Anything to Stop the Pain - BPD and Non-BPs

An ex-member of my Google email list sent me a message telling me that the media is reporting that K-Fed’s attorneys are saying that Britney Spears has “some sort of bipolar disorder.” Some sort? Sounds like Bipolar II or Borderline to me. Recently, one publication told the media to “stop diagnosing her!” OK, well… at my daughter’s therapist last Monday, Time magazine mentioned Borderline in a sidebar called ” What’s wrong with Britney?” (or something like that). More updates soon…

Bon Dobbs :: Jan.27.2008 :: Celebrities, Borderline Personality Disorder :: 1 Comment »

It was widely reported in the press after Britney Spear’s “breakdown” and stand-off with the police over the return of her children that she has “a bipolar disorder.” See this excerpt from TMZ.com:

TMZ reported that Spears’ friends “have known for a while that Britney has a very serious mental condition — likely a bipolar disorder that is now in the red zone.”

I think the language here is quite important. Borderline Personality Disorder is so maligned that not a single celebrity has come out and stated that they have the disorder. Bipolar disorder, on the other hand, is not considered just the result of “bad behavior” – it is considered biological in nature – and therefore many celebrities have come out and admitted they have bipolar disorder. Bipolar is an Axis I disorder, BPD an Axis II.

Unfortunately, this distinction is a fallacy. Experts are considering changing the name of BPD to Emotional Regulation Disorder (or emotional dysregulation disorder) and making it Axis I. Why? Because clearly a large part of BPD is biological.

One of the main differences between bipolar and BPD is the length of the mood swings. In the case of Bipolar Disorder the length of the manic and depressive episodes (and mixed episodes) usually lasts days or weeks, if not longer. There is the case of Bipolar II in which a person may experience hypomania – which is possibly why the media has reported Britney to  have “a” bipolar disorder, rather than just “bipolar disorder” (although some of the media has removed the “a” from in front of the reported disorder). Substance abuse and suicide are both common with Bipolar Disorder and it effects about one half to 1 and one half of a percent of the population.

Borderline Personality Disorder is actually more common than bipolar disorder – some estimates say that it is up to 5% of women and about 2% of the population at large. It is characterized by wildly swinging emotions – not moods. Although many want to classify it as a subclass of mood disorders (like Cyclothymia), it is more a dysregulation of the emotional system. Emotions are immediate and the behaviors, impulsiveness, rage, “moods”, etc. only last for HOURS, not days or weeks. The DSM-IV says this about BPD:

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).

Substance abuse is so common with BPD sufferers that most estimates say it is co-morbid in over 75%. Also, self-destructive impulses are common (like cutting, over-eating, eating disorders, shopping, shoplifting, sexual deviance or inappropriateness) with BPD. As are suicidal gestures and thoughts, but these are usually impulsive. Impulsivity is a major problem with BPD and here is what the DSM-IV says about that:

Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

While I am not a doctor and not knowledgeable enough to diagnose Britney, I suspect that she may have BPD (or bipolar II) and, if she does have BPD, I would hope that she could be the first celebrity to come out and say so. It’s not her fault. It’s not just “bad behavior”. It is a serious mental illness and should be taken care of immediately. What I don’t understand is why she doesn’t get herself a “helper” to aid her in the regulation of her obviously dysregulated and impulsive behavior.
 

Bon Dobbs :: Jan.08.2008 :: Celebrities, Impulsiveness, Borderline Personality Disorder :: 6 Comments »

Here are my top-five candiates for celebrities with Borderline Personality Disorder (BPD). Remember I am not a doctor and this is a “arm chair” analysis of the documented behaviors of each of these celebrities. Others considered for the list were: Kurt Cobain, Princess Di, Heather Mills, Christina Ricci, Elizabeth Wurtzel, Pete Doherty, Winona Ryder, and OJ Simpson. But here are my top five BPD celebrities (from least to most likely to have the disorder) and some links to illustrative articles on the web… drum roll please….

5. Angelina Jolie

• Self-Injury.
• Volatile Relationships.
• Sexual Confusion.
• Eating Disorder.

4. Courtney Love

• Substance Abuse.
• Possible Eating Disorder.
• Inappropriate Anger.
• Shame.
• Self-Injury.

3. Lindsey Lohan

• Dangerous driving.
• Substance abuse.
• Eating disorder.
• Unsafe sexual behavior.
• Possible Self-Injury.

