A therapy that helps to rebuild broken lives

SHEILA WAYMAN

Tue, Dec 27, 2011

ANNE* ALWAYS felt she was different from everybody else and, having had a difficult early childhood, by the time she was a teenager she did not think she belonged in this world.

“I believed I was invisible – I didn’t think people saw me,” she says. “I was insecure and very mixed up about my own identity; I did not know who I was, or how to fit in to life.”

From her mid-teens on, she attended a succession of psychiatrists and counsellors and was prescribed various medications for her “mood”. However, becoming a wife and mother gave her a new, positive feeling of belonging, and she moved on to become a mature student, followed by short-term work placements and voluntary work.

But when, in her 40s, life threw up challenges over which she had no control, her thoughts and emotions began to change rapidly.

Old fears of being abandoned returned; she became angry and impulsive. She started to self-harm and contemplate suicide; she misused alcohol and became dependent on prescribed medication.

It was only then that she was diagnosed with borderline personality disorder (BPD) and she began to understand the impact it had on her.

BPD is a broad category of mental health problems, often defined by “really powerful emotional distress and sometimes a lot of problems in relationships”, says Jim Lyng, a counselling psychologist with Cluain Mhuire, a community-based adult mental health service in the southeast of Dublin.

Affecting an estimated 1-2 per cent of the population, the disorder is characterised by impulsive and often life-threatening, self-destructive behaviour. Problems tend to start to show before a person reaches adulthood, as they begin to cope with their emotions in extreme ways.

“In a heightened state, people start to make desperate choices,” he explains. Talking of deliberate self-harm or attempts at suicide as “cries for help” misses the point, he suggests. “They are desperate attempts to cope.”

Luckily for Anne, she is living in one of the few areas of Ireland where the successful, evidence-based treatment programme of dialectical behaviour therapy (DBT) is available. Within weeks of diagnosis, she started DBT at Cluain Mhuire.

DBT was developed by Dr Marsha Linehan from the University of Washington to help people with a history of repeated self-harm and suicidal behaviour, many of whom would be classified as having borderline personality disorder.

And it was only this year Linehan disclosed that she has struggled with the disorder herself – so first-hand experience informs the therapy.

It involves a minimum of one year of treatment, with both a weekly one-to-one session of psychotherapy and a weekly group session for learning new skills in managing emotions.

Participants keep a daily diary of their feelings and responses to them. Telephone support is also provided for difficulties that may arise in between sessions.

“Fifty per cent of DBT is learning to accept and 50 per cent is learning to change,” says Lyng. “It sounds simple, but it is very difficult to put into practice.”

For people struggling with extreme emotions, DBT can be “the difference between complete chaos and not being understood, to having some framework to cope with what’s going on and to start building a life worth living”.

When DBT was piloted in Cluain Mhuire more than 10 years ago, the benefits were so overwhelming – a dramatic reduction in the use of inpatient psychiatric beds and in attendance at hospital emergency departments by participants in the two-year follow-up period – it quickly became a “serious option for many of our clients”, he says.

Now a special DBT group for people aged 18-25 who are self-harming has been started on a pilot basis at Cluain Mhuire and it is thought that they will benefit faster as the behaviour they are trying to change is less entrenched.

Self-harm is on the rise in Ireland. The 2010 annual report of the National Registry of Deliberate Self-Harm showed hospital attendance for self-harm was up for the fourth year in a row.

A total of 11,966 presentations to hospitals in 2010 were due to self-harm and these involved 9,630 individuals.

With a 4 per cent rise in the rate of self-harm overall, the most notable increase in 2010 was among 20-24 year olds.

There is a strong link between self-harm and suicide; it is estimated that between a quarter and a half of those who take their own lives have previously carried out a non-fatal act.

DBT is not for everybody, says Lyng, but it is the treatment with the most international research supporting its effectiveness.

And he is frustrated and concerned at its limited availability across the State in a mental health system that is effectively a “post code lottery”.

To be able to avail of DBT, people have to live in the catchment area of the approximately 10 teams of mental health professionals that are offering it, in the east of the State and across Co Cork.

Private services offer elements of DBT, he says, but not “comprehensive” DBT programmes.

There are between 20 and 25 participants in the two DBT programmes currently running at Cluain Mhuire and it has had people moving into its catchment area to try to access the treatment.

Although DBT requires a lot of resources initially, it is, in the long term, a much better use of the health services, Lyng argues, rather than leaving people to turn up at emergency departments with the physical consequences of their disturbed emotions or admitting them for very costly inpatient psychiatric care, which has not proven to be effective.

There is a good chance that people completing the programme can be discharged completely from the mental health services.

Anne has not reached that stage yet, but DBT has “given me hope”, she says.

“It is a new way of living.” If she is having a bad day, she can now draw on coping skills to manage her emotions.

“I know what to do when I become overwhelmed. I am beginning to know who I am and I am not struggling so much with identity issues. It allows me to function in the real world,” adds Anne, who believes it is a “massive injustice” to people like her who can’t have this treatment.

*Name has been changed
© 2011 The Irish Times

Related posts:

1. Mentalization Based Therapy Shows Promise with BPD
2. On the edge: Group helps families cope with borderline personality disorder
3. Can therapy actually hurt borderlines?

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New guidance for management of self-harm issued

23 Nov 2011

The healthcare guidance body NICE has today published a new clinical guideline on the longer-term care of adults, children and young people who self-harm. The guideline development group was chaired by Professor Navneet Kapur in The University of Manchester’s Centre for Suicide Prevention.

This new guideline follows on from the NICE guideline on the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (NICE clinical guideline 16). The new recommendations focus on the longer-term psychological treatment and management of self-harm.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: “Self-harm is a very broad term for a behaviour that can be expressed by those affected in very individual ways, which is why it is so important that each person receives the right care plan for them. The previous NICE guideline on the short-term treatment of self-harm focused on the first 48 hours of an episode and the care they received in the Emergency Department. This new guideline aims to help healthcare professionals support, in the longer term, people who are known to self-harm in reducing and then stopping the behaviour.”

Professor Kapur, Professor of Psychiatry and Population Health in the University’s School of Community-Based Medicine, said: “People may keep self-harm a secret which means it is difficult to know how widespread it is. Many cases are unreported unless medical treatment is required. However, it is thought to be common, especially amongst young people, with one UK study finding that 1 in 10 girls aged 15-16 had self-harmed in the previous year. This new guideline is an important step in improving health professionals’ understanding of self-harm and thereby helping to ensure people receive the treatment and support they need.”

You can listen to a podcast about self-harm by Professor Kapur here (link takes you to the NICE website).

Key recommendations include:

• Working with people who self-harm: Health and social care professionals working with people who self-harm should aim to develop a trusting, supportive and engaging relationship with them, be aware of the stigma and discrimination sometimes associated with self-harm and ensure that people are fully involved in decision-making about their treatment and care.
• Risk assessment: When assessing the risks of repetition of self-harm or suicide, identify and agree with the person who self-harms the specific risks for them, taking into account:

1. methods and patterns of current and past self-harm
2. specific risk factors and protective factors (social, psychological, pharmacological and motivational) that may increase or decrease the risks associated with self-harm
3. coping strategies that the person has used to either successfully limit or avert self-harm or to contain the impact of personal, social or other antecedents

• Do not use risk assessment tools and scales to predict future suicide or repetition of self-harm.
• Care plans: Care plans should be multidisciplinary and developed collaboratively with the person who self-harms and, provided the person agrees, with their family, carers or significant others. The care plan should identify realistic and optimistic long-term goals, including employment and occupation and identify short-term treatment goals (linked to the long-term goals) and steps to achieve them
• Interventions for self-harm: Consider offering 3 to 12 sessions of a psychological intervention that is specifically structured for people who self-harm, with the aim of reducing self-harm. The intervention should be tailored to individual need and could include cognitive-behavioural, psychodynamic or problem-solving elements. Therapists should be trained and supervised in the therapy they are offering to people who self-harm. Therapists should also be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.
• Treating associated mental health conditions: Provide psychological, pharmacological and psychosocial interventions for any associated conditions as described in the relevant NICE guidelines, for example, borderline personality disorder (NICE clinical guideline 78), depression (NICE clinical guideline 90), bipolar disorder (NICE clinical guideline 38).

Professor Tim Kendall, Consultant Adult Psychiatrist, Director of the National Collaborating Centre for Mental Health (NCCMH) and Medical Director at Sheffield Health and Social Care Trust, said: “Self-harm is very common and involves a wide range of methods, the most common being self-poisoning with prescribed or over the counter medicines, or by cutting. People self-harm for numerous reasons, and although self harm is not usually an attempt at committing suicide, it is a way of expressing deeper emotional feelings, such as low self-esteem, the emotional results of previous abuse and hurts. However, people who self harm are much more likely to die by suicide, and many suffer from long term physical effects of self injury and self poisoning, as well as psychiatric problems such as depression. It is very important that we help identify people who self harm sooner and to help them come to terms with the underlying problems and access treatment when they need it. This guideline is a really important step to achieving this”.

Dr Suzanne Kearney, GP in Aylesbury and guideline developer, said: “Although most people who self-harm do not wish to end their lives, it does increase the likelihood that the person will eventually die by suicide by between 50- and 100-fold. NICE has already published guidance on what services should be offered to people immediately after an episode of self-harm; with this new guideline on the longer term management, we hope to provide healthcare professionals with clear recommendations on how to work with people who self-harm and enable them to choose the right treatment for their individual needs.”

Mr Gareth Allen, guideline developer representing service user and carer interests, added: “Every person who self-harms is different; they do it for individual reasons and have their own individual needs. It is hoped the recommendations made in this new guideline will help healthcare professionals identify the needs and risks that should be considered when assessing a person who has self-harmed and the types of treatment available.”

Related posts:

1. Self harm on the increase in UK
2. Bill of Rights for People Who Self-Harm
3. Self-embedding: a new trend in self-harm?

