From Bloomberg…

Mental Health Coverage Expanded by Rescue Package (Update2)
By Aliza Marcus

Oct. 3 (Bloomberg) — Health insurers that provide mental- health benefits will be barred from providing less coverage than they do for other medical services under the $700 billion financial-markets rescue package approved by Congress.

The plan was backed by a 263-171 vote in the House of Representatives today and signed by President George W. Bush. The package incorporates a measure requiring so-called mental health parity for health plans enrolling more than 50 employees.

“Aren’t we all pleased across America that this legislation includes the mental health parity act?” House Speaker Nancy Pelosi, a California Democrat, said in a speech before the vote.

The mental-health measure was among provisions added to the financial rescue package to win support after the House initially rejected the bailout legislation. The Senate, which supported the expansion of mental health coverage benefits in tax legislation passed last month, approved the revised financial rescue plan on Oct. 1.

“It seemed like it was getting lost after the bailout issue arose, but now with this bill it’s just happened,” said Steve Vetzner, spokesman for the Mental Health America advocacy group in Alexandria, Virginia. “This has been a long struggle and long fight.”

The act is intended to eliminate what supporters call unequal access to care from insurers that set higher co-payments and other limitations on services such as mental health counseling compared with physical ailments.

$3.4 Billion

The House and Senate previously disagreed about how to cover the cost to the federal government of the expanded benefit, estimated at $3.4 billion over five years by the Congressional Budget Office in 2007.

The estimate is related to tax revenue that would be lost because employers would pay more for health insurance premiums, to cover the expanded benefits, instead of turning over some of this money as taxable wages to employees.

Health insurers and businesses worked with Congress on the measure, which built up wide support from stakeholders in the health-care field, said Aetna Inc. Chief Executive Officer Ronald Williams in a statement on Business Wire.

“They had a deal for a long time,” said Kim Monk, an analyst at Capital Alpha Partners, in Washington, in a telephone interview. “The challenge was how to off-set the cost,”

Employers will now be looking for well-managed mental health networks to help them reduce costs associated with implementing the legislation, Monk said. “Not all insurers have this, so they may have to beef it up.”

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net

Last Updated: October 3, 2008 15:26 EDT

Bon Dobbs :: Oct.06.2008 :: Resources, Treatment :: 1 Comment »

This is an editorial from the NY Times…

October 1, 2008

Editorial

Oh So Close to Mental Health Parity

Congress is within a whisker of passing a sound and fair-minded bill to require that group health insurance coverage for mental illness and substance abuse be provided on the same terms as coverage for physical illnesses. It would be a shame if the legislation, which caps more than a decade of struggle to achieve mental health parity in insurance coverage, were allowed to die while Congressional energies are focused on the all-consuming economic crisis.

The bill would not require employers or health plans to cover mental illness or drug or alcohol abuse. But if they do, the treatment limits and financial requirements could be no more restrictive than those that apply to medical or surgical benefits. A 1996 law had required parity in setting annual and lifetime spending limits, but insurers found ways to circumvent it. The new bill closes loopholes by requiring parity in deductibles, co-payments and out-of-pocket expenses — and in setting treatment limitations, such as the maximum number of doctor visits and days of coverage allowed.

The bill is endorsed by President Bush, business groups, insurance companies, the medical community and mental health advocates. Both the House, in a stand-alone bill, and the Senate, as part of a broader tax relief bill, have approved it by large margins. But it requires a final shove because the measure is snarled in a broader legislative struggle over how to pay for tax revenues that would be reduced by this measure and others. Is there a statesman who can push this worthy parity legislation through to final passage before adjournment?

