ADHD was not the largest risk factor for SUD. Instead, when she controlled for both ADHD and BPD, Torok found that CD posed the biggest risk for future drug abuse in the participants.
Conduct Disorder Predicts Drug Use in Adults With ADHD (link)
April 17, 2012 @ 3:58 PM
Attention-deficit hyperactivity disorder (ADHD) has been linked to many negative outcomes. Usually first diagnosed in childhood, ADHD is characterized by impulsivity and inability to focus on tasks. Until recently, it was believed that ADHD did not widely persist into adulthood. However, new research has shown that many individuals still struggle with the symptoms of ADHD through their adult lives.
Participate in a Dialectical Behavior Therapy (DBT) group, where one is taught the four effective stress-reducing skills of distress tolerance, mindfulness, emotion regulation and interpersonal effectiveness. You will learn to cope better.
Let’s face it: We all get stressed sometimes, but why does stress seem to affect some people more than others? Would you say that:
» Others know what they are doing and you feel like you don’t?
» Others don’t seem to be bothered by life’s little “zings?”
» Others are moving toward something positive or away from something negative and you are stuck?
» Others have unconditional faith and you just feel lost?
» Others been able to desensitize themselves to repeated stressors and you always seem to get knocked over by them?
But let’s pose another question: Do you practice getting a daily balance of rest and exercise, ensure good nutrition and take time to take care of yourself?
These sound like great clues as to how others seem to manage so effortlessly. How can we gain the same advantage that others have and add these benefits to our lives?Let’s look at some of the practices used by individuals who are able to manage their stress levels. Many of these skills can be learned on your own; others may need the help of a professional.
Set daily goals for yourself and make sure to prioritize. Be realistic and make sure these are reasonable goals you can accomplish without adding additional stress to your day.
Make good choices. Think about the pros and cons before you make a decision. Don’t act impulsively; you have to pay for it in the end.
Take time every day for relaxation, guided imagery or meditation. Take the time for “me” — the most important person in your life.
Practice mindfulness, which is the art of living in the present moment without any judgment towards yourself. Mindfulness assists us in teaching our minds to stay focused in the present and reduce the “what ifs” that so often dominate our thoughts. Sound easy? Practice for a few minutes and gradually increase the length of time you can manage this technique. You will be amazed at how quickly stress can be managed using this skill. Continue reading When it’s all about your feelings and what you can do →
Mentalization-based Treatment for Families (MBT-F) is for parents of children between the ages of seven and 16 experiencing difficulties in the parent/child relationship.
Mentalization-based Treatment for Families (MBT-F) (Detailed)
Name of intervention:
Mentalization-based Treatment for Families (MBT-F)
Who is the programme for?:
Families experiencing relationship difficulties because of child emotional or behavioural difficulties.
Mentalization-based Treatment for Families (MBT-F) is for parents of children between the ages of seven and 16 experiencing difficulties in the parent/child relationship. Parents attend 10 to 12 fortnightly individual sessions where they learn how to understand their child’s mental states and support his or her emotional wellbeing.
MBT-F has preliminary evidence of improving children’s behaviour.
About 2 weeks ago, I got another 1 star review on Amazon for my book When Hope is Not Enough. When I read that review, I realized that many people don’t understand my book well. Perhaps it’s my writing or perhaps it’s in their reading. I certainly know that my book will not just tell you what you want to hear about your loved one with borderline personality disorder (BPD). If you want to be validated and hear what you’d like to hear about being a victim of someone with BPD, I’d suggest you read Stop Walking on Eggshells. That was the book I read at the beginning of the realization that my wife had BPD. It’s a really good book for Non-BPDs who are angry and looking to be vindicated for the behavior of their borderline. It’s not such a good book if you’re determined to stay with your partner or if you have to parent someone with BPD. My book is not for a person that needs to be right more than they wish to be effective.
One thing I have been saying a lot around here and in my Internet group is: “I don’t excuse behavior. I try to explain behavior.” This is where the notion that emotional dysregulation and “it’s all about his/her feelings” (IAAHF) with which the critics of my techniques have such a problem. The thing is: these critics don’t understand that when they pick up my book, those two things explain why someone with BPD would behave in the manner that they do. Emotional dysregulation is the hallmark of the disorder. Marsha Linehan has even tried to have the name of the disorder changed to something like “Emotional Regulation Disorder”. So, emotional dysregulation is not an excuse. It’s just the way these people are. They have poor emotional regulation skills. I think it’s better to know what you’re dealing with rather than to not accept it and try to fit reality into your view of how things are supposed to be.