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I’m gonna jump (link)

THE DOCTOR SAYS
By Dr MILTON LUM

The are several factors that increase the risk of a person commiting sucide.

EVERYONE’S life has its ups and downs, with feelings and emotions accompanying many of these situations. Most people adapt and cope with the downs. However, there are some who are so overcome with these emotions that they take their own life.

Suicide is an individual’s intentional act of ending his or her life.

Many suicide attempts are preceded by a history of self-harm, in which there is deliberate injury that a person inflicts on his or her body. This does not mean that the person who self-harms wants to commit suicide, but is an effort by the person to cope with intense emotions.

However, self-harm is an indication that the person needs immediate assistance.

Suicide is a common cause of death in young people worldwide. According to the National Health and Morbidity Survey 2006, there was a 6.3% rate of acute suicidal ideation, and 25.8% of chronic suicidal ideation. The highest prevalence rate of suicidal ideation of 11% was found in those aged between 16 and 24 years.

The National Suicide Registry Malaysia (NSRM) 2008 report stated there were 290 suicides in that year, of which 219 were men and 71 women, with Chinese comprising 53.5%, Indians 27.3%, and Malays 13.9%.

The youngest suicide victim was 12 years, while the oldest was 83 years. The NSRM estimated that there were 425 suicides between January and August 2010, averaging 60 per month, ie two daily.

It is estimated that the suicide rate is similar to that of the United States.

Although women are more likely to attempt suicide and other self-harm behaviour, it is the men who are more likely to succeed in suicide. The suicide rate in men in many countries is about three times that of women.

Risk factors

The reasons why some people commit suicide while others in similar situations do not, have not been determined. However, there are some factors that increase the risk of suicide.

Genetics is believed to be a risk factor as suicide has been found to be more common in certain families. There are several genetic mutations reported that may alter the chemicals in the brain, increasing the vulnerability to suicidal thoughts and behaviour. However, no specific gene for suicide has been identified.

Mental health conditions are the most significant risk factor, particularly serious and chronic mental health conditions. It has been estimated that about 90% of people who commit or attempt suicide have a mental health condition.

Severe depression is associated with misery and hopelessness – there is a 20-fold increase in the likelihood of attempted suicide than the general population.

Sufferers of bipolar disorder alternate between extreme joy to severe depression. About a third of these sufferers attempt suicide, and about 10% commit suicide.

Patients with schizophrenia are unable to think logically, and have difficulty differentiating between real and unreal experiences, with about 5% committing suicide. The risk is greatest when the diagnosis is made, but with the passage of time, they are better able to cope with their situation.

Anorexia nervosa is a condition in which anxiety about body weight leads to extreme efforts at limiting food consumption. About a fifth of anorexics will attempt suicide.

Patients with borderline personality disorder have altered thinking, unstable emotions, impulsive behaviour and unstable relationships. About half of these sufferers will attempt suicide, with an increased risk in those who were sexually abused in childhood.

It is believed that a combination of other factors increases the risk of suicide. These factors may or may not be significant, depending on the person’s vulnerability at the point in time. They include:

• History of a recent traumatic experience, eg end of a relationship, bullying, loss of job, bereavement.
• History of a traumatic experience in childhood, eg sexual or physical abuse, bereavement, parental neglect.
• A parent with a serious mental health condition, eg severe depression, bipolar disorder, schizophrenia, or who committed suicide.
• A previous attempt at suicide.
• Social isolation, with few family members or friends.
• Misuse or abuse of drugs and alcohol .
• Unemployment or poor job satisfaction or security.
• Debt.
• Occupations which permit access to the means to attempt suicide, eg doctor, nurse, pharmacist, planter.

Danger signs

There are warning signs that indicate that a person is suicidal. They include talking or writing about death or suicide threats to injure or kill himself or herself, and actively seeking methods of committing suicide, eg stockpiling medicines, particularly sleeping pills, and/or pills used to treat serious mental conditions.

Other warning signs include:

• Complaints, talk or behaviour that indicate hopelessness or a meaningless life.
• Loss of interest in personal appearance, eg poor dressing, cessation of use of make-up.
• Reckless or risky behaviour without concern for the consequences.
• Sudden mood changes, anxiety, agitation.
• Increased withdrawal from interactions with family members and friends.
• Insomnia or sleeping all the time.
• Abuse or misuse of drugs or alcohol.
• Putting their affairs in order.

When warning signs are noticed, it would be useful to encourage the affected person to talk about it and to listen attentively. One should listen to what the person has to say to let them know that there is someone who cares about them.

A non-judgemental manner and empathy are essential. One should not influence what is said, but rather, facilitate honest and frank conversation.

Any questions raised by the listener have to be open-ended, and not end the conversation.

At the same time, the person’s doctor or nurse should be contacted. If it is not possible to do so, the accident and emergency department of the nearest hospital should be contacted as to how to get professional help for the affected person. If one assesses that the affected person has a high risk of dying by suicide before the arrival of professional help, one should contact the nearest ambulance service.

At the same time, any possible means of suicide should be removed from the immediate environment of the affected person. This would include medicines, household chemicals, sharp objects, etc.

Providing care to a suicidal person is stressful and distressing, and it can impact upon the carer’s mental health. Professional help may be required to address the carer’s emotions after the event.

Preventing suicide

Mental health is no different from physical health. Measures can be taken to improve mental health so that one is stronger emotionally and better able to cope with the downside of life, thereby reducing the risk of developing mental health conditions like depression.

Exercise is effective in the management of depression. Physical activity reduces stress and anxiety, improves mood, and promotes the release of brain chemicals called endorphins, which makes one “feel good”.

A healthy diet not only provides protection against physical health problems, but may also be vital in maintaining mental health.

Avoidance of social isolation is an important measure as it is a risk factor for suicide. Having friends is beneficial for mental health. If there is individual difficulty in making friends, you should consider joining a local activity group or support group. There is evidence that people involved in providing assistance to others through voluntary or charity organisations are mentally healthier than the general population.

Having a positive attitude is vital as persistent negative thoughts increase the risk of isolation. Cognitive behaviour therapy (CBT) is a type of talking treatment that assists in the management of problems by changing the thoughts and actions of the affected person.

Many people use drugs to help them cope with life’s problems. Their misuse or abuse may lead to more problems and increases the risk of developing serious mental conditions like depression.

Even recreational drugs like marijuana, which is perceived to be less harmful, increase the risk of depression and schizophrenia in some people.

Many people use alcohol to help them cope with life’s problems. Its misuse or abuse may lead to more problems and increases the risk of depression. It would be prudent to avoid exceeding the recommended daily alcohol consumption limits – ie three to four units for men and two to three units for women. A unit is the equivalent of about half a pint of normal strength lager, a small glass of wine, or 25ml of spirits.

A consultation with your regular doctor would be helpful if there are problems with drug usage or alcohol consumption.

However, the evidence is that an effective preventive strategy is to educate doctors on how to recognise and treat depression, and restricting access to lethal methods of suicide. Another promising strategy is to train particular groups of people on how to identify those at risk and refer them for treatment.

Support groups provide counselling and practical advice to people who are depressed, or have suicidal thoughts. The local support group are the Befrienders and their contact details are 95, Jalan Templer, Petaling Jaya 46990 (Telephone: 03 7956 8144 or 03 7956 8145; email: sam@befrienders.org.my)

If you do not like the idea of talking to someone on a helpline, you can talk to a family member, trusted friend, doctor or religious leader. You should also consult your doctor, who can prescribe treatment for mental health conditions.

> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Related posts:

1. Pre-teen Girls Suicide Rates Go Way Up
2. New guidance for management of self-harm issued
3. Out of the darkness, Daughter Raises Awareness of BPD and suicide

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Depression and grief can be a trying experience for anyone. You feel pain in every area of your body and mind. Sometimes you will just want to retreat to your bedroom and go to sleep for hours, just to get some relief from the physical and mental anguish you feel. The sleep represents a distraction of both the mind and the body from the experience of complete pain. You might also use alcohol to relieve the pain by “turning off your mind.” Many people “drink themselves into a stupor” and, in doing so, extinguish the pain for a short period. Pain-killers, whether over-the-counter or prescription, can also remove pain by working on the pain at its source (in the brain where pain is actually felt). Once, when I was asked by one of my daughters about how the Tylenol knew to go to her foot (which was in pain), rather than to her head (because she’d taken it for headaches before), I explained that it acts in the brain where she feels the pain, not where the pain actually “is.” In the case of emotional pain, the pain seems to be both in the body and in the mind, but the pain-feeling area of the brain is where these drugs act. See below about substance abuse.

People with BPD are likely to feel emotional pain many times a day every day. Since these emotions are basic (like fear, sadness and anger) the reactions to them are both physical and mental. These emotional pain-states are powerful and have the ability to overpower rational thinking. When you are in pain, regardless of the source, the main reaction of the body and mind is to get out of or to relieve the pain as soon as possible and by whatever means necessary.  I used the example of someone who is literally on fire. This person will try to douse the flames in any way, without thinking about the people around her and what harm may come to others if the flames spread. This situation is analogous to a person in deep emotional pain. The person will do anything to stop the pain, which is why my Internet site and Internet list are called “anything to stop the pain” (ATSTP). This “anything” includes self-destructive and relationship-damaging behaviors.

Self-injury

Self-injury can come in many forms and includes cutting oneself with razors or knives, burning oneself with cigarettes or matches, pulling out clumps of hair and picking at oneself (especially the nails and/or cheek) until blood is produced. Self-injury is one of the most difficult behaviors for the loved one to understand. In the case of BPD, self-injury is done for the purpose of pain relief, not to “get attention” or to manipulate the loved one. Most self-injury is done in private and done without the knowledge of the loved one. Occasionally, the self-injury cannot be covered-up (i.e. the blood and/or scars are apparent or the hair is missing in large area of the head) and others notice the activities. The actions themselves are fraught with shame and may lead to even more shame for the person.