Bon Dobbs :: Oct.01.2008 :: Resources, Treatment :: 1 Comment »

I have discovered some resources on the web that may help those with BPD (and those nons who are in a relationship with someone with BPD). These resources are:

Mass General Hospital Mood Charting (thanks to Tides…)

DBT Skills Help:

Emotional Regulation Skills… from dbtselfhelp.com … from Borderline Personality From the Inside Out

Mindfulness Skills… from dbtselfhelp.com

Distress Tolerance Skills… from dbtselfhelp.com

Interpersonal Effectiveness Skills… from dbtselfhelp.com

DBT Family Skills Training… from middle-path.org

You can gain access to more DBT resources, to other pertinent files, and to advice from me and other group members by joining the ATSTP (Anything to Stop the Pain) Google Email List.

Bon Dobbs :: Sep.17.2008 :: Resources, DBT-FST, Mindfulness, DBT, Borderline Personality Disorder :: No Comments »

Why boundaries and  detaching can make things worse….

I decided to write this post because I have seen many non-BPs frustrated over the fact that when they try to use the tools in certain books with their BP, the tools seem to cause more rage and emotional dysregulation. The two “tools” that I have found that cause the most problems are boundaries and detachment. I’ve already written a LOT about boundaries and where my view of boundaries diverges with some of the other “Non-BP authors.” Today, I’d like to turn to detachment.

“Stop Walking on Eggshells” recommends on page 98, that a Non-BP “detach with love” from a BP and BPD-like behavior. This concept was “borrowed” from Al-Anon as it is made clear in SWOE. I think that “detaching” (whether with or without love) works in some situations and blows up in the Non’s face in others.

What are the differences? In WHINE, I explain that the “engine” of BPD is emotional dysregulation (which is the opposite of regulation). A person with BPD will heat up more quickly and cool down more slowly than someone without the characteristic of emotional dysregulation. One study that I cite in WHINE deals with “neutral” reactions to someone who is dysregulated. The basic evolution of an (as “Tides” calls it on her blog) Emotionally Dysregulated Moment (or EDM) is trigger -> cognition -> emotion -> expression -> behavior. Emotions can spur on other emotions. Anger is IMO the most powerful of the basic emotions and it is easily triggered, especially when a person with BPD is feeling judged. Ok, now back to detachment. On page 39 of WHINE, I explain that:

One of the most interesting findings of a study in which scientists used functional magnetic resonance imagining (fMRI) to measure the emotional reaction (limbic system activation) of patients with BPD is that these people react to neutral faces in the same manner they react to angry faces. In essence, when shown a picture of a person with a neutral expression, people with BPD showed amygdala activation as if the picture was one of a person with an angry expression. These people expect judgment and anger in others towards them and react physically and mentally to neutral situations as if they are threatening. They are likely to find “meaning” that is judgmental or threatening in an event that others would see as meaningless. A member of my list compared this reactivity to neutral faces to neutral feedback on eBay. As a buyer on eBay, you don’t give neutral feedback to a seller when everything about the sale is perfect. You give [neutral] feedback when something is wrong. A person with BPD will interpret a neutral face as “something wrong.”

Emotional detachment from an EDM will trigger more emotional dysregulation within a person with BPD. Instead, an EDM is a time to engage someone with BPD and engage them on an emotional level. Otherwise, if you detach emotionally from the situation, the BP will interpret your “calmness” and detachment as judgment or criticism. Additionally, they will likely consider you untrustworthy to validate their emotional states. What I mean by this is that if they are feeling so much emotional pain that they are dysregulated what they are really trying to do (regardless of the content what they say) is to communicate that pain to you. If they’re “dying in pain” and you’re detaching and calm, they feel they can’t come to you with the problem. On page 95-96 of WHINE, I describe this situation as follows:

The purpose of someone coming to you in an emotionally dysregulated (or close to one) state is to communicate the emotions that she feels. She may have difficulty expressing these emotions and may use other means for expressing them such as blame, sobbing, cutting, raging or other behaviors that are difficult for you to deal with. The underlying point however is one of communication – she is trying to tell you something, but she doesn’t have the language for it. Therefore, if you respond to an emotional communication in either an invalidating fashion (using one of the many, many invalidating phrases above) or in a way that doesn’t match the emotional distress, the BP will feel unable to communicate. She will think “I’m going off the deep end here and you are so calm! You don’t understand anything! You’ll never understand me!”, and not trust you. The tenor of your voice is more effective if you express your emotional identification with emotion in your voice as well, but with slightly less emotion than the BP is feeling. In other words, express distress in the identification, but less emotion than if you are actually in distress yourself.