2. Britney Spears

• Dangerous driving.
• Substance Abuse.
• “Bipolar”.
• Eating Disorder.
• Inappropriate anger.

1. Amy Winehouse

• Self-Injury.
• Substance Abuse.
• Volatile relationships.
• Sexual Confusion.
• Eating Disorder.
• Implusive Behavior.
• Shame.
• Suicidal.

Bon Dobbs :: Jan.05.2008 :: Celebrities, Borderline Personality Disorder :: 5 Comments »

First of all, BPD is not a pleasant experience. Being awash with negative emotions all the time is quite painful and unpleasant. Most people with BPD know that they are “not normal” in some way and don’t like feeling like they do. No one would as it is very painful.

A person with BPD is characterized by having a dimished ability to regulate one’s emotions during the interactions with other people. This means that someone with BPD will likely react much more emotionally to a given situation than someone without BPD. People with BPD are likely to get angry and, at times, fly into a rage of seemingly trivial events and interactions. They also have a tendency to personalize external events. In other words, the person suffering from BPD will believe that other people’s behavior and comments are “about them”, sometimes interpreting veiled criticism or judgment of their behavior when the evidence shows that there is none. The person with BPD is also likely to be seemingly obsessed with blame and fault-finding. You will likely hear a person with BPD say, “It’s not my fault!” or “I did nothing wrong!” These comments and fault-finding behaviors are a consequence of sensitivity to judgment and rejection.

Everyone has both an in-born and learned capacity to regulate his or her emotions. I will discuss what factors contribute to these capacities and how you, as a loved one of someone with BPD, can cope with the problem. As stated earlier, emotions play a vital role in our ability to survive in a sometimes threatening environment. They are “mind reflexes” that protect and inform the mind of the state of the body and the body’s assessment of the immediate surroundings. Unfortunately, as with BPD, the messages that are sent are sometimes misaligned with the actual environment.

The ancient Hindu text characterizes this “misperception” of reality in the following manner: “A rope may be momentarily perceived as a snake before ignorance is lifted.” [Sankaras Aparoksanubhuti, verse 44]  The importance of this “ignorance” is that during the time the rope is perceived as a snake, your emotions react almost completely automatically. (I say “almost” because if you have been taught to love snakes and not to fear them, you will not have a fear reaction even if you misperceive the rope as a snake). You feel fear, it is real and you jump away. Your body reacts as well. When I say “feel fear” I really mean it. Your heart rate increases, the capillaries in your extremities contract to save blood for vital organs, adrenaline is released to your blood stream. Your fear is real and felt directly. However, it is based on a misperception with reality. When you see that it is actually a rope, you might feel foolish or you might, if you had BPD, still try and convince everyone else and yourself it is really a snake or it is a rope that can harm you. The reason is that your feelings are so immediate and seem so “true” than you have to make “reality” match your feelings, rather than the other way around. When an emotional reaction conflicts with the state of the environment for whatever reason, it is said to be a “misaligned” emotional reaction.

The core problem with BPD is poor emotional regulation. However, that particular problem can cause other symptoms to arise as the person with BPD becomes emotionally dysregulated. This term emotionally dysregulated (or just dysregulated) is used to denote the state in which a person with BPD is overcome with powerful and, at many times, misaligned emotional reactions. Remember that emotions don’t arise on their own; they are based on cues or triggers from the environment and compared by our “emotional immune system” to the meaning of the cue. For a person with BPD, the meaning can be wrong or, as is more often the case, the sensitivity to emotional cues is greatly heightened.

An example is a heat-sensing system that helps to detect and suppress fires. Sometimes companies will install heat-sensing equipment in addition to smoke detectors so that they can protect assets that need a certain temperature to operate (e.g. computer equipment which might cease working at a high temperature). The setting at which an alarm goes off might be 80 degrees Fahrenheit. In the case of someone with BPD, the setting (or “tolerance” as it is called in the control community) is naturally set much lower, at say, 50 degrees Fahrenheit. That means that the alarm will be raised much more often and lead to a reaction to the alarm. In other words, people with BPD will experience many, many (what you would consider) false alarms. However, these false alarms seem completely real to them, because their tolerance for emotional triggers is set very low.