As for IAAHF, many of my critics point to that and say “What about MY feelings!!!!” The intention of IAAHF has nothing to do with the overall relationship or about your emotional health and well-being. IAAHF helps explain the motivation behind the behavior. That is, the behavior is motivated by this person’s emotional responses to the world around them. I don’t recommend “walking on eggshells” to avoid triggers. What I recommend is that you get a clearer view of what is the cause of the behavior (the dysregulated emotions) and work on that. In my experience, if the emotions are not there, the behavior is not there.
Dr. Marsha M. Linehan, an expert in the treatment of suicidal behaviors, personality disorders – including eating disorders – and other complex mental disorders, has been selected as the recipient of the 2012 Joan and Stanford Alexander Award in Psychiatry.
Psychiatry award recipient to present lecture on dialectical behavior therapy (link)
HOUSTON — (April 17, 2012) — Dr. Marsha M. Linehan, an expert in the treatment of suicidal behaviors, personality disorders – including eating disorders – and other complex mental disorders, has been selected as the recipient of the 2012 Joan and Stanford Alexander Award in Psychiatry.
The award was established in honor of Dr. Stuart Yudofsky, professor and chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, who was also its first recipient.
Each year, the award honors a mental health professional who has made significant contributions in research, education and clinical or community service for people suffering from severe and persistent mental illness. The award consists of an annual prize and lecture of international scope. Previous winners have included psychiatrists Eric Kandel, winner of the Nobel Prize in Medicine, and Nora Volkow, director of the National Institute of Drug Abuse.
Linehan will receive the award and present grand rounds on Wednesday, April 25, at 10:30 a.m. in BCM’s Cullen Auditorium. Her lecture is titled “Dialectical Behavior Therapy: Where it started. Where it went. Where it may be now. Where we are going.”
Linehan is professor of psychology and director of the Behavioral Research and Therapy Clinics at the University of Washington. She developed dialectical behavior therapy – a treatment originally developed for treating suicidal behaviors that has expanded to treating borderline personality disorder and other severe and complex mental disorders. The treatment has been shown to be effective in reducing suicidal behavior and is cost-effective compared to both standard and community treatments delivered by expert therapists.
She has received several awards for her clinical and research contributions to the study and treatment of suicidal behaviors, including the Louis I. Dublin Award for Lifetime Achievement in the Field of Suicide and the Distinguished Research in Suicide Award from the American Foundation of Suicide Prevention. The American Association of Suicidology established the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behaviors in her honor.
Joan and Stanford Alexander are pioneer advocates for providing parity in the reimbursements for psychiatric care for the mentally ill and work to fight the effects of stigma on those who suffer from mental illness.
Dr. Sharp and her colleagues worked with 111 teenagers ages 11 to 17 years old, who were being treated in a residential psychiatric facility and tested them for the way they “mentalize.” Mentalize is a technical term that means to act like an armchair psychiatrist in order to understand why others behave the way they do and to predict their future behaviors.
One Way to Identify Borderline Personality Disorder Is by Testing “Mentalization” Skills (link)
Borderline personality disorder probably shows up before adulthood, and now a new study has found a way to detect it in teenagers.
The conventional thinking is to diagnose personality disorders only in adults over age 18 years old, because the human personality is still forming in adolescence. However, Dr. Carla Sharp, an associate professor and director of the Developmental Psychopathology Lab at the University of Houston, believes there could be benefits to diagnosing the disorder she studies earlier.
Dr. Sharp’s specialty is borderline personality disorder, a serious condition characterized by turbulent emotional reactions, impulsive behaviors, anxiety, depression, suicidal ideation, and intense fears of abandonment. The disorder is more frequently found in women.
“We know that the brain is only fully developed by age 25, so how can we diagnose a personality disorder in someone if they don’t have a fully developed brain?” she said. “On the one hand, we are finding in our research that kids do have a stable pattern of interaction with others. Parents will describe their kids to you in terms that remain stable over time. Therefore, personality researchers have highlighted the point that teens do not wake up at age 19 and have a personality disorder on the first day of their 19th year, so there must be some precursors to the disorders. This group of people, including myself, are advocating that we do not necessarily diagnose borderline personality disorder in adolescents, but that we access for it to make sure that we don’t miss these children.”
Dr. Sharp and her colleagues worked with 111 teenagers ages 11 to 17 years old, who were being treated in a residential psychiatric facility and tested them for the way they “mentalize.” Mentalize is a technical term that means to act like an armchair psychiatrist in order to understand why others behave the way they do and to predict their future behaviors. Everyone mentalizes about other people based on their own experiences as human beings, but there is such a thing as normal mentalization as performed by healthy personalities. People with autism usually under-mentalize, which means they do not or cannot put a normal effort into understanding others’ feelings, motivations, and behaviors. People with borderline personality disorder, on the other hand, tend to over-mentalize or even hyper-mentalize, which means they think too much about others and are therefore more likely to misread other people. Since borderline personality disorder is characterized by an inability to regulate one’s own emotions, misreading other people can lead to a borderline’s “flying off the handle” and overreacting.