Bon Dobbs :: Aug.07.2008 :: WHINE Book, Resources, Emotions, Borderline Personality Disorder :: 2 Comments »

There has been numerous articles and discussion in the therapeutic community about renaming BPD. Here is the text of an interview with Dr. Leland Heller about a new name and about his feelings about the current Borderline Personality Disorder Name (the emphasis in this article is mine):

A POSSIBLE NEW NAME FOR BORDERLINE PERSONALITY DISORDER

Many people would like to change the terminology of the “borderline personality disorder” to a new term that more accurately describes the illness. The term “BPD” in and of itself is as if the whole person (and the personality) is flawed, rather than looking at the BPD as a medical problem it actually is.

The term “borderline personality disorder” implies that there is no hope for treatment as many mental health professionals unfortunately still believe. There is thought that this illness borders on schizophrenia, thus the term “borderline.”

What then is borderline personality disorder? These questions have been posed to Dr. Leland Heller, expert in treating borderline personality disorder.

Q. What do you think about the term “borderline personality disorder”?

A. “I think it’s a horrible, insulting label for a real medical illness. The name alone reduces serious research, stigmatizes victims, and implies the person is crazy. It denies the medical nature of the process, and implies simply a personality problem.”

Q. Do you think “borderline personality disorder” is an accurate description?

A. “No I don’t. It implies a character problem. While I’ve encountered many people with a bad character who had the BPD, most borderlines I’ve treated (over 2100) do not have character problems. “Borderline” means patients live “at the border” between psychosis and reality. When borderlines are well treated medically, psychotic experiences are few and far between - and can be treated well. Borderlines don’t live at that border, they simply go into psychosis too easily under stress.”

Q. What is the BPD?

A. “The BPD is a medical problem, likely a form of epilepsy (brain cells firing inappropriately and out of control). The characteristic symptoms include inappropriate moodiness, chronic anger, emptiness, boredom, dysphoria (anxiety, rage, depression and despair) and psychosis. The other criteria are symptoms related to these medical problems.

ALL neurological disorders can have an effect on the personality, such as Parkinson’s disease which isn’t called the ‘shaking personality disorder.’ ”

Q. What does this term “Dyslimbia” mean?

“ ‘Dys’ means malfunction, and limbia meaning from the limbic system.

‘Dyslimbia’ is malfunction of the limbic system. While other neuropsychiatric disorders involve malfunction of the limbic system, the limbic system dysfunction is profound in the BPD. I chose Dyslimbia for my patients to take the stigma away. The BPD needs a new name, one that emphasizes healing not labeling.

I don’t care if it’s renamed ‘Dyslimbia’ or not, but a more honest, humane, and hopeful name needs to be made for this illness. Patients deserve to get medical attention for ‘Dyslimbia’ (or an equivalent name), rather than have doctors and therapists shun them because they are ‘borderlines.’”

I’d like to write more about the struggle for a new name… but one of the things to note is that most researchers in this area have recommended dropping the word “personality” from the name and reclassifying it Axis I. The most common and likely new name is “Emotional Regulation Disorder (ERD).”

More on this later.

