Anything to Stop the Pain - BPD and Non-BPs

One of the big problems I have seen in meeting people with BPD children is that often the mental health professionals believe that the ONLY cause of BPD is childhood abuse. While 75% of adult female borderlines report childhood abuse (and many sexual abuse), what if those are the only ones that seek treatment? And what of the other 25%? In other words, parents of borderlines - who are confused, angry and scared about the welfare of their children – are often the ones blamed for the disorder by mental health professionals. A good corollary is the reactions of health care workers when someone appears at the hospital with a self-inflicted wound. I have heard reports that the patients are “looked down on” and their treatment is delayed so that “real” cases can be attended to. Rather than dealing with the pain and injury whatever the cause, the self-injured are treated as “head cases” rather than given the care and attention they deserve. The same is true with suicidal people. A person I know was yelled at by the doctors and their family members when the suicide attempt was “over.” Why would one think that a suicide attempt is not serious or, worse, can be dealt with by discipline? Not all suicide attempts are a “cry for help” or a means of getting attention. Sometimes suicide seems like the only way to squelch the pain. The parents of these children (particularly ones that exhibit SIB) are generally confused and saddened. They don’t need the mental health professionals to examine the family situation to find signs of childhood abuse and neglect or to (worse) send in poorly-trained and overworked department of family services workers. Treat the actual disease, not the supposed “root” cause. That doesn’t help the borderline at all.

bon :: Mar.23.2006 :: Treatment, Parenting, Borderline Personality Disorder :: No Comments »

I’d like to talk about “The Borderline Child”. Most professionals would say that the Borderline Child does not exist. I recently spoke with a woman I know who has a daughter who has given her a great deal of trouble. The girl, who is only 14, cuts herself, drinks her own urine, has risky sex, does drugs, has run away from home and exhibited a number of other “borderline” behaviors. When I mentioned the diagnosis to the mother, she spoke with professionals who told her that her child was “too young” to be diagnosed with BPD. OK, so what is the cut-off? This is a quote from an article I found on the net from Psychiatric Times magazine. The article is dated 1996 and is by Joseph M. Rey, M.D.:

Seeking to clarify some of these issues, my colleagues and I followed up a group of adolescents who had been referred for assessment to an adolescent unit in Sydney, Australia (Rey and others). Follow-up consisted of a lengthy interview during which a variety of diagnostic instruments and questionnaires was administered. These included the Personality Disorders Examination (Loranger). At the time of initial assessment, the average age was 14 years, while at follow-up it was 20 years. Of the 205 subjects who were located, 145 were fully interviewed. About half of these (44 percent) were female. During the ensuing six years, four of the subjects had died. One female, initially diagnosed as having attention-deficit disorder with hyperactivity, died of a heroin overdose following a period of severe disturbance during which she probably met criteria for conduct disorder. Two males suffered from conduct disorder. One committed suicide; the other died of multiple organ failure caused by hepatitis one day after being released from prison. One male had an adjustment disorder with disturbance of conduct. Reports from relatives at the time of follow-up suggest he was well-adjusted. He died in a car accident. There were 114 (56 percent) individuals with a disruptive disorder diagnosis among the 205 subjects located. Although numbers are too small to draw conclusions, these findings suggest that mortality (3.5 percent) among adolescents with these conditions is likely to be high.

Putting the mortality rate aside, we find that 56% were diagnosed with a disruptive disorder as children. The point here is that there was something wrong with them as children, although it was not labeled a “personality disorder.” If up to 10% of people with BPD take their own life, then it would seem to me that identifying the candidates for BPD as children would be paramount. If there is a constellation of childhood illnesses – childhood bipolar, ADHD, ODD, CD, etc. – then these children can be monitored to help them develop emotional skills to handle their labile emotional states. Here is a quote from a personal interview with a Borderline:

At about the age of 13. I kept feeling like something was missing in me, like I was “”defective”". My social skills were bad, and there was a growing feeling of a void inside me. I went to the school counselor, but as I could not yet identify what was wrong, was not really helped. At 14 I started to suffer from suicidal thoughts. It has never gone since. It’s always there, like some undercurrent. My parents are emotionally crippled in many ways and they could not help or understand, they would tell me to stop being so sensitive.

http://www.borderlinepersonalitytoday.com/main/interviewc.htm

bon :: Mar.22.2006 :: Parenting, Borderline Personality Disorder :: No Comments »

A funny note from a DBT site:

The therapist is asked to adopt a non-defensive posture towards the patient, to accept that therapists are fallible and that mistakes will at times inevitably be made. Perfect therapy is simply not possible. It needs to be accepted as a working hypothesis that (to use Linehan’s words) “”all therapists are jerks”".

About the responsiblity of the therapist in DBT.http://www.priory.com/dbt.htm

Bon Dobbs :: Mar.22.2006 :: DBT :: No Comments »

Here’s an article about ODD and Conduct Disorder (CD) in children and the correlation to adulthood personality disorders:

Borderline Personality Disorder is called this because patients have many traits from different psychiatric disorders. They have very unstable moods, like bipolar disorder. They often have strange experiences, like people with schizophrenia. Their relationships with others are usually quite unstable. They often don’t have much of a sense of who they really are or where they are going. They often cut themselves. Most of the people with this problem are female. If you have ODD/CD and are female, you have approximately a 15% chance of getting this.