Dr. Sharp had the participants watch a movie about four different characters and then relate how they understood the characters’ thinking and feeling. About 23% of the participants met the criteria for borderline personality, and this group had a higher frequency of over-mentalizing their responses to questions about the movie. Hyper-mentalization was also linked to emotional regulation. When this group hyper-mentalized and then misread people, they became upset, had more problems with emotional regulation, and experienced an increase in their symptoms.
“This research is groundbreaking in that it is the first to provide empirical evidence of a link between borderline personality disorder and mentalizing in adolescents,” said Dr. Sharp. “By identifying and treating BPD early in adolescence, we can use validated treatments to help these children. The danger of not recognizing precursors in adolescents is that it can lead to years of confusion and pain for family members and the individual with misdiagnosis and lack of appropriate treatment.”
Borderline personality disorder, especially in young people, is often misdiagnosed as bipolar disorder, conduct disorder, or even as Asperger’s syndrome.
The study was published in the Journal of the American Academy of Child and Adolescent Psychiatry.
When Melodie Moore was recovering from a broken heart and wondering why her relationship had soured, Dr. Google had the answer: borderline personality disorder.
Internet advice is not meant to replace healthcare provider: doctor (link)
By: Alexandra Posadzki, The Canadian Press
15/03/2012 3:56 PM | Comments: 0
TORONTO – When Melodie Moore was recovering from a broken heart and wondering why her relationship had soured, Dr. Google had the answer: borderline personality disorder.
“I wanted to know what was wrong with me, that this boy didn’t want to be with me,” said the 22-year-old from Markham, Ont. Soon she had diagnosed herself with several ailments, including BPD and narcissistic personality disorder.
“I think I cried for a good hour,” said Moore. “I just felt really alone.”
Moore was reading about personality disorders in preparation for her psychology studies. She hopes to begin an undergraduate degree at Trent University this fall.
“We live in the information age, but information can be a catch-22,” said Moore. “It can be helpful, but the analytical side of us can also over-think things.”
Moore is experiencing what Oakville psychiatrist Dr. Kenny Handelman calls “medical school syndrome.” It’s what happens to first-year med student when they start studying various diseases. Suddenly a simple headache becomes a brain tumour, a rash morphs into flesh-eating disease. Continue reading Internet advice is not meant to replace healthcare provider: doctor →
The present study demonstrates that narrative exposure therapy (NET) can within weeks achieve a marked improvement in borderline patients with comorbid PTSD.
Bon: I’ve never heard of this therapy….
Narrative exposure therapy can be used with BPD patients in a standard clinical setting (link)
Published on March 30, 2012 at 4:39 AM
An investigation published in the current issue of Psychotherapy and Psychosomatics introduces a new treatment for borderline personality disorder (BPD) that ensues after a traumatic stress.
The present study demonstrates that narrative exposure therapy (NET) can within weeks achieve a marked improvement in borderline patients with comorbid PTSD, even under the often less than ideal conditions in a psychiatric ward. NET can be used with borderline patients in a standard clinical setting (out- and inpatient).
Whereas BPD is already characterized by a high rate of psychiatric problems, current evaluations indicate that the frequency of comorbid posttraumatic stress disorder (PTSD) ranges between 33 and 61% among patients with BPD. When there is comorbid PTSD, BPD symptoms are potentially intensified by the related anxiety, hyperarousal and intrusions, triggering sudden, uncontrollable and incomprehensible attacks of tension and fear. This prompts a vicious circle of uncontrollable swings in tension and dysfunctional behavioral patterns (e.g. self-inflicted pain and injuries), which in turn makes it impossible to modify maladaptive core beliefs. The present approach sought to test the feasibility of narrative exposure therapy (NET), a trauma-focused therapy suitable for both in- and outpatient settings which can be taught to clinically experienced therapists in a short-term training program and implemented in a comprehensive treatment for BPD patients with comorbid PTSD. Within an open trial, 10 women with BPD and comorbid PTSD were treated at the Center of Integrative Psychiatry in Kiel using NET. NET is a standardized, controlled short-term intervention which is based on the core assumption that a maladaptive trauma related network of memory representations has resulted from multiple adverse and fearful experiences. NET is now considered to be a comparatively well-tested therapy approach for patients who have survived different types of trauma, ranging from domestic violence and emotional neglect to organized violence. It aims primarily at reducing PTSD symptoms by changing associative memory related to the traumatic experiences through recall of the event and exposure, assigning each event the respective time and place at which it had been experienced. This promotes a coherent autobiographical memory associated with the sensory, affective and cognitive cues of the event, and in addition has non dissociative effects. During the period between January 2009 and May 2010, 12 women presenting with BPD and comorbid PTSD were recruited from a clinic. Prior to treatment, a diagnosis was reached by conducting a standardized and structured clinical interview based on the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. After the initial diagnosis, the Posttraumatic Stress Diagnostic Scale (PDS) was applied as an interview. This instrument records PTSD symptoms in accordance with the DSM-IV. Depression symptoms were assessed by clinician ratings using the Hamilton Depression Rating Scale (HAM-D), as well as by means of the Hopkins Symptom Checklist 25 (HSCL- 25). The severity of BPD symptoms was evaluated by self- assessment with the aid of a short version of the Borderline Symptom List 23 (BSL-23), and dissociative symptoms were recorded by means of the Fragebogen zu dissoziativen Symptomen (FDS).
