence the individual’s larger support system so it too begins to reinforce healthy behavior.

    It helps if everyone uses a consistent approach and language. The group has also proved to be a very successful training vehicle for other professionals who have then gone on to start their own STEPPS groups in other locations. STEPPS emphasizes that the trainees can and should take responsibility for taking steps to help key players in their system respond more effectively. Specifically, STEPPS incorporates the following 4 components to address the trainees support system:

    1. Teaching the trainee to challenge cognitive distortions and to develop more realistic expectations about what types of support are appropriate from key players in their support team.

    2. Teaching the trainee a series of strategies for dealing with anxiety, anger, depression, and self-destructive thoughts which can be accomplished either independently or with a level of input from others that the support system can comfortably provide.

    3. Encouraging the trainee to share appropriate sections from their red manual with close friends and significant others (as well as her/his other mental health providers) so that these individuals can better understand the illness, the terminology, and ways of responding to the trainee that reinforce the strategies taught in the STEPPS program.

    4. Offering two special evening sessions in which key members of the support team are invited to come and learn about BPD, how STEPPS works, and what they can do to help. We provide written guidelines that summarize how to respond to the trainee on occasions when the trainee is feeling desperate and out of control.

    Integrating STEPPS With Other Treatments

    Clearly, STEPPS is not a comprehensive treatment program for managing individuals with borderline personality disorder. From it’s inception, STEPPS was designed to be a “value added” treatment intervention which augments rather that replaces the existing network of mental health providers. This approach helps reduce the time and expense needed to set new STEPPS treatment groups. STEPPS has been implemented in a wide variety of settings and is usually well received by other providers who continue to provide mental health services to individuals enrolled in STEPPS

    Clients in the STEPPS program are frequently being treated with one or more psychopharmacologic agents, most often antidepressants and mood stabilizers. The program addresses compliance with medications as prescribed by the client’s physician as an important enabling factor for the group therapy program. Substance abuse is viewed as treatment disabling and clients are required to seek appropriate substance abuse treatment and maintain abstinence either before or concurrently with the STEPPS program. Clients with a severe eating disorder are similarly required to be in an appropriate treatment program.

    Trainers should note that in the development of this treatment approach, the need for traditional individual therapy may be reduced. In fact, a team approach to working with a person with BPD who is familiar with the skills and behavior patterns has been found by Bartels and Crotty to be preferable to an individual approach. The optimal treatment system is one in which, in addition to the weekly skills training, the person with BPD receives skill and behavior pattern reinforcement from all treatment system personnel, family, and friends. This approach encourages the person with BPD to rely on peers, family, and others for reinforcement and reduces the possibility that the person with BPD will focus exclusively on a single therapist who then runs the risk of being alternately over-idealized and devalued by the person with BPD. Those individuals receiving individual therapy are eligible for the STEPPS program provided the therapist agrees to support the program by reviewing the STEPPS materials with the client as they add the lessons to the red notebook each week. We provide several opportunities for professionals, relatives, and significant others to participate in the program. During the 20 weeks, a special evening session is held that also includes professionals, relatives, and significant others. In addition, we have found that the clients are quite willing to have significant others and even their individual therapist attend a regular group meeting, and group members are given permission to bring them to any two sessions following the evening session.

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    Personality disorders: One of the most controversial & misunderstood areas of mental health      By Anthony Bateman Notebook  September, 14 September 2011  

    Ask the average person what they associate with personality disorders and you get a blank stare or description of a human chameleon capable of changing from normality to social menace in the blink of an eye. 

    In reality, the majority of people with a personality disorder are a greater danger to themselves than others, with high rates of self-harm and attempted suicide as a way of managing often turbulent emotions. 

    Most of us recognize our moods and feelings and manage them until they pass, while many people with personality disorders have a tendency to get stuck in these emotional states which increase in intensity, resulting in behaviour that many of us find unusual. 

    These limiting patterns of behaviour and response become engrained like a scratched record, producing great feelings of anxiety and frustration.

    Sadly, public perception of the condition is largely media driven with a succession of sensationalist headlines, films and books. These inevitably focus on people with antisocial personality or psychopathic conditions which are among eleven recognized disorders. 

    There is no doubt that those with severe psychopathic traits are dangerous and prone to criminal activity. This is  through characteristics that include impulsive self centred behaviour that puts their own needs above others. However, they are in a minority and their impact on society is greatly exaggerated and dramatised in all but the most extreme cases. 

    It is somewhat ironic that that the media’s highly manipulative and attention grabbing behaviour itself shows the collective symptoms of a personality disorder. They involve showing signs of extreme behaviours that we all share, which is why we can recognize and identify many of the traits in ourselves – albeit at a less amplified level. 

    An interesting illustration of this was a study by psychotherapists in 2005 that matched the personalities of top British executives with psychiatric patients at Broadmoor Hospital. The results found the two groups had more in common than first expected. This included Histrionic Personality Disorder, whose characteristics include superficial charm and ego-centricity, Narcissistic Personality Disorder, which includes grandiosity and self focused lack of empathy, and Obsessive Compulsive Disorder, reflecting excessive devotion to work, dictatorial tendencies and perfectionism. 

    Of course, this should be taken with a pinch of salt. There are people who can function with personality disorders but they are rare, and the severity of their condition questionable. 

    In reality, diagnosed disorder types have difficulty forming or maintaining relationships, meaning many are isolated by unemployment and have associated conditions such as depression and anxiety.

    So how common are personality disorders? A sensible bench mark is around 1% of the population, with some of these conditions being more common than others, such as Obsessive Compulsive Personality disorder. These individuals become fixated on orderliness, cleanliness and being in control, while those with borderline personality disorder have a poor self image and often experience feelings of emptiness, depression and paranoia. Although I’d be the first to admit that diagnosis isn’t straightforward as the disorders often share overlapping symptoms.

    There has been much debate about the stigmatization of labeling people with conditions, but I have found patients and families often find relief in finding something tangible to get to grips with. 

    Seeing more than 30 patients a week in one-to-one and group sessions, I primarily use one of several ‘talking therapies’ I co-developed called Mentalisation. This teaches patients to become more aware of their own thinking and learn to rationalise, manage and understand their mental states and emotions, as well as those of others. Therapy can take up to two years and the good news is that the majority of patients make a significant or full recovery through a combination of talking therapy treatments like ‘Mentalisation’ and ‘Improvement with Age’. 

    Two of the biggest challenges our profession currently face are: 

    Firstly, discovering an effective way of measuring the severity of personality disorders so we can plan the duration and intensity of treatment and its likely long-term impact on mental health services. 

    Secondly, we have to treat people with these disorders as a matter of course and that calls for greater education and awareness both in and outside the health service. 

    There are still incidences where an as yet undiagnosed patient may turn up at a GP surgery or reception areas of some NHS facility and be told to leave the premises because they are being difficult or aggressive. Staff probably don’t recognize the possibility of an underlying problem and that is something that needs to be more widely addressed so patients can be quickly and effectively signposted to the right service. 

    Greater public awareness and compassion are powerful tools that can be used to give both ourselves and those being treated a greater insight into personality disorders.

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