In the hospital, ER doctors take a dim view of those who injure themselves and a person who engages in self-injury often avoid hospitals to avoid the inevitable judgment and lack of compassion these doctors (and nurses) will exhibit toward her. What is important for a loved one to understand is that self-injury has a purpose and that purpose is usually pain relief, not self-punishment or attention-getting. The person who engages in this behavior may feel and describe a deep “itch” inside her body that she has to rid herself of immediately.

While self-injury can provide relief from pain (through the release of endorphins, or natural, pain-killing substances within the brain), it can have risks and negative consequences. These include embarrassment, scars, infection and, in some cases, death.

Substance Abuse

As stated above, many people use alcohol and/or drugs to dampen the effects of emotional pain. With BPD, it is likely that alcohol and/or drugs will be used for this purpose. Drugs and alcohol CAN function to reduce pain. However, this pain reduction is temporary. What I have noticed from the ATSTP group is that people with severe BPD are likely to use large quantities of alcohol and/or drugs to deaden their pain. Some estimates of substance abuse by people with BPD are as high as 75%.

Many people with BPD use and abuse alcohol and drugs. Often, they will ingest large quantities (more than someone without BPD could handle) and not overdose or even pass out. They may take both prescription drugs with anti-anxiety medication, such as Xanax, Ativan and Klonopin (and others); painkillers, such as Oxycotin, Vicodin or Codeine (and others); or they may take illicit drugs, such as Marijuana, Cocaine, Heroin, or Methamphetamine (and others). The purpose, again, is to remove emotional pain. Unfortunately, these substances, especially in the quantities consumed, can have several negative effects and consequences, including overdose, driving violations and an increase in impulsivity or dyscontrol.  These periods of impulsivity and dyscontrol and the behaviors that result (such as “risk-taking behavior” below) may cause more shame and self-punishment when the BP sobers up.

Risk-taking Behavior

People with BPD also engage in risk-taking behaviors of various forms. These behaviors include risky sexual behaviors, reckless driving and thrill-seeking behaviors. Many of these activities could be considered life-threatening either in the short term (by having a car accident) or in the long term (by contracting HIV or another fatal sexually transmitted disease). The people with BPD will, at the time of the risk-taking behavior, most likely not consider the consequences to life and limb – either physical or legal. Again, the purpose is to halt and/or deaden the emotional pain. In other words: “it seemed like a good idea at the time.” Sexual activities can provide pleasure, dangerous driving can provide a thrill and other risky behaviors, like hanging out of windows or jumping off cliffs into lakes, can provide a rush of adrenaline that temporarily removes the emotional pain. The point is for you, the loved one, to understand that the motivation of these behaviors, however short-sighted and ill-conceived you think they are, is to remove pain.

One member of the ATSTP group reported that her husband had totaled four cars in a period of eight years. These behaviors are impulsive and therefore not “thought through.” They are another method to “put out the fire” within the person. Certainly, these behaviors can have significant consequences, physical, legal, financial and otherwise.

Eating Disorders

Another behavior that many people with BPD engage in (particularly females) is eating disorders. Whether it is starving oneself or binging-and-purging or overeating (especially secret overeating), the eating disorder is another tool someone with BPD can use to alleviate emotional pain.

Again, eating disorders can have negative consequences including starvation, ill-health, poor self-image and obesity.

Other Binge Behavior

Other binge behaviors (or indulgent/irresponsible behaviors) are binge shopping, obsessive plastic surgery and “running away” through binge travel. These behaviors provide temporary relief from emotional pain as well. And again, they can have negative consequences by damaging a relationship or financial consequences.

On a final note on dangerous behaviors: it is important to prioritize when you are trying to help the BP halt or alter their behavior. You will want to start with the most dangerous first. If your daughter with BPD is having unprotected sex and smoking marijuana, regardless of your feelings about drugs, the unprotected sex will have to come first. Also, you need to be practical about it. Giving her condoms and saying, “I can see how buying these or asking your boyfriend to wear one might be embarrassing to you” rather than insisting she no longer see the boy is probably more effective, again regardless of your feelings about premarital sex. Once the genie is out of the bottle, it is difficult to stuff it back in. You can, however, help make it safer and you do so by being effective. Of course, you also have to be brave in this situation. It can be very difficult for a parent to talk to a child about sex.

Adapted from When Hope is Not Enough

Related posts:

1. A Borderline describes cutting
2. 5th Anniversary of ATSTP List and Some Support for Non-BPDs
3. Ask Bon: Why does my loved one with BPD fear judgment so much?

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June 23, 2011
Expert on Mental Illness Reveals Her Own Fight
By BENEDICT CAREY
HARTFORD — Are you one of us?

The patient wanted to know, and her therapist — Marsha M. Linehan of the University of Washington, creator of a treatment used worldwide for severely suicidal people — had a ready answer. It was the one she always used to cut the question short, whether a patient asked it hopefully, accusingly or knowingly, having glimpsed the macramé of faded burns, cuts and welts on Dr. Linehan’s arms:

“You mean, have I suffered?”

“No, Marsha,” the patient replied, in an encounter last spring. “I mean one of us. Like us. Because if you were, it would give all of us so much hope.”

“That did it,” said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. “So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward.”

No one knows how many people with severe mental illness live what appear to be normal, successful lives, because such people are not in the habit of announcing themselves. They are too busy juggling responsibilities, paying the bills, studying, raising families — all while weathering gusts of dark emotions or delusions that would quickly overwhelm almost anyone else.

Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation’s mental health system is a shambles, they say, criminalizing many patients and warehousing some of the most severe in nursing and group homes where they receive care from workers with minimal qualifications.

Moreover, the enduring stigma of mental illness teaches people with such a diagnosis to think of themselves as victims, snuffing out the one thing that can motivate them to find treatment: hope.

“There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life,” said Elyn R. Saks, a professor at the University of Southern California School of Law who chronicles her own struggles with schizophrenia in “The Center Cannot Hold: My Journey Through Madness.” “We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.”

These include medication (usually), therapy (often), a measure of good luck (always) — and, most of all, the inner strength to manage one’s demons, if not banish them. That strength can come from any number of places, these former patients say: love, forgiveness, faith in God, a lifelong friendship.

But Dr. Linehan’s case shows there is no recipe. She was driven by a mission to rescue people who are chronically suicidal, often as a result of borderline personality disorder, an enigmatic condition characterized in part by self-destructive urges.

“I honestly didn’t realize at the time that I was dealing with myself,” she said. “But I suppose it’s true that I developed a therapy that provides the things I needed for so many years and never got.”

‘I Was in Hell’

She learned the central tragedy of severe mental illness the hard way, banging her head against the wall of a locked room.

Marsha Linehan arrived at the Institute of Living on March 9, 1961, at age 17, and quickly became the sole occupant of the seclusion room on the unit known as Thompson Two, for the most severely ill patients. The staff saw no alternative: The girl attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.

The seclusion room, a small cell with a bed, a chair and a tiny, barred window, had no such weapon. Yet her urge to die only deepened. So she did the only thing that made any sense to her at the time: banged her head against the wall and, later, the floor. Hard.

“My whole experience of these episodes was that someone else was doing it; it was like ‘I know this is coming, I’m out of control, somebody help me; where are you, God?’ ” she said. “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.”

Her childhood, in Tulsa, Okla., provided few clues. An excellent student from early on, a natural on the piano, she was the third of six children of an oilman and his wife, an outgoing woman who juggled child care with the Junior League and Tulsa social events.

People who knew the Linehans at that time remember that their precocious third child was often in trouble at home, and Dr. Linehan recalls feeling deeply inadequate compared with her attractive and accomplished siblings. But whatever currents of distress ran under the surface, no one took much notice until she was bedridden with headaches in her senior year of high school.

Her younger sister, Aline Haynes, said: “This was Tulsa in the 1960s, and I don’t think my parents had any idea what to do with Marsha. No one really knew what mental illness was.”

Soon, a local psychiatrist recommended a stay at the Institute of Living, to get to the bottom of the problem. There, doctors gave her a diagnosis of schizophrenia; dosed her with Thorazine, Librium and other powerful drugs, as well as hours of Freudian analysis; and strapped her down for electroshock treatments, 14 shocks the first time through and 16 the second, according to her medical records. Nothing changed, and soon enough the patient was back in seclusion on the locked ward.

“Everyone was terrified of ending up in there,” said Sebern Fisher, a fellow patient who became a close friend. But whatever her surroundings, Ms. Fisher added, “Marsha was capable of caring a great deal about another person; her passion was as deep as her loneliness.”

A discharge summary, dated May 31, 1963, noted that “during 26 months of hospitalization, Miss Linehan was, for a considerable part of this time, one of the most disturbed patients in the hospital.”

A verse the troubled girl wrote at the time reads:

They put me in a four-walled room

But left me really out

My soul was tossed somewhere askew

My limbs were tossed here about

Bang her head where she would, the tragedy remained: no one knew what was happening to her, and as a result medical care only made it worse. Any real treatment would have to be based not on some theory, she later concluded, but on facts: which precise emotion led to which thought led to the latest gruesome act. It would have to break that chain — and teach a new behavior.

“I was in hell,” she said. “And I made a vow: when I get out, I’m going to come back and get others out of here.”

Radical Acceptance

She sensed the power of another principle while praying in a small chapel in Chicago.

It was 1967, several years after she left the institute as a desperate 20-year-old whom doctors gave little chance of surviving outside the hospital. Survive she did, barely: there was at least one suicide attempt in Tulsa, when she first arrived home; and another episode after she moved to a Y.M.C.A. in Chicago to start over.

She was hospitalized again and emerged confused, lonely and more committed than ever to her Catholic faith. She moved into another Y, found a job as a clerk in an insurance company, started taking night classes at Loyola University — and prayed, often, at a chapel in the Cenacle Retreat Center.

“One night I was kneeling in there, looking up at the cross, and the whole place became gold — and suddenly I felt something coming toward me,” she said. “It was this shimmering experience, and I just ran back to my room and said, ‘I love myself.’ It was the first time I remember talking to myself in the first person. I felt transformed.”