Overall, it was possible to carry out NET for all patients. On average, 14 NET sessions (range: 11-19 sessions) were necessary, taking into account that the number of sessions depends on the amount and severity of traumatic events. Based on Wilcoxon tests, there was a significant reduction in symptoms of PTSD (p<0.05) as assessed by the PDS, depression (p<0.05) as assessed using the HAM-D, and dissociation as assessed by the FDS (p<0.05). With respect to BPD symptoms, recorded using the BSL-23, the noted drop would become significant if an α level of 0.10 were used. So far, the present study has demonstrated the feasibility of NET, in that a team of clinicians (psychologists and psychiatrists) who has received a 2-day training in NET, as well as subsequent group supervision, can within weeks achieve a marked improvement in borderline patients with comorbid PTSD using NET as a treatment module, even under the often less than ideal conditions in a psychiatric ward. Thus, the findings of this study demonstrate that NET can be used with borderline patients in a standard clinical setting (out- and inpatient).
I had been insecure about the way I looked at 20; now that I was pushing 40, I could only imagine how my slow physical decline would impact my already fragile self-esteem. I was scared—really scared. I had my addiction under control (as under control as I could have it) but my borderline personality disorder, my body dysmorphic disorder and my depression were taking a toll.
I had three-and-a-half years sober when I tried to kill myself by overdosing on Phenobarbital. It was the 4th of July and I’d joke later that I was still so torn up by the split of America from England that I couldn’t take it anymore. But at the time there was nothing funny or patriotic about it.
I had tried to kill myself once before, when I was 34 and living in London, by slashing my wrists with a box cutter. It was terrifying: blood was pouring everywhere and I could see the muscles and tendons and flesh inside. In my experience, the British healthcare system—especially mental healthcare—leaves something to be desired: all they did was sew me shut, give me a tetanus shot and send me on my way.
But this time was different. I was in living in Los Angeles, and I’d been to a meeting that very day. I had called my sponsor. I had sponsees. I was performing regularly as a comic and getting good reviews. And yet I still felt that deep despair—I hated myself and worried that my husband hated me too. I had been insecure about the way I looked at 20; now that I was pushing 40, I could only imagine how my slow physical decline would impact my already fragile self-esteem. I was scared—really scared. I had my addiction under control (as under control as I could have it) but my borderline personality disorder, my body dysmorphic disorder and my depression were taking a toll. I was tired of fighting to feel “normal.” I wanted out, but I was scared to pick up drugs again. My drinking and using always landed me quickly in the ER or jail. I knew that wasn’t the answer, but what was?
The paradigm for modern psychiatry is evidence-based medicine (EBM)—it represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence-based treatments too often are ineffective.
Does Evidence-Based Medicine Discourage Richer Assessment of Psychopathology and Treatment? (link)
By Simon Sobo, MD | April 5, 2012
Dr Sobo practices psychiatry in Northwestern Connecticut. Many of his other articles can be found at his Web site, www.simonsobo.com.
The paradigm for modern psychiatry is evidence-based medicine (EBM)—it represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence-based treatments too often are ineffective. Even with treatment compliance, many patients do not return to their premorbid selves. Their ailment may last for years. A given percentage is not helped at all. Typically, 30% to 50% of depressed patients will not respond, and among nonresponders only 23.5% to 28% are helped by a second medication.1-4 The relatively common failure of evidence-based treatments to achieve remission is not unique to depression. Similar results are found throughout the full spectrum of DSM-IV disorders, which frustrates both doctors and patients.
This is not surprising. The science of psychiatry is still young, its conclusions necessarily preliminary. Psychiatry has not found its penicillin, a drug that will succeed 99% of the time in eliminating strep throat, because it kills the germ causing the illness. DSM-IV diagnoses are operational definitions, the best attempt by committees of experts to group manifestations of psychopathology into “disorders.” This cataloguing is not the same thing as understanding cause and effect. We haven’t yet discovered the etiology of any DSM-IV diagnosis. Continue reading Does Evidence-Based Medicine Discourage Richer Assessment of Psychopathology and Treatment? →
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