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In theory there is no difference between theory and practice. In practice there is.
-Yogi Berra


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Xanax + Borderline Personality Disorder (BPD) = Serious Dyscontrol

Those receiving alprazolam (Xanax) had an increase in the severity of the episodes of serious dyscontrol.

Pharmacotherapy of Borderline Personality Disorder
Alprazolam, Carbamazepine, Trifluoperazine, and Tranylcypromine
Rex William Cowdry, MD; David L. Gardner, MD

Sixteen female outpatients with borderline personality disorder and prominent behavioral dyscontrol, but without a current episode of major depression, were studied in a doubleblind, crossover trial of placebo and the following four active medications: alprazolam (average dose, 4.7 mg/d); carbamazepine (average dose, 820 mg/d); trifluoperazine hydrochloride (average dose, 7.8 mg/d); and tranylcypromine sulfate (average dose, 40 mg/d). Each trial was designed to last six weeks. Tranylcypromine and carbamazepine trials had the highest completion rates. Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol. As an adjunct to psychotherapy, pharmacotherapy can produce modest but clinically important improvement in the mood and behavior of patients with borderline personality disorder. As a research tool, patterns of pharmacological response may provide clues to biological mechanisms underlying dysphoria and behavioral dyscontrol.

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Ask a Psychiatrist: How Does Silver Linings Playbook Handle Mental Illness?

Ask a Psychiatrist: How Does Silver Linings Playbook Handle Mental Illness?

By Gwynne Watkins

It’s to be expected that one (or both) of a romantic comedy’s protagonists will go a little crazy in some way. Silver Linings Playbook takes things a step further: Bradley Cooper’s character, Pat, is newly released from a mental hospital, and his romantic foil Tiffany (played by Jennifer Lawrence) is battling her own demons. Neither, however, has the typical Hollywood version of mental illness, i.e. “My second personality is a prostitute with a Cockney accent!”
Pat’s bipolar disorder and Tiffany’s unnamed condition manifest themselves in ways that are realistically, even heartbreakingly mundane; Tiffany texts relative strangers for booty calls when she gets depressed, and Pat channels his mania into long jogs and rants about Hemingway. Yet the film has generated controversy among some reviewers about its portrayal of mental illness. Do the characters get off too easily, their symptoms falling by the wayside as soon as they find one another? Does the film imply that Pat’s medication was doing him more harm than good? Seeking a professional opinion, Vulture consulted with Harvard Medical School psychiatrist Dr. Steven Schlozman. He loved the film.

We know that Jennifer Lawrence’s character, Tiffany, has been on meds, but we don’t actually get a diagnosis. What was your take on her from a psychiatric perspective?

It’s hard not to see that character and wonder a little about borderline personality disorder for her. I think we’re probably supposed to think that, and then we’re supposed to feel bad about thinking that after we hear her history — which is silly, because people are allowed to have horrible histories and people are allowed to have borderline personality disorder, and there’s nothing wrong with either of those things.

So she’s had a significant response to a pretty awful trauma, the death of her husband. But she wasn’t doing well even before then, because we know she said, “Look, I can barely take care of myself.” And we don’t know whether those medications she talked about being on actually predated or came after that trauma. We can make the assumption that there’s depression, because someone put her on Effexor, which is an antidepressant. But you can have both: You can have depression and borderline personality disorder. I guess I’d be most comfortable just saying: She’s not doing well.

So her symptoms seem plausible: the promiscuity, the mood swings, the lying.

Oh yeah. What was frustrating to me as a watcher of the movie is, since she’s basically a foil for Pat’s character development, you don’t see her develop a whole lot. I think her life’s more complicated than she’s leading on. So she’s not out of the woods yet. I’d actually worry a little bit more about her than about him.

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Silver Linings Playbook (Amazon Instant Video)

Director: David O. Russell
Starring: Bradley Cooper, Jennifer Lawrence, Robert De Niro, Jacki Weaver, Chris Tucker
Rating: R (Restricted)

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How I escaped suicidal depression

I had two alternatives. One was to kill myself, to end my struggle. The other was to find something rigorous and unorthodox to conquer this depression.

How I escaped suicidal depression
‘I had two alternatives. One was to kill myself.’

By Leslie Contreras Schwartz, special to the Houston Chronicle November 17, 2014

“You will mostly likely have several suicide attempts in the future,” the psychiatrist said, sitting across from me in carefully crossed ankles.

“And you will have severe clinical depression the rest of your life.” With a closed-lip smile, she closed my enormous patient file on her lap. “You must take medication the rest of your life. You have no choice.”

Since my freshman year in college, I had been confronted with overwhelming sadness. Except for a few close friends, I was socially isolated, and the more lonely I felt, the worse my depression became. I was self-admitted to a psychiatric hospital for a week my sophomore year, which made my outlook on life even worse and my emotions more numb.

After five years, I had tried dozens of psychiatratric medications with the hope that I would get better: among them, Wellbutrin, Prozac, Effexor, and Celexa. Nothing seemed to work, and I lived my life for the next ten years in a flux of anxiety or depressive lulls where it was hard to get out of bed, to carry out a semi-functioning writing career. I was told I had Borderline Personality Disorder, and was doomed to live a repetitive life of mistakes.

Through my course of therapy, help groups, and chance meetings, I met women of all ages, all of different socioeconomic backgrounds, races and religions with the same story: We were severely, secretly depressed and nothing was helping. I met lawyers, women with high-powered jobs, and high school dropouts, women who had a never held a job, adult women who lived with their parents. We are everywhere, hiding behind the secretaries’ desks, in the classroom, leading a board meeting, standing in front of you with a full set of makeup and a smile.