The high lasted about a year, before the feelings of devastation returned in the wake of a romance that ended. But something was different. She could now weather her emotional storms without cutting or harming herself.

What had changed?

It took years of study in psychology — she earned a Ph.D. at Loyola in 1971 — before she found an answer. On the surface, it seemed obvious: She had accepted herself as she was. She had tried to kill herself so many times because the gulf between the person she wanted to be and the person she was left her desperate, hopeless, deeply homesick for a life she would never know. That gulf was real, and unbridgeable.

That basic idea — radical acceptance, she now calls it — became increasingly important as she began working with patients, first at a suicide clinic in Buffalo and later as a researcher. Yes, real change was possible. The emerging discipline of behaviorism taught that people could learn new behaviors — and that acting differently can in time alter underlying emotions from the top down.

But deeply suicidal people have tried to change a million times and failed. The only way to get through to them was to acknowledge that their behavior made sense: Thoughts of death were sweet release given what they were suffering.

“She was very creative with people. I saw that right away,” said Gerald C. Davison, who in 1972 admitted Dr. Linehan into a postdoctoral program in behavioral therapy at Stony Brook University. (He is now a psychologist at the University of Southern California.) “She could get people off center, challenge them with things they didn’t want to hear without making them feel put down.”

No therapist could promise a quick transformation or even sudden “insight,” much less a shimmering religious vision. But now Dr. Linehan was closing in on two seemingly opposed principles that could form the basis of a treatment: acceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it. The only way to know for sure whether she had something more than a theory was to test it scientifically in the real world — and there was never any doubt where to start.

Getting Through the Day

“I decided to get supersuicidal people, the very worst cases, because I figured these are the most miserable people in the world — they think they’re evil, that they’re bad, bad, bad — and I understood that they weren’t,” she said. “I understood their suffering because I’d been there, in hell, with no idea how to get out.”

In particular she chose to treat people with a diagnosis that she would have given her young self: borderline personality disorder, a poorly understood condition characterized by neediness, outbursts and self-destructive urges, often leading to cutting or burning. In therapy, borderline patients can be terrors — manipulative, hostile, sometimes ominously mute, and notorious for storming out threatening suicide.

Dr. Linehan found that the tension of acceptance could at least keep people in the room: patients accept who they are, that they feel the mental squalls of rage, emptiness and anxiety far more intensely than most people do. In turn, the therapist accepts that given all this, cutting, burning and suicide attempts make some sense.

Finally, the therapist elicits a commitment from the patient to change his or her behavior, a verbal pledge in exchange for a chance to live: “Therapy does not work for people who are dead” is one way she puts it.

Yet even as she climbed the academic ladder, moving from the Catholic University of America to the University of Washington in 1977, she understood from her own experience that acceptance and change were hardly enough. During those first years in Seattle she sometimes felt suicidal while driving to work; even today, she can feel rushes of panic, most recently while driving through tunnels. She relied on therapists herself, off and on over the years, for support and guidance (she does not remember taking medication after leaving the institute).

Dr. Linehan’s own emerging approach to treatment — now called dialectical behavior therapy, or D.B.T. — would also have to include day-to-day skills. A commitment means very little, after all, if people do not have the tools to carry it out. She borrowed some of these from other behavioral therapies and added elements, like opposite action, in which patients act opposite to the way they feel when an emotion is inappropriate; and mindfulness meditation, a Zen technique in which people focus on their breath and observe their emotions come and go without acting on them. (Mindfulness is now a staple of many kinds of psychotherapy.)

In studies in the 1980s and ’90s, researchers at the University of Washington and elsewhere tracked the progress of hundreds of borderline patients at high risk of suicide who attended weekly dialectical therapy sessions. Compared with similar patients who got other experts’ treatments, those who learned Dr. Linehan’s approach made far fewer suicide attempts, landed in the hospital less often and were much more likely to stay in treatment. D.B.T. is now widely used for a variety of stubborn clients, including juvenile offenders, people with eating disorders and those with drug addictions.

“I think the reason D.B.T. has made such a splash is that it addresses something that couldn’t be treated before; people were just at a loss when it came to borderline,” said Lisa Onken, chief of the behavioral and integrative treatment branch of the National Institutes of Health. “But I think the reason it has resonated so much with community therapists has a lot to do with Marsha Linehan’s charisma, her ability to connect with clinical people as well as a scientific audience.”

Most remarkably, perhaps, Dr. Linehan has reached a place where she can stand up and tell her story, come what will. “I’m a very happy person now,” she said in an interview at her house near campus, where she lives with her adopted daughter, Geraldine, and Geraldine’s husband, Nate. “I still have ups and downs, of course, but I think no more than anyone else.”

After her coming-out speech last week, she visited the seclusion room, which has since been converted to a small office. “Well, look at that, they changed the windows,” she said, holding her palms up. “There’s so much more light.”

 

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“…BPD is present in about 6% of primary care patients and persons in community-based samples and in 15 to 20% of patients in psychiatric hospitals and outpatient clinics,” writes John G. Gunderson, MD, from the Psychosocial and Personality Research Program, McLean Hospital in Belmont, Massachusetts. “Patients with BPD usually enter treatment facilities after suicide attempts or after episodes of deliberate self-injury. Such episodes result in an average hospital stay of 6.3 days per year and nearly 1 emergency room visit every 2 years, rates that are 6 to 12 times those among patients with a major depressive disorder.”

As you can see BPD has a major financial impact on the health care system, not to mention the distress for the patients and their families.

When reviewing the various treatment options, the author says this about mentalization therapy:

Mentalization-based therapy is a cognitive or psychodynamic therapy including individual as well as group therapy. While assuming a “not-knowing” stance, the therapist insists that the patient “mentalize,” or examine and label his or her own experiences and those of others. This emphasis on thinking before reacting may be a process central to all effective therapies.

That “not-knowing” stance is what I tell the nons that I know: Be a detective, not a judge.

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In my group recently, a non-BPD was questioning his own “sanity” (I put it in quotes because I don’t believe that people with BPD are insane) and speculating that he was the one with BPD. One of our longer-time posters replied:

If you’re not throwing full-blown temper tantrums, freaking out because EVERYONE is out to get you, threatening to hurt or kill yourself, running away from those who love you because you’re afraid they’re going to leave you first, complaining that NOBODY loves or respects you AND popping pills and guzzling alcohol all at the same time… then, I think, you can go ahead and disqualify yourself.

Based on the polls that I have conducted over the past few months, I believe that she is right on the money. Here are the poll results from the last few polls about borderline behavior:

Borderline Behavior Poll Results

As you can see by these polls results, more than 73% responded that their borderlines (or themselves if they have the disorder) indicated that they have engaged in self-injury, suicide attempts and/or substance abuse. While these polls are certainly not scientific and it’s pretty much impossible for me to understand the profile of a person that responded, they results are, for me, striking. If 7 out of 10 (or more) individuals engage in these “low functioning” or ineffective borderline behaviors at some point in their lives, what should that tell us?

I believe that it tells us that the “typical” profile of someone with BPD is the “low functioning” or “classic” borderline. While I am sure there are others out there that operate in pretend mode (and pretend everything is ok while they “white-knuckle” their way through life), the vast majority of people with BPD seem to be caught in a spiral of ineffective and often dangerous behavior. They seem to me to be sending the message that they are in a great deal of emotional pain and are suffering greatly – that they will do anything to stop the pain that they feel. It also indicates to me that it is vital for parents of child with borderline-like traits and feelings do their best to get the child into appropriate treatment before their teenage years.

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I believe that there is no right or wrong way to approach human emotions – there’s an effective way and an ineffective way and there are shades of grey in between those “polar” opposites. The effective way gets a positive outcome. That positive outcome is typically the return to baseline of the borderline and the establishment of a modicum of trust with others. One of the most important issues with borderlines seems to be the idea that they believe no one understands them (they feel “strange” – I said “broken” in WHINE, but I think that it was [a recovered borderline on the list] who clarified that it’s more like a “not feeling ‘normal’ and ‘fitting in’ feeling”), they can’t trust anyone with their emotions because many people have invalidated their feelings throughout their life and this leads to “silent desperation” and the inability to communicate effectively how they feel. If, through the use of my tools, you are able to gradually establish an environment in which your wife feels that she can safely express her emotions, which will go a long way toward establishing trust.

Secondly, you posted that you feel as through your feelings do not have a forum for airing and validation. Unfortunately for you, your wife sounds like a typical borderline. She is impulsive, she cuts, she abuses substances – especially painkillers. The divorce talk is probably born of either shame (“I will leave you before you leave me”) or of a feeling that she is being judged and/or disrespected (or not appreciated and accepted for whom she feels that she is). That leads to a certain mind-set that essentially makes her believe that, since no one has ever listened to her feelings before, she must dig in and hold on to her feelings as if she is the only person in the world. That is, “if I don’t fight for myself no one will”. This situation makes it difficult for you to express how you feel because she gets the message (even if it is not true): “YOU MADE me feel this way” because she thoroughly believes that about you. The reason she believes that you (and others, not just you) make her feel like she feels is that she is unable to self-regulate and looks to others to regulate her own emotionally states. When [a recovered borderline on the list] said something about her being more worried about what you think of her, she hit the nail on the head, because a borderline (and possibly for biological reasons) has a great deal of internal chaos and the usual strategy (also possibly biological) is to internalize other’s feelings and opinions about her self. It’s odd, yet I think that this dynamic is the one in which all the talk of not respecting boundaries arises. She feels at some level that you are actually a “part” of her, because she requires external validation. When that external validation turns to judgment, she has to cut you out of her mind. Sadly, she will continue to seek others (particularly men) to self-regulate until she can self-regulate.