There is also info about Antisocial Personality Disorders. My question is: are these really separate disorders or does emotional dysregulation play a part in all of them? If someone is emotionally volatile it seems to me that they will act out in different ways depending on the emotion they feel most often - anger, sadness or guilt/shame. So, all these different “”disorders”" - ODD, CD, ADD, BPD, APD and others - are they really the same disorder (emotional dysregulation) exhibiting itself in different forms?http://www.klis.com/chandler/pamphlet/oddcd/oddcdpamphlet.htm

bon :: Mar.21.2006 :: Other Disorders, Anger :: No Comments »

This is a quote from “Decartes’ Error” by Antonio Damasio:

The distinction between diseases of the “brain” and the “mind”, between “neurological” problems and “psychological” or “psychiatric” ones, is an unfortunate cultural inheritance that permeates society and medicine. It reflects a basic ignorance of the relation between brain and mind. Diseases of the brain are seen as tradgedies visited on people who cannot be blamed for their conditions, while diseases of the mind, especially those that affect conduct and emotion, are seen as social inconveniences for which sufferers have much to answer. Individuals are to be blamed for their character flaws, defective emotional modulation, ans so on; lack of willpower is supposed to be the primary problem.

This statement seems to sum up much of the attitudes of “nons” (including therapists) with respect to BPD. Damasio goes on to show strong relationships between brain function and mind states.

Labels: biology, BPD

Bon Dobbs :: Mar.11.2006 :: Biology, Borderline Personality Disorder :: No Comments »

The Publisher’s Weekly review of Diana in Search of Herself : Portrait of a Troubled Princess by Sally Bedell Smith:

Devotees who remember Princess Diana as a beautiful, warm-hearted mother dedicated to good works, whom an adulterous husband and the British Royal family unfairly victimized, will find little comfort in this treatment of her life. Smith relentlessly but convincingly portrays Diana as a woman with severe psychological problems (characterized here as a “”borderline personality”") who never overcame a serious eating disorder and was unable to sustain relationships. Based on research and interviews with Diana’s friends, Smith (Reflected Glory: The Life of Pamela Harriman) carefully presents Diana’s childhood as darkened by divorce and neglect, leaving Diana with deep feelings of unworthiness; by the time of her marriage she was, Smith contends, not only a bulimic but also a pathological liar. According to Smith, Prince Charles had completely severed relations with Camilla Parker-Bowles out of determination to make his marriage work, and did not revive his affair with her until the relationship with his wife fell apart. Diana, certain that Charles was still seeing Camilla from the date of their wedding, retaliated with a series of tawdry romances, and also engaged in self-mutilation, binge eating and other erratic behaviors that alienated Charles. Though Smith acknowledges that the princess dearly loved her sons, she also describes occasions when Diana placed emotional demands on them that they were too young to handle. This is a sharply etched and engrossing study of an insecure and emotionally damaged woman coming apart at the seams.

Buy the book from Amazon by clicking here: Diana in Search of Herselfhttp://www.amazon.com/exec/obidos/ASIN/0812930304/permanenthoneymo/102-7417918-4008965

bon :: Mar.09.2006 :: Celebrities, Borderline Personality Disorder :: No Comments »

Can BPD be inherited? Here’s an article on the biological aspects of BPD.

Genetic studies of monozygotic and dizygotic twins suggest that there may be genetic factors for these dimensions of emotional reactivity and impulsive aggression, while there does not appear to be a heritability for BPD as a category. Family members of BPD patients are more likely to demonstrate affective instability or impulsivity, although not necessarily both. Impulsivity and aggression seem to be heritable in studies of normal twins as well. It is noteworthy that in the studies of prolactin responses to fenfluramine, blunted prolactin response to fenfluramine in a patient is a better predictor of impulsivity and aggression in their relatives than was impulsive aggression as a behavior in itself in the patient. These results would suggest that what is inherited is not the behavior, but an alteration in the serotonergic system that may at times be expressed in a propensity to impulsive aggression.

So, according to this article, it’s not BPD that’s inherited, only the traits of BPD (impulsive aggresion). On a personal note, I have twins (dizygotic or fraternal) and one seems to have the emotionality and impulse control issues, the other does not.http://www.mhsanctuary.com/borderline/siever.htm

bon :: Mar.08.2006 :: Biology :: No Comments »

Although this site is not an introduction to Borderline Personality Disorder, and I am not a doctor or therapist, I thought it might be helpful to look at the DSM-IV diagnosis criteria. If you have 5 of these 9, you are considered a borderline:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 3. identity disturbance: markedly and persistently unstable self-image or sense of self 4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) 7. chronic feelings of emptiness 8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9. transient, stress-related paranoid ideation or severe dissociative symptoms

To me, this seems sort of weird, because there would be hundreds, if not thousands, of flavors of BPD.http://www.fortunecity.com/campus/psychology/781/bpd-dsm.htm

bon :: Mar.08.2006 :: Treatment, Borderline Personality Disorder :: No Comments »

Article on the paradox at the center of Borderline Personality Disorder:

It is the acceptance of the paradoxical irony that is the very nature of Borderline Personality Disorder (BPD) that is at the epicenter of recovery. Paradox exists within the center of contradiction. The apparent contradiction for those with BPD is found in the reality that what is understood and perceived borderline reality is not in essence real in the here and now. Rather, what is perceived and/or experienced in distorted ways now is really the dissociative re-experiencing of past traumatic events. In the active throes of BPD, borderlines, more often than not, are unaware of this. The inability to distinguish between the past and the here and now in times of triggered regressive dissociation is the root of the irony. This irony is housed within the borderline incongruity between what might be expected (or what one erroneously misperceives as unfolding) and what actually is occurring.

The notion that Borderlines have a difficulty with time and memory is interesting.http://www.borderlinepersonality.ca/borderparadoxepicenterrecovery.htm

Bon Dobbs :: Mar.08.2006 :: Borderline Personality Disorder :: No Comments »