Therapists tried to help me, as they do a lot of women, of course, through talk therapy and rehashing the past or looking at specific issues and trying to change stubborn ways of thinking. But in 2010 I was done with depression and done with methods that weren’t helping — I just wasn’t changing.

I had two alternatives. One was to kill myself, to end my struggle. The other was to find something rigorous and unorthodox to conquer this depression. I was now married, with a one-year-old daughter. I remember the moment: I was on the bathroom floor with a bottle of aspirin, crying, while my husband begged for me to open the door.

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An important comment from a reader about safety and BPD

Here’s a comment from one of my readers regarding safety and BPD. I was planning on writing about this at some point because the core issue seems to be safety and a sense of well being.

People suffering from borderline personality disorder, through no fault of their own, have no sense of safety within themselves, so are on a constant search for any form of safety from external sources. Unfortunately, and ironically, the ‘safety’ they have experienced in the past has been found in crises.They therefore feel ‘comfortable’ and safe in the midst of a crisis, whether this is in a relationship setting or any other. So they rebound continually from one crisis to another, feeling ‘safe’ in the moment of this unfortunate familiarity, seemingly ignorant of the stress and strain they are putting not only on their own well-being and recovery, but also on others close to them.They become stuck in this spiral and it is the most difficult of all achievements to spin themselves right out of it, as anything outside of this spiral is extremely threatening and unsafe, to them.


The Scarlet Label: Close Encounters with ‘Borderline Personality Disorder’

If so-called ‘borderline personality disorder’ symptoms are really responses to an unpredictable and perhaps unsafe environment then the real shame of it is that we are stigmatizing people that disclose the pain of our human world. We are judging people who have sensitive dispositions and absorb the world around them; people who are essentially struggling with basic life issues. And as a system – the mental health system – that sort of prides itself on exploring human behavior without judgment, this is a failure — not on our client’s part, but on the part of professionals and systems that are supposed to be caring for them.

The Scarlet Label: Close Encounters with ‘Borderline Personality Disorder’

Jacqueline Simon Gunn, Psy.D.and
Brent Potter, Ph.D.

October 22, 2014

To help my non-recovery oriented colleagues understand the stigma/resentment associated with ‘borderline personality disorder,’ I simply mention this: “Let’s say I call you and say, ‘Hey, I’ve got a referral for you. She’s been diagnosed with borderline personality disorder . . .’” I need to go no further; without fail, my colleague will smile or laugh. We both know that such a referral is a no-no, so much so that it doesn’t even have to be mentioned; it is a given.

Irvin Yalom, at a recent APA division conference, was asked if he continues to work with clients. He responded with something to the effect of, “Well I am not taking any borderline clients.” The audience exploded with laughter. From celebrity to average clinician, it is known that ‘borderline’ people are to be avoided. But wait, it’s not just professionals in the field. A simple Google search for ‘borderline personality disorder’ gets more than 248,000 hits. There are countless best-sellers on Amazon dealing specifically with the ‘disorder.’ The vast majority of the books out there, as a matter of fact, aren’t even for clinicians. Most of them are about how to live with (or otherwise be with) someone afflicted, or how to accept that you’re the one with the disease and how to get proper professional help.

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The patterns of behavior of those with borderline personality disorder (BPD) are often frustrating and mystifying to both clinicians and family members, despite several decades of study and research on this form of distress. Borderline Personality Disorder: New Perspectives on a Stigmatizing and Overused Diagnosis presents a thorough critical and historical review of the diagnosis of BPD and explores—through academic and clinical narratives—the different processes that occur in borderline behavior patterns.

The authors offer new perspectives that emphasize the whole person rather than a diagnosis, addressing the emotional storms and mood instability of BPD, providing guidance on managing emotional chaos in the therapeutic relationship, and explaining how to use one's own feelings as a clinical tool. Their approach gives an intimate experiential feel for the interpersonal processes that occur in psychotherapy for both the patient and therapist. The result: readers will better understand who the person behind the diagnosis is, and comprehend what it really feels like to be someone struggling with these difficult interpersonal patterns.

List Price: $37.00 USD
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Child of Parent with BPD?

Inability to express or regulate emotions, difficulties establishing and maintaining relationships, and feelings of guilt, shame and emptiness were also noted among children of parents with borderline personality disorder.

Understanding the impact of parents’ mental illness

Research from the University of Adelaide has found that the children of parents suffering from an emotionally unstable form of personality disorder are at risk of developing behavioural and emotional issues – but the children can also be protected from experiencing similar difficulties to their parents.

For her PhD research, Dianna Bartsch in the University’s School of Psychology has surveyed clinicians who work with parents who have been diagnosed with borderline personality disorder (BPD) and their families.

BPD is a mental illness that affects approximately 1-2% of people in the general population. It is categorised by difficulty managing emotions, impulsive and self-harming behaviour, intense and unstable relationships, chronic feelings of emptiness, stress-related paranoia and other symptoms.

In a paper published in the journal Personality and Mental Health, Mrs Bartsch says clinicians have identified a number of potential impacts on children whose parents suffer from BPD.

“The most frequently cited issues for children are behavioural problems – which may include impulsive and in some cases self-destructive behaviour – and situations where the child takes on a parental role,” Mrs Bartsch says.

“Inability to express or regulate emotions, difficulties establishing and maintaining relationships, and feelings of guilt, shame and emptiness were also noted among children of parents with borderline personality disorder.

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