As for IAAHF (“It’s all about his/her feelings”), one thing that many people read into that is that EVERY interpersonal situation is about her feelings and that she will not EVER be able to empathize with yours. This is neither the intent of IAAHF or the case. Borderlines are really empathetic (really no kidding they can be) but only when they are not on fire internally and emotionally. The intent of IAAHF is to EXPLAIN the “crazy” behavior, not to make a blanket statement about the relationship. When asked “why would she cut herself?” (for example) the answer is IAAHF. She’s in pain and the cutting helps alleviate that pain. Or asked “why is she raging at me over nothing?” (which happened to me the other night, presumably out of the blue). The answer is IAAHF.

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Websites may encourage self-injury in teens, young adults

Young adults and teens may believe that hurting themselves is normal and acceptable after watching videos and other media on Web-sharing sites like YouTube, new research indicates.

The findings, published in the journal Pediatrics, warn professionals and parents to be aware of the availability and dangers of such material for at-risk teens and young adults.

Deliberate self-injury without the intent of committing suicide is called “nonsuicidal self-injury” or NSSI. An estimated 14% to 24% of youth and young adults engage in this destructive behavior, according to the study. NSSI can also include relationship challenges, mental health symptoms, and risk for suicide and death, the study noted. Common forms of self-injury include cutting, burning, picking and embedding objects to cause pain or harm.

While other studies have looked at the availability of online information about self-injury, the authors focused on the scope of self-injury in videos uploaded on YouTube and watched by youth. They described their work as the first such study and noted that their findings could be relevant in risk, prevention and managing self-injury.

The authors focused on YouTube because, according to the site, since its inception in 2005 “YouTube is the world’s most popular online video community, allowing millions of people to discover, watch and share originally-created videos.”

Using the site’s search function the researchers looked for the terms “self-harm” and “self-injury,” identifying the site’s top 50 viewed videos containing a live person, and the top 50 viewed videos with words and photos or visual elements. The top 100 items that the study focused on were viewed over 2 million times, according to the analysis, and most – 80% – were available to a general audience.

The analysis of the self-injury content found that 53% was delivered in a factual or educational tone, while 51% was delivered in a melancholic tone. Pictures and videos commonly showed explicit demonstrations of the self-harming behavior.

Cutting was the most common type of behavior; more than half of the videos did not contain warnings about the graphic nature of the behavior. The average age of uploaders of the self-injury material was 25.39 years, according to the findings, and 95% were female. The authors surmise that the actual average age is probably younger because many YouTube users say they are older in order to access more content.

The study concludes that the findings about the volume and nature of self-injury content on YouTube show “an alarming new trend among youth and young adults and a significant issue for researchers and mental health workers.”

The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the risk for self-injury.

The study warns that health professionals need to be aware of this type and source of content, and to inquire about it when working with youth who practice self-injury because sites like YouTube can reach youth who may not openly discuss their behavior.

Self-harming is not typical behavior for otherwise untroubled teens and young adults, explained Dr. Charles Raison, an Emory University psychiatrist and CNNHealth.com’s mental health expert. It’s an action that kids with psychiatric problems may try.

“NSSI is a young person’s affliction…one in ten will kill themselves,” he said. “A lot of people will outgrow the behavior.”

Raison said that it’s common for troubled young people to share information about hurting themselves. Treatments can include antidepressants, antipsychotic drugs and psychotherapy.

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Lindsay Lohan Breaks Down in Court

Well, it’s been some time since I have written anything about celebrities with possible borderline personality disorder. Personally, I wish some celeb would just come out and admit that they have the disorder and help others by showing that there’s effective evidence-based treatments for BPD. I guess the stigma is too great and they feel that it would hurt their careers. Of course, for some, their behavior is what is hurting their careers. Today, I am turning again to Lindsay Lohan (click here to see all posts about LiLo). Lately I have been receiving a ton of alerts with news stories that contain LiLo’s name and reference BPD. These are usually in the user comments. I can’t find a single legit magazine or news article that has speculated on BPD and LiLo. Recently, her behavior has accelerated, even as she is facing jail. Here are some recent articles that could indicate that (in combo) LiLo has BPD (remember, this is just speculation at this point):

Lindsay Lohan goes Doctor Shopping
http://entertainment.oneindia.in/hollywood/top-stories/scoop/2010/lilodoes-doctor-shopping-for-prescriptionmeds.html

Washington, July 12 (ANI): Lindsay Lohan apparently obtains her dangerous combination of prescription drugs through “doctor shopping” across the country.

According to a source, Lohan goes to six different doctors for prescriptions.

“When one doctor says no to refilling a prescription, she will go to the next. It’s a whole process to get what she needed, ” TMZ quoted the source as saying.

Lindsay who has prescriptions for- Zoloft (antidepressant), Trazodone (antidepressant), Adderall (stimulant to control ADHD), Nexium (acid reflux) and the extremely powerful painkiller Dilaudid, have doctors both in Los Angeles and New York.

In fact, one of her past rehab facilities still prescribes her meds.

The source even added that, Lohan “would get a large supply every time” she visited a doctor.

Lindsay Lohan and Suicidal Ideation
http://www.hollywoodlife.com/2010/07/14/lindsay-lohan-suicide-watch-kill-herself-jail-90-days/

Lindsay Lohan would rather kill herself than be locked away in jail. The 24-year-old actress is reportedly so upset over the 90 day jail sentence looming over her since July 6, that she’s threatening to take her own life.

“She just kept repeating, ‘I can’t go to jail,’ and, ‘I’ll kill myself first,’” a source tells Star magazine. “She’s mentally unstable and getting worse.”

After Lindsay’s discovered she’d be serving time at the Century Regional Detention Facility in Lynwood, Calif., Star reports she went home and broke everything in sight.

“She ran around breaking mirrors, cutting herself and rambling like a lunatic. She tore her house apart before she finally just broke down,” reveals a source. “Lindsay’s on a 24/7 suicide watch, it’s so bad. She isn’t doing well with this.”

Not only is Lindsay going around saying she wants to kill herself but she’s taking a lethal dose of prescription drugs.

“She has been doctor shopping across the country,” she says. “She is utterly unable to control her use of any mind-altering substance.”

Lindsay Lohan and Self-Injury
http://www.radaronline.com/exclusives/2009/11/exclusive-self-harm-sign-%E2%80%9Cseverely-disturbed-behavior%E2%80%9D

In shocking phone conversations exclusively obtained by RadarOnline.com Lindsay Lohan’s mom, Dina, is heard expressing her concern over her daughter’s self mutilation. And with good reason, as experts in the field tell RadarOnline.com that self harm is often just one factor of greater, underlying emotional issues.

Renown psychotherapist, and author of Cutting: Understanding and Overcoming Self-Mutilation, Dr. Steven Levenkron tells RadarOnline.com that Lindsay’s behavior is a sign of disturbed psychiatric behavior and that it will take time and energy to help her heal. “Whether (a given patient’s) condition is termed being ‘out of touch with reality,’ ‘psychotic,’ or ‘in a diagnosed state,’ the scene constitutes severely disturbed psychiatric behavior,” Levenkron says. “ This is the element that must be present in order to meet the criteria for self-injury. ‘Severely disturbed behavior’ does not mean hopeless, but it does mean that it will take a long time, lots of focused attention, and an intense emotional bond between helper and sufferer in order to repair the damage.”

And Dr. Wendy Lader, PHD, President and Clinical Director of the S.A.F.E ALTERNATIVES program, a nationally recognized treatment approach, professional network and resource base, and an international speaker on self-injury elaborates, telling RadarOnline.com, “The main reason for self injury is to deal with emotional regulation. For whatever reason it helps them to calm down.

“People who self harm have the inability to communicate the depth of  their feelings.

“They can’t talk about their emotions. And they want to do something quick to deal with their frustration or anger. Cutting works immediately. As soon as they split the skin there is a release.

“The problem is that most people don’t just self harm by cutting. Many have eating disorders too.

“Its all about control. They have non over the way they are feeling but they can control their body image. It’s a dangerous combination.

“Some people describe the feeling as euphoric. But I think they are confusing that for release of tension.

“The way to help these people is to make them recognize that when they have an impulse to hurt themselves, it’s a clue that they don’t want to feel something.

“They need to focus on what it is they don’t want to deal with and try to attack it in a different way.

“Some people do manage to stop by themselves but others go their whole lives cutting or harming themselves.

“I encourage anyone going through this to be assessed.”

Lindsay Lohan and Emotional Regulation
http://www.torontosun.com/entertainment/celebrities/2010/07/13/14694551.html

Defence attorney Stuart V. Goldberg has spoken of his worries for Lindsay Lohan, insisting the jailbound actress lacks “awareness” of the “urgency” of her dire situation.

Goldberg was contacted by the Mean Girls star after her lawyer Shawn Chapman Holley attempted to resign last week, and held a six-hour meeting with Lohan, her mom and teen sister Ali in Hollywood to discuss her case.

The legal eagle, who ultimately turned down the case, admits the Lohans “didn’t seem to understand the urgency and gravity” of the situation, prompting Goldberg’s fears for the actress.

He tells People.com, “My impression of Lindsay is that she’s a fragile lost child – a sleeping beauty with her head in the sand. I found her not fully forewarned of the consequence of her actions.

“I’m concerned that she’s not disciplined or tethered enough to the reality of adult consequences. She doesn’t seem to have the awareness of what’s going to befall her.”

Goldberg asked Lohan if she might hurt herself, which moved the star to begin “sobbing quietly.” He adds: “She was genuinely in pain.”

He advised Lohan to move out of the “toxic environment” of Los Angeles but she seemed to refute the suggestion: “She was like Teflon to that comment. It just slid right off her. She seemed to have some inner deep sadness that that was her fate.

“My real worry for her is not just the jail time but my fear is that she’s overly susceptible to a probation system that’s set up for her to fail.”

The 24 year old was sentenced to 90 days in jail last week after Judge Marsha Revel ruled she had broken the terms of her probation from a 2007 DUI arrest by failing to attend court-ordered alcohol education classes.

Lohan’s lawyer Holley has been banned from quitting until papers for a replacement are filed in court.