Bon Dobbs :: Jan.03.2008 :: Emotions, Borderline Personality Disorder :: No Comments »

I often peruse the web for articles and posts about dealing with people with Borderline Personality Disorder and what I usually find is incorrect and misguided. I recently stumbled upon a post that can be found here:

http://www.helium.com/tm/339437/individuals-suffering-borderline-personality

In which the author gives some insight and advice about “dealing with” someone with Borderline Personality Disorder. I’d like to look at her advice by excerpting some of her text and then offer a little commentary.

First of all, she says this:

Individuals suffering from borderline personality disorder are very self-destructive and they have great difficulty forming any good relationships. A deep-seeded fear of abandonment is behind every wayward action and prolonged mood swing. It’s [sic] victims are mainly women who show frequent displays of inappropriate anger and who exhibit forms of self-mutilation. They also act on impulse, without regards to consequences and than [sic] hold others responsible for their actions. They are sexually permissive and may indulge in binge eating and drug abuse. Victims of this disorder may shop lift. Hell bent on harming themselves, they live with no discipline or boundary.

While this characterization is generally true, it suffers from what wikipedia calls “weasel words”. Basically, the words that are used slant the information toward being extremely judgmental. What I mean is the use of the words “great difficulty forming any good relationships,” “every wayward action and prolonged mood swing,” “show frequent displays of inappropriate anger,” and “they live with no discipline or boundary” all show us that the author is judgmental toward the sufferer. The idea of “prolonged mood swing” is incorrect as well, since the “moods” of a person with BPD generally last only hours. Also, the idea that “they are sexually permissive” MAY be true for some of the sufferers, but not for all. The idea that a “fear of abandonment is behind EVERY wayward action” is also incorrect. Much of the “actions” are motivated by pain relief and/or shame. Use of the words “no discipline” betrays the authors true feelings about people with the disorder and tells me she doesn’t understand the disorder very well (see below on “Tough Love”).

The author goes on to say:

Group therapy can resolve self-destructive behaviors. These individuals learn better from their peers because of their resistance to authority. Impulse behavior can be curtailed in this same setting.

Which is basically wrong. Group therapy does work (especially in the context of DBT), but not for the reasons that the author suggests. It is not a “resistance to authority” that drives the effectiveness of group therapy. Instead, seeing that one is not the only sufferer and having the ability to support one another normalizes the disorder. You are not just the broken, shameful person that you feel you are. Interestingly, many people with BPD will criticize others in the group and report that they are not as “crazy” as those people are.

The thing I have the most problem with is this:

Tough love may be needed from family members and loved ones before the person asks for assistance.

This statement is completely false and possibly harmful. Here is the text of a post of mine in the ATSTP group which addresses Tough Love:

Depending on the actual problem with your son(s) the idea of “tough love” might be the worst thing for him (them). While it seems to work for substance abuse, tough love can be an awful mixture for those with ERD-like issues. The problem comes down to the “invalidating environment” as Marsha Linehan puts it. Tough love will invalidate a person’s basic feelings and lead to shame and the feeling of “brokenness”. I have seen this first-hand with one of my daughter’s friends. This friend is 16 now and is a classic BPD/ERD case. She has been kicked out of several “lock down” facilities. Recently her mother sent her to a “tough love”/boot camp. It was a total disaster for the kid and for the family.

A better approach IMO, is emotional validation + a sense of personal responsibility. This combination is built through letting the person know that feelings are not wrong or right, they just ARE. The second half comes through building mastery over their behavior associated with feelings. Bad feelings just exist. This is important because often a person with such issues will use behaviors (like drug abuse or cutting or raging) to make the bad feelings go away as quickly as possible. They need to learn to tolerate the distress and behave in an effective manner. Once this new behavior/reaction to feelings is practiced, they can eventually build mastery over the behaviors. This works backward to help quell the feelings.

It seems that most parents believe that emotional validation = “giving in” (or agreeing with the child or “poor discipline” or whatever). This is NOT the case. It’s difficult for me to express this more firmly. Remember the word “emotional” is important. If you validate invalid behavior, you are enabling. It is important to separate in your mind the emotions (which are natural) from the behavior (which can be painful to all involved). If that separation can be communicated to the person with ERD, it can be worked with. It is difficult, but possible.

Unfortunately, tough love is not the answer.

Bon Dobbs :: Jan.02.2008 :: Treatment, Boundaries, Borderline Personality Disorder :: 3 Comments »