"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
Statement 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 bad it can really get.
I slowly
realized the need for
researching and designing a website of this topic in May
of 2009; this website'smain 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 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 allabout 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
Borderline Personality Disorder Webquest, this site
comes up as #1, #2, #3, #7, and
Amy Allison on Borderline Personality Disorder
Webquest search yields results #1-10 in the search results.
No kidding. 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
over 7 years, I have discovered that there are many, mnay
therapies that are being accepted and widely used to
treat BPD, with amazing successes! 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 Topwill keep you coming back. Keep
coming back.
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.
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
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)
Amygdala & Emotional Intelligence (5-19-11)
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?"
(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.
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)
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.
.
We need to increase public awareness
about BPD. It can be fatal.
Welcome, you have
come to the right place if BPD is somewhere in your
life.
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)
Dr. Marsha Linehan Linked page devoted to Dr. Linehan
(6-24-11) Faculty ofUniv. 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
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
(BASEencompasses 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.
For Non-BPD's
An entire page for you* (Updated 5-25-11)
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)
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.
(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
linkto my article there. I invite you to read it.
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
"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.
(8-27-10)
"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)
"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.
"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.
"I Hate You Don't Leave Me"
by Jerold J.
Kreismanis 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.
Contact Lense Buy discount contact lenses online at euroLens.co.uk. We carry all major brands as well as hard-to-find specialty lenses. Over 1 million lenses in stock.
The
Experience Project website(2-3-12)
BPD
blog
New York Times BPD
blog
Anonymous Blog of a
real-life Borderlineas it
happens I
have gotten permission to follow a BPD's
Journey of Recovery in a personal blog on
Blogger.com. (7-14-09)
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.
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.
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.
. 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.
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.
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.
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.
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.
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.
Holidays or any major
interruption to a Borderline's
daily patterns can be disruptive
and disconcerting.
11-26-09
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.
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.
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.
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.
The Suicide Rate for Borderlines is 60 times that
of the general population.
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.
Back to
Top
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%).
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 Stats
(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 onlyfrom 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 onlyfrom 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.
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.
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.
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.
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.
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.
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.
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")
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.
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
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.
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."
Borderline
Personality
Disorder
Caused
by
Genetic
Material
on
Chromosone
9
Written on June 10, 2009 by Dr. Giuseppe Spezzano C. Psych. in Mental Health
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.
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.
(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.
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
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.
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.
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.
Complications of BPDfrom 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.
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
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.
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:
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.
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.
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.
)
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.
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.