Lindsay Lohan and Substance Abuse
http://www.mtv.com/news/articles/1643621/20100714/lohan_lindsay.jhtml

http://www.latimes.com/entertainment/news/la-ca-lindsay-lohan-20100704,0,4835943.story

Lindsay Lohan and Blaming Others
http://today.msnbc.msn.com/id/38127652/ns/today-entertainment/

LOS ANGELES — Lindsay Lohan had a message written on her middle fingernails while in court on Tuesday — and it was far from a note of contrition.

The 24-year-old actress — who was sentenced to 90 days in jail for violating her probation — had “f— u” written across her middle fingernail on both of her hands.

As previously reported on AccessHollywood.com, Lohan must turn herself into the court by July 20. She will then be held in Century Regional Detention Facility in Lynwood, Calif., where she will be in seclusion.

Steve Whitmore, a spokesperson for the Sheriff’s Department, told Access Hollywood on Tuesday that general, non-violent females are eligible to serve just 25 percent of their sentence — which in Lohan’s case would amount to around 22 days.

Clearly, the woman is in a lot of emotional pain, unable to regulate her feelings and behaviors and in need of someone to help her. Unfortunately, first, she has to admit she has an issue and seek help.

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Updated: Saturday, 31 Oct 2009, 1:37 PM EDT
Published : Saturday, 31 Oct 2009, 1:35 PM EDT

By MIKE BRODY

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“Sam and Lindsay are speaking,” the source tells PEOPLE. “But Sam has begged Lindsay to get help.”

“Lindsay, despite appearances, is insecure and has relied on Samantha and their relationship to build her up,” explains the pal. “Lindsay barely sleeps, which explains a lot of her behavior. She’s exhausted. She can’t even sit down for a minute without pacing around the room. It’s really sad.”

Sam is begging Lindsay to get help? For what? Well, perhaps we know.  Looking at Lindsay’s case, I can’t help but see Borderline Personality Disorder (BPD). She is erractic, emotional and sexually confused. She has all the classic signs of an untreated person with BPD. I hope she gets help – and I hope that, if she is diagnosed with BPD, she would come out publically and say so – to reduce the stigma of the disorder.

Lindsay Lohan and BPD?

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Celebrity Searches on ATSTP

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

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Celebrities’ bad behavior is rooted in mental illness, according to “Dr. Drew” Pinsky, who is best known as the host of Celebrity Rehab and Loveline — a nationally syndicated radio show that invites listeners to call in with questions about sex and drugs.

In his latest book, The Mirror Effect (on bookstore shelves Tuesday), he spells out a theory that stars are predisposed to narcissistic personality disorder long before they become famous. Their dysfunctional behavior is rewarded by Hollywood and portrayed as normal by the press.

“As reporting on celebrity behavior becomes even more ruthless and mean-spirited, I am struck by this disconnect between how a
celebrity’s behavior is portrayed in the media, and the very real problems that underlie their actions,” wrote Pinsky.

He argues that the media fails to acknowledge that celebrities are mentally ill when holding them up as role models, so everyday people have begun to emulate their unhealthy behavior.

In 2006, Pinsky and his co-author Mark Young published the first systematic study of celebrity psychology in the Journal of Research in Personality. The new book explains that research and how it fits into the larger context of our culture, which they argue has been soiled by shameless producers, agents and paparazzi.

The first three chapters read like a history textbook, recapping famous celebrity mishaps and an era when those unfortunate episodes were carefully hidden from the public. It gives readers a glimpse of just how conservative Pinsky really is. He seems to prefer the  good old days when movie studios were able to keep Rock Hudson in the closet.

The celebrity doctor is not a fan of MySpace or Facebook either, because they allow people to seek attention by acting out like celebrities — posting provocative pictures and personal stories about irresponsible behavior.

“Without appropriate monitoring, these social networking platforms are subject to abuse by those who are most vulnerable to the endless feedback loop they create,” wrote Pinsky. “This is known as an urge/compulsion/reinforcement cycle, and it’s very similar to what happens to those who crave drugs or other addictive substances.”

After that rather stiff introduction, the book becomes a psychology lesson with celebrities as examples.

Pinsky seems fond of interpreting behavior in the light of evolution, and gave this explanation for the asinine stunts performed by Johnny Knoxville and Steve-O on the show Jackass.

“Some have speculated that such acting out may be deeply rooted in our genes, as a way to display genetic prowess and adaptability,” wrote Pinsky. “In this theory, males (in particular) who survive dangerous stunts are displaying their biological capacity to survive in adversity.”

In their 2006 study, Pinsky and Young found that celebrities from reality television score the highest on the Narcissistic Personality Inventory. Pinsky is convinced that the producers of those shows carefully select contestants with psychological problems, because they will bring extra drama to each show.

“Having served as a consultant to several reality shows, I know what the producers are looking for in contestants,” wrote Pinsky. “The standards regarding mental health are extremely fluid.”

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Self-Mutilating Teens Embed Pins, Needles in Skin

Study Reports a New Form of Self-Injury, but Some Doctors Are Not Surprised

By LAUREN COX
ABC News Medical Unit

Dec. 9, 2008—

Some doctors are alarmed by what they see as a growing trend by adolescents to mutilate their bodies through “self-embedding” — inserting shards of wood, glass or paper clips under their skin.

Other medical experts, however, claim the embedding of needles and other objects in the skin is not a new syndrome, but is part of a growing problem of self-injury that is gaining attention.

The grisly debate began last week after a report at the annual Radiological Society of North America conference described “self-embedding syndrome” as a new development. The report cited 10 teens in Ohio who had slipped a sharp object into their skin.

“I was just sitting in class. I was kind of getting the urge to cut, but knew I couldn’t leave class right then,” Allie W., 16, told ABCNews.com in an e-mail interview. Allie, who is not one of the 10 Ohio teens in the Radiological Society report, asked that her full last name not be published for privacy issues.

“I had a safety pin in my purse and sometimes I scratch with that or something similar…like cutting, just less messy and less noticeable,” she said. “So I was going to do that, but for some reason I decided to slide it under my skin.”

At the time, Allie had been cutting for two years. She still self-mutilates, although she has tried to get help and support on cutting support groups online. Allie says she only rarely, and temporarily, embeds safety pins in her skin.

“I don’t think it’s any newer than cutting. To me it just seems like another form of cutting or self-injury,” she wrote. “As for it being a disorder. … I think it depends on if people think self-injury in general is a disorder. I personally don’t think it is because it always stems from something else; it’s more like a symptom.”

Allie said that her symptoms are also an addiction.

Since the report was issued Dec. 3 at the Radiological Society’s meeting, psychiatrists and psychologists who deal with self-injury have challenged that description.

“I know a lot of patients who have done this,” said Wendy Lader, a clinical psychologist, co-founder and clinical director of the Self Abuse Finally Ends, or S.A.F.E. Alternatives in Denton, Texas.

Lader said, “The majority of self-injurers don’t do one form of self-injury.”

From a simple survey of patients at S.A.F.E. Alternatives, Lader estimates at least 5 percent of people she has treated for self-injury have embedded an object under their skin.

Self-Embedding Known, but Rare

“Is it the most common form of self-injury? No,” said Lader. “But, I’m not quite sure why these particular radiologists are discovering this now.”

The Ohio radiologists who presented the “self-embedding” assert they could not find evidence of this behavior anywhere.

“We’ve got a very large children’s hospital, and we had not seen this disorder prior to 2005,” said Dr. William E. Shiels, chief of the department of radiology at Nationwide Children’s Hospital in Columbus, Ohio.

Besides a random handful of men piercing their eyes, Shiels said, “The medical literature has not had any reports [of self-embedding], ever.”

“We even talked to our chief of psychiatry, and he talked to his colleagues around the country, and they haven’t heard about this phenomenon,” he said.

Shiels said cases in five other cities in Ohio and several reports in Naperville, Ill., popped up once he and his colleagues announced the self-embedding disorder. “What happens, we believe, is that people are just discarding it as a fluke case,” he said.

Veteran psychiatrists disagree about why self-embedding stayed underneath the radar of so many other medical professions.

Lader suggested embedding may only be one small part of a growing problem of self-injury that has been gaining attention.

“Self-injury in general has definitely increased over the years, and probably in the last five or 10 years it has gone exponential,” Lader said. “We just finished a school manual [for teacher awareness] and we haven’t even fully advertised it yet, but people are clamoring for it.”

Other experts in self-injury and adolescents say that embedding may not turn out to be a lasting trend, but rather one example of how self-destructive behavior moves in fads.

“Embedding things or putting things in one’s body has been a pretty old-fashioned part of self-mutilation,” said Dr. Alexander Obolsky, a distinguished fellow of the American Psychiatric Association and an assistant professor of clinical psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine in Evanston, Ill.

Trends in Self-Destructive Behavior

“It doesn’t strike me as a particularly new thing,” said Obolsky, who has seen young adults embed objects in their genitals or under their skin in his private practice in Chicago.

Nadine Kaslow, professor and chief psychologist at the Emory School Medicine/Grady Hospital in Atlanta, has certainly seen self-embedding, even a generation ago.

“This has been around for a long time. I remember patients doing this in the ’80s,” said Kaslow.

“These things kind of goes in waves,” she said. “There was a wave of anorexia, there was a wave of bulimia. & This may be one of the current trends in self-mutilation.”

Despite doing in-depth interviews with the 10 patients at his hospital, Shiels said he still could not pinpoint how the idea of self-embedding passed from teen to teen.

“Two of them may have spoken with each other because they were in the same group home,” said Shiels. However the other adolescents had no contact with each other, and according to Shiels, all the patients say they did not find the information on the Internet.

According to Kaslow, it’s not necessary for a Web site or a group to directly spread a trend; it just takes some talk of an idea to spread around.

“It’s sort of a contagion factor, kids hear about it, it’s a new idea. & Then there’s a subgroup who finds it appealing,” she said. “Recently it was the choking game.”