Bon Dobbs :: Jul.22.2008 :: Resources, Other Disorders, Borderline Personality Disorder :: No Comments »

A few weeks ago I discovered the “Tides of Crazy Love Blog,” which is written by someone I “know” (meaning I know her via an email board). I LOVE her writing. I really do. Recently, she started “debunking” Internet myths and misunderstanding about BPD. More power to her! Here is an excerpt from her debunking the “Rules of Engagement” from BPD411.org (the first paragraph comes from BPD411.org):

“Rule #5: If at any time the Non figures out the Rules of Engagement for BPD Land, the BPD’er must change the situation, rewrite history, and thereby purchase the Non a one way ticket back to BPD Land.” (BON Note: this is excerpted from rules of engagement)”

[Oh, good grief! This rule is crazy-making to me! Sheesh! The author writes as if the BP has the ability to come up with some big elaborate plan to drink, steal, cheat and lie. I’m beginning to think this person was dealing with an NP or an anti-social-type, not a BP. (Or MAYBE she was an NP and was merely projecting her own inner motives behind why she feels BPs do what they do. BTW, I suspect that some nons do come out of BP relationships with many more narcisistic characterists than they went in with… especially when abuse is part of the history between them. This seems to be the case with my mother and my MIL, anyway.)

Again, BPs impulsively react during moments of dysregulation… initially in response to a feeling (anxiety or fear, oftentimes) and their behavior can escalate as a result of their thoughts when they believe someone has invalidated their feeling (judged/persecuted them.) Their instinctive (or possibly “learned” in abusive situations) nature is to please, they suffer incredible amounts of shame… therefore, why would they PLAN to be bad? The fact is, most never learned how to do this “planning” thing effectively, which is why they are so prone to total freak-outs. They don’t know what else to do at that moment to make themselves feel better. In addition, they sit around ruminating about their own mistakes so much, they don’t have time to come up with a plan for their own healing, much less a plan for anything else. They live in the moment.

Yes, that’s exactly it. I’d love to post “Tides…” complete debunking posts. They’re great. Check them out here:

 http://thetidesofcrazylove.blogspot.com/2008/07/net-debunk-introduction.html

http://thetidesofcrazylove.blogspot.com/2008/07/net-debunk-rules-of-engagement-for-bpd.html

http://thetidesofcrazylove.blogspot.com/2008/07/net-debunk-rules-of-engagement-for-bpd_14.html

Bon Dobbs :: Jul.21.2008 :: Resources, Borderline Personality Disorder :: 1 Comment »

Now that my book, When Hope is Not Enough has appeared on Amazon (see it here), I have been checking my Amazon sales ranking daily (ok, maybe more like hourly). It’s painful and exhilarating at the same time. I have been as high as 33,000 (which ain’t great I know) and as low as 300,000+. As I write this the book is around 62,000. Some book with comparable content:

• Stop Walking on Eggshells - 495 in books (whoa!)
• SWOE Workbook - 5,772 (I’d settle for that)
• Tears and Healing - 930,985
•  One Way Ticket to Kansas - 21,832
• Breaking free from Boomerang Love - 22,865
• Why does he do that? - 1,912
• Emotional Vampires - 3,041
• And the upcoming Essential Family Guide to BPD - 440,683 (but not yet published)

Oh the ups and downs. Of course, I have of late been plugging my book because I think it can really help family members and loved ones with understanding and dealing with someone with BPD.

Here’s another quote from my list from a reader of WHINE (my book):

Seriously, Bon, your book is the only thing out there that has a complete set of tools for dealing with BP behavior, written in plain English.  SWOE offers some good tools but not a systematic process, like yours do.  The DBT materials are great but not really targeting Nons, as far as I can tell.   What I see you doing is adapting [a] theory and process for Nons, and making it very accessible and easy to understand.  And SWOE has a lot of time and momentum on its side and a real publisher behind them, so it’s not at all surprising how well it is ranked compared to WHINE.

Bon Dobbs :: Jul.16.2008 :: WHINE Book, Resources :: 1 Comment »

I am pleased (as punch) to announce that my book When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder is available for sale on Amazon. You can view/buy it here:

http://www.amazon.com/When-Hope-Not-Enough-Dobbs/dp/1435719190

Today, I got a review of the book from someone in my ATSTP Email List. Here is the text of the review:

Bon, I read your book in one sitting yesterday.  I couldn’t put it
down.  It’s fantastic.  Thanks man, you’re helping me to change my
life.  Lot’s more to say but no time for now.

I hope (haha) that it helps you in your relationship as much as it should help this Non-BP. I’ll update all the links on my website(s) to link to the Amazon version as well as the Lulu version (Lulu’s the publisher BTW, so you can buy it directly from them, but many people are more comforatble buying from Amazon).

Bon Dobbs :: Jul.10.2008 :: WHINE Book, Resources, Borderline Personality Disorder :: No Comments »

The  next “Telephone Hour” put on by the National Education Alliance for Borderline Personality Disorder (NEA-BPD) focuses on partners. Here is the notice put out by the NEA-BPD:

Alan E. Fruzzetti, Ph.D., author of The High Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy, & Validation, (foreword by Marsha Linehan, Ph.D.), will be the keynote Presenter on the NEA- BPD Call-In Hour on Friday, July 11 at 6-7 pm EST. Dr. Fruzzetti is Associate Professor of Psychology at the University of Nevada, Reno. He is also the Director of the Dialectical Behavior Therapy and Research Program there, which treats adolescents, adults, couples and families with BPD and related problems.

Registration is limited to allow participation in dialogue and pre-registration is required. To reserve your spot, please register today by going to NEABPD.org.

Bon Dobbs :: Jul.08.2008 :: Resources, Treatment, Borderline Personality Disorder :: No Comments »

Here is a nice book review I found of my book When Hope is Not Enough. I “know” this reviewer through my email list ATSTP. She is incredibly wise and knowledgeable about BPD and being a Non-BP. She should write her own book IMO.

 The author of this book, Bon Dobbs, is the founding leader of my online google support group - ATSPGroup. His wife has been diagnosed with BPD and his daughter struggles with emotional dysregulation similar to that of BPD.

When I found this group, I had just come away from the Welcome To Oz group known as WTO-Staying. I was tremendously discouraged (support-wise), because the folks there just didn’t seem to “get” this disorder… from my perspective as a suffer and as a non to my BPDH. There were a few informed folks who were seriously trying to explain the underlying fears and irrational thoughts behind BPD, but most of the nons couldn’t seem to get past their own hurts, fears and thoughts to learn the type of communication that is most effective with a BP. I knew immediately from reading Bon’s supportive responses to group members that he and I shared many of the same thoughts and opinions about the disorder… and about how non’s tend to become affected negatively by it over time, which inevitably contributes to the further erosion of the relationship.

“When Hope Is Note Enough” (WHINE) explains all this, and goes on to offer excellent and insightful tips on how to support the BP in your life without condoning the inapproprate behavior (projecting, blaming, intense anger, impulsiveness, etc.) or agreeing with the irrational thoughts you oftentimes find yourself subjected to by the BP in your life. It’s a very validating resource, especially for nons, that teaches you how to provide a validating environment in which your BP can finally heal without sacrificing your own values, beliefs and feelings.

I’ve been using the approach in this book (naturally… thanks to my own previous therapy) since the day I found out about hubby’s MH issues. It was challenging at first, as I had to view what I knew from a different perspective, but over the past 8 months, we have really begun to see an improvement in our relationship and in my hubby’s healing process. (I think my life updates in this blog will be a testament to that… once I get them all posted anyway, lol!) I was glad to see Bon write this book. Many times, I had considered doing the same, but unfortunately, I’m not organized enough in my mind to take on such a project… at least not at this point in my life. He did an superb job bringing it all together in a way readers can easily follow and implement! I highly recommend this book, not just to nons of BPs, but to anyone who is caught up in a high conflict relationship with someone they love.

This book is not yet available in stores or on Amazon. To purchase, visit this link: http://www.lulu.com/content/2461208

Thanks! Hope you enjoy and can use the book (of course, sometimes “hope” is not enough - haha).

Bon Dobbs :: Jul.08.2008 :: WHINE Book, Resources, Borderline Personality Disorder :: No Comments »