While the majority of adolescents may just spread the idea and never self-injure, Kaslow said some susceptible proportion of people who hear the idea will try it.

Dr. Armando Favazza, author of the book “Bodies Under Siege” and a professor of psychiatry at the University of Missouri-Columbia, has found evidence of a spontaneous self-embedding trend in early 19th century Europe.

“Back in 1896 psychiatrists compiled medical reports on women [they labeled them all as hysterical] who stuck pins in their bodies,” said Favazza.

Just like Shiels presented Dec. 3, doctors in the 1890s presented X rays of women with needles, sometimes hundreds, embedded in their skin.

“It was a cultural influence that produced these ‘needle girls,’” said Favazza. “There was a lot of fascination with holy men in the Near East & and entertainers.”

Edward Gibson, a popular vaudeville entertainer in the late 1800s, used to ask the audience to push pins into his limbs, hands and feet. Favazza said couple this idea with emotional pain, and some women turned to embedding needles.

Self-Embedding Trends Across History

Whether embedding and self-injury became a trend in the 1890s, or the 1980s or the 2000s, psychiatrists assert that these behaviors are more serious than a fad.

“These are mostly women who have a severe history of childhood abuse, particularly neglect,” said Obolsky.

“What happens to them is the dissociation, it’s a painful state where they may space out for long periods of times,” he said. “To prevent this they may cut themselves, because pain, believe it or not, feels better than the dissociation.”

Favazza’s research indicates the population of self-injurers is 60 percent women, 40 percent men. He found dissociation as a reason, but several other motivations too.

“The most common reason by far, the most common reason is to reduce anxiety,” said Favazza. “Part of it can be to get to get attention, too.”

Kaslow said the self-mutilators could be suffering from a range of situations: troubled families where there’s lots of conflict; adolescents who are struggling with their identity or to fit in school; and abuse.

“It makes you raise the question of abuse, but it’s not necessarily a sure sign of abuse,” said Kaslow.

While Kaslow worries media reports will only make more susceptible teens try self-embedding, Shiels think it may be a better way to get them treatment.

“The big message we gave is this is not a story of despair. Now that we know what it is, we can treat it,” he said.

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Article published Dec 5, 2008
Innocent plea entered by caregiver in case where woman died
By Thatcher Moats Times Argus Staff
BARRE – Julie Davis is accused of doing too little too late to help a vulnerable adult who died while in her care last summer.

Davis, 47, of Calais pleaded innocent in Vermont District Court in Barre Thursday to neglect of a vulnerable adult by a caregiver, which carries a potential penalty of 15 years in prison and a $10,000 fine.

Davis was the caregiver responsible for Jean Lemire when Lemire, 45, died last August of hypothermia after being removed from Davis’ Calais home.

Lemire’s core body temperature was 82 degrees when she arrived at Central Vermont Medical Center, and she had multiple bruises, lacerations and a broken rib, court records state. When rescue workers found Lemire, she was soaking wet and had significant bruising on her face and chest, according to Jay Copping of the East Calais rescue squad. Lemire had been eating mud and grass, and Copping told police that he extracted muddy water and grass from Lemire as he attempted to force a tube down her throat.

The court records paint a picture of Lemire as a difficult person to handle, who become more so in the days leading up to her death. Her worsened condition may have been triggered by news of the death of her nephew, who family members said she was close to. Lemire was also scheduled to be moved from Davis’ residence, according to the affidavit, which also may have caused anxiety.

Davis told investigators that Lemire was a self-mutilator who would punch herself in the face and slam her face into the walls. Davis said that in the five days before she died, Lemire refused to sleep and often ran into the woods naked. She also ran over to a neighbors’ house without her clothes on a few days before her death.

On the day of Lemire’s death, Davis said Lemire had been given her morning dose of medication and then spent the majority of the day outside.

However, Davis didn’t call 911 until Lemire collapsed and stopped breathing. Davis had been trying to get Lemire to eat and drink Gatorade, she told investigators, and she performed CPR on Lemire until rescue workers arrived.

Shirley Cichonowicz, a sister and guardian of Lemire, told police that at the hospital the family decided to take Lemire off life support. Lemire died that Aug. 9 at about 10 p.m., according to court records.

Thursday’s proceeding in Vermont District Court in Barre was brief, and Davis was released on conditions. About 15 of Lemire’s family members were in the courthouse, and they filed out of the courtroom after the arraignment but declined to comment.

In an interview with police, Davis’ supervisor and Lemire’s case manager, Karen Daley-Regan, said that Lemire should have been placed in a crisis home based on her behavior in the days before her death.

Daley-Regan said that Lemire’s behavior before her death was uncharacteristic. But she also said that Lemire was known to take her clothes off and had an eating disorder, two of the things that lead to the woman’s death.

On Aug. 5, Daley-Regan prepared a monthly log that indicated no irregular issues with Lemire or Davis, court records state.

But the next day Davis reported that Lemire had gone to a neighbor’s home naked.

Daley-Regan then told Davis that she needed to have her eyes on Lemire at all times, but Daley-Regan did not do a home visit.

Daley-Regan told police that on Aug. 7 she checked in with Davis, who did not say there was an emergency.

Daley-Regan told police that had she known what was going on at the Davis residence, she would have intervened.

Davis told investigators that she tried to communicate what was going on when she talked to Daley-Regan, but also admitted she did not try hard enough. Davis also told police that she knows she should have done more to help Lemire, according to court records.

Communication was not Davis’ strength, according to a former colleague who was the case manager for one of Davis’ previous clients.

Troy Busconi, of the Vermont Crisis Intervention Network at Upper Valley Services, was the case manager for Shawn Leary, whom Davis cared for at one time.

Busconi told police that Davis lacked communication skills, and said he heard about a seizure that Leary had had only long after the incident. And when Davis asked for help, she would “not communicate it directly,” Busconi told investigators.

Davis had a limited skill set, but did the best she could, Busconi told police.

Last May, Adult Protective Services received a complaint that a caregiver was being abusive to her client in a local drugstore. The complainant, Lisa Sargent, took down the license plate number on the vehicle, which was registered to Doug Ballou, who lived with Davis in Calais.

Sargent also told police that the caregiver was referring to the client as “Jean.”

Another caregiver told police that he witnessed Davis scream at Lemire to get her to do things.

It also appears that Lemire was not the first client to die while in the care of Davis. The affidavit is not entirely clear on how much responsibility Davis may have had for the death of a man named Doug Lafrance, who, according to court records, died of pneumonia. But he was in her care when he died, according to the affidavit.

Police pointed out that in the two deaths, Davis did not call 911 until it was too late.

Lemire had been a client of Lincoln Street Inc., a non-profit agency based in Springfield, dedicated to caring for people with developmental disabilities, for 24 years. She was diagnosed with borderline personality disorder, according to the affidavit, and also suffered from anorexia, bulimia, seizure disorder and other conditions.

Lemire required daily doses of a handful of mood stabilizing and anti-depressant drugs.

Davis, who has been a homecare provider for 11 years, began caring for Lemire late last March.

Joan Senecal, the commissioner of the state Department of Aging and Disability, could not be reached for comment yesterday. Cheryl Thrall, the executive director at Lincoln Street declined to comment.

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Instead of cutting, some teens insert objects in skin

10:36 AM, December 3, 2008

As many as 20% of adolescents and young adults are believed to intentionally injure themselves, usually by cutting, as a response to emotional pain or trauma. But the number of ways people self-injure seems to be growing, perhaps spurred by Internet communication.

One researcher has identified a new phenomenon he calls “self-embedding disorder.” In a study presented today at the annual meeting of the Radiological Society of North America. Dr. William E. Shiels II says he has removed such items as unfolded paper clips, wood slivers, metal staples, needles, pencil lead and stones from the arms or legs of teenagers. An expert in extracting foreign objects from the body, Shiels described 19 episodes of self-embedding injury in 10 girls ages 15 to 18 and found some common characteristics. Ninety percent of the girls had self-injured before and most had attempted suicide or had thought about it. Forty percent had a history of sexual abuse. Most had other psychiatric disorders, such as bipolar disorder, depression, post-traumatic stress disorder or borderline personality.

Self-injury often takes the form of cutting, burning, biting or hair pulling. However, Shiels warned his colleagues to look for mysterious wounds that don’t heal. Patients rarely admit that they’ve inserted objects into their skin, he says.

“They come in with swelling and say they fell or something,” said Shiels, chief of radiology at Nationwide Children’s Hospital in Columbus, Ohio, in an interview. “I have spoken to doctors at five different hospitals and every one of them has seen this, but they didn’t know what to call it.”

Shiels, who developed an expertise in removing foreign objects from the body while working at military hospitals, said more research is needed on why people self-injure and how to prevent and treat it. Parents and healthcare providers should be aware of the high rates of self-injury and that some children and teens are discussing it on the Internet. In one of his cases, he said, a girl was coached by another teenager through Internet communication on how to insert objects in the skin.

“We need to interrupt this cycle of self-harm,” he said. “But parents often don’t see the behavior evolving . . . Adolescence seems to be increasingly more difficult for some children to handle.”

The Los Angeles Times Health section will present an in-depth look at self-injury later this week online and on Monday in the Health section.

– Shari Roan

Photo: Several pieces of metal grouped near the wrist can be seen on these two views of a teenage girl’s hand. Credit: William E. Shiels II, Nationwide Children’s Hospital.

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Ventura murder trial opens

By Raul Hernandez
Originally published 12:01 a.m., November 20, 2008
Updated 01:00 p.m., November 19, 2008

A Ventura woman tried break free from her killer’s grip but was stabbed more than 130 times in a deadly attack, a prosecutor told a jury today in the murder trial of 24-year-old Uriel Cruz.

Prosecutor Rebecca Day told jurors that the 2007 death of Barbarita Yvonne Luna, 25, was premeditated murder and that her alleged killer, Cruz, had been lying in wait.

“She was using her hands to push him away, but she couldn’t get out of his grasp,” Day said in her opening statement to the Ventura County Superior Court jury.

The prosecutor said Cruz and Luna were romantically involved until she broke off their relationship, and she refused his numerous requests to get back together.

Cruz is accused of stabbing Luna to death in a car in the parking lot of the Target store on Main Street in Ventura on May 11, 2007. Authorities say he drove away and was arrested later the same day by Los Angeles County sheriff’s deputies in Calabasas after his relatives urged him to turn himself in.

Today, the jury saw photographs taken by Los Angeles County deputies. One showed Cruz standing next to his car with blood on his clothes and face. Other photos showed the victim’s lifeless and bloody body, slumped in the passenger side of the car.

Cruz’s lawyer, Josie Banuelos of the county Public Defender’s Office, said he never intended to kill Luna.

In her opening statement to the jury, Banuelos said Cruz has a borderline personality disorder and a history of cutting himself to relieve his mental pain. Banuelos said he bought the knife to mutilate himself and had no intention of killing Luna.

“That knife was for him because he was going to go see Ms. Luna. He was afraid he might be hearing something he didn’t want to hear, and he could cut himself to relieve the pain,” Banuelos said.

She said every interview Cruz had with detectives indicates that he told them: “I didn’t intend to kill her. Why would I kill the woman I love?”

Day pointed out to jurors that Cruz isn’t using the insanity defense in his trial.

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May 30, 2006

Behavior

A Case in Point for the Maxim ‘Do No Harm’

By RICHARD A. FRIEDMAN, M.D.

Everyone knows that talking about your feelings is supposed to be good for you. In part, that’s probably why psychotherapy is widely viewed as a healthy pursuit. Conventional wisdom has it that self-knowledge is always a boon, and, like wealth, you can never have too much of it.

That’s what I thought until I met Helen.

Helen was a successful 52-year-old professional who had been married for 30 years. After watching “The Celebration,” a movie in which the family patriarch is publicly unmasked as a sexual predator by his children, Helen recovered what she believed were memories of sexual abuse by her father.

Over the course of several months, she felt depressed and angry and decided to start psychotherapy for the first time. Her therapist recommended twice-weekly sessions and encouraged her to discuss her childhood and memories of sexual abuse.

She became more depressed and anxious during the initial treatment, hardly unexpected given the traumatic material she had to deal with. But then something alarming began to happen.

Helen began to abuse alcohol, something she had never done before, and to cut her wrists superficially, an old behavior that she had stopped in her 20′s.

Helen was confused. If therapy was supposed to help her, why did she feel so much worse? What could explain the fact that this previously high-performing professional woman had become a serious alcohol abuser who was cutting her wrists several times a week with a razor?

The problem was that Helen had what psychiatrists call borderline personality disorder, and therapy had encouraged a process of self-exploration that proved toxic to her.

She did not have the psychological resources to deal with the intense emotions that this kind of therapy unleashed.

Borderline patients frequently use alcohol or drugs to try to stabilize their overly reactive moods, and they often injure themselves to relieve unbearable psychic pain.

In hindsight, it’s easy to see that this was just the wrong treatment for this particular patient. Yet even when she was given a more supportive treatment, aimed at helping her cope rather than delve into her feelings, she still floundered and didn’t function nearly as well as she did before having any therapy.

It will sound heretical coming from a psychiatrist, but there are some patients who feel worse and get worse when they are in psychotherapy. For some, the problem is getting the wrong type of treatment; for others, it may be the relationship with the therapist that is problematic, regardless of the specific treatment.

In an analysis of psychotherapy studies, Dr. Michael Lambert, a professor of psychology at Brigham Young University and a well-known expert in psychotherapy research, found that about 5 percent to 10 percent of patients deteriorated with psychotherapy.

This is not a trivial problem considering that 3.5 percent of all Americans were in psychotherapy each year from 1987 to 1997, according to a 2002 study published in The American Journal of Psychiatry by Dr. Mark Olfson of the College of Physicians and Surgeons of Columbia.

Although we are not very good at predicting which patients are likely to get worse with treatment, it’s not that hard to spot them once they are in therapy and things aren’t going well.

A few years back, one of my residents was treating a young man in psychotherapy who had great difficulty deciding what he wanted to do with his life.

He wasn’t depressed, but he was a very passive person.

It became clear that the patient was using the treatment not to understand his passivity, but to indulge it; he enjoyed talking about what he should do, but made no steps outside of therapy despite many attempts to address his behavior. We stopped his psychotherapy and referred him for vocational counseling.

The possible benefits of no treatment go beyond just patients who get worse in therapy. Some patients have been in psychotherapy for so long that it isn’t clear what the advantage of treatment is; in some of these cases, stopping therapy gives patients a chance to discover that they might do fine without it.

Others might seek treatment during a crisis or when they are grief-stricken. As painful as these situations can be, if people are generally healthy and have good social supports, they are likely just to feel better with time and probably don’t need any treatment at all.

At first blush, it might sound paradoxical — even uncaring — but sometimes the best treatment is no treatment at all.

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Amy Winehouse threatens to kill herself

Singer on 24-hour watch by worried friends

Monday, 6 October 2008

Amy Winehouse is said to be on suicide watch after she allegedly threatened to stab herself.

The singer is thought to have been pushed further downhill after her husband Blake Fielder-Civil rejected an offer of parole last month – because he didn’t want to stay with his mum Georgette Civil or wear an electronic tag.

Amy, 25, apparently held a knife to her chest in front of friends.

‘She said she was “caught up in a nightmare”,’ a source tells the Daily Star. ‘Her friends managed to get the knife away from her but are now holding a 24-hour watch on her.

‘Her emotions are exaggerated. She is either high as a kite or, when she hears something she doesn’t like, she is suicidal.’

Blake, 26, is being held at Edmunds Hill Prison after he was found guilty of GBH and attempting to pervert the course of justice. It is now thought that he has accepted another offer of early release.

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I recently  I had a member of my email list post a message thatsaid something to the effect of “these people (with BPD) have to punish themselves” (with self-injury).Of cours, I couldn’t disagree more. More often than not, it’s about relieving pain, not causing it.BTW, I don’t self-injure, but my wife’s self-injury was my introduction to BPD.

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The study, “8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual,” is the latest analysis of a randomized trial first reported in AJP in October 1999 and titled “Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial.”

Joel Paris, M.D., an expert on BPD, explained that mentalization therapy, developed by Bateman and Fonagy in the 1990s, is based on attachment theory and on observations that BPD patients have a failure of “mentalization”—the ability to observe their own emotions and those of other people and to appreciate how their behavior may affect others.

“Mentalization-based therapy can be considered as an amalgam of psychodynamic and cognitive methods,” he told Psychiatric News.

For instance, a case report included in the study describes a 24-year-old woman who was referred from forensic services after her arrest for setting fire to her university dormitory.

She had a history of recent suicide attempts and regularly burned herself with cigarettes and a hot iron. In individual sessions, treatment initially focused on clarifying her own feelings and others’ experience of her; later it progressed to helping her appreciate how her experiences of self-doubt and emotional turbulence led to a sense of fragmentation that was controlled only by experiences of intense physical pain, according to Bateman and Fonagy.

“The individual therapist identified these processes while focusing on the way she represented her own mental states and those of others with whom she interacted,” they wrote. “Gradually this was explored within the relationship with the therapist.”

They report the patient as stating, “It never occurred to me that what I did had an effect on anyone else.”

I have to say the suicide figures are astounding, especially when it comes to attempts. I mean, over 80% in two of the categories!

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© 1998-2001 Deb Martinson. Reprint permission granted with proper credit to author.

So, it is rather old, but I think it still applies…

Bill of Rights for People Who Self-Harm

Preamble

An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike. Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm

1. The right to caring, humane medical treatment.
   Self-injurers should receive the same level and quality of care that a person presenting with an identical but accidental injury would receive. Procedures should be done as gently as they would be for others. If stitches are required, local anesthesia should be used. Treatment of accidental injury and self-inflicted injury should be identical.
2. The right to participate fully in decisions about emergency psychiatric treatment (so long as no one’s life is in immediate danger).
   When a person presents at the emergency room with a self-inflicted injury, his or her opinion about the need for a psychological assessment should be considered. If the person is not in obvious distress and is not suicidal, he or she should not be subjected to an arduous psych evaluation. Doctors should be trained to assess suicidality/homicidality and should realize that although referral for outpatient follow-up may be advisable, hospitalization for self-injurious behavior alone is rarely warranted.
3. The right to body privacy.
   Visual examinations to determine the extent and frequency of self-inflicted injury should be performed only when absolutely necessary and done in a way that maintains the patient’s dignity. Many who SI have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of future self-injury while making the person subject to the searches look for better ways to hide the marks.
4. The right to have the feelings behind the SI validated.
   Self-injury doesn’t occur in a vacuum. The person who self-injures usually does so in response to distressing feelings, and those feelings should be recognized and validated. Although the care provider might not understand why a particular situation is extremely upsetting, she or he can at least understand that it *is* distressing and respect the self-injurer’s right to be upset about it.
5. The right to disclose to whom they choose only what they choose.
   No care provider should disclose to others that injuries are self-inflicted without obtaining the permission of the person involved. Exceptions can be made in the case of team-based hospital treatment or other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. Patients should be notified when others are told about their SI and as always, gossiping about any patient is unprofessional.
6. The right to choose what coping mechanisms they will use.
   No person should be forced to choose between self-injury and treatment. Outpatient therapists should never demand that clients sign a no-harm contract; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. No client should feel they must lie about SI or be kicked out of outpatient therapy. Exceptions to this may be made in hospital or ER treatment, when a contract may be required by hospital legal policies.
7. The right to have care providers who do not allow their feelings about SI to distort the therapy.
   Those who work with clients who self-injure should keep their own fear, revulsion, anger, and anxiety out of the therapeutic setting. This is crucial for basic medical care of self-inflicted wounds but holds for therapists as well. A person who is struggling with self-injury has enough baggage without taking on the prejudices and biases of their care providers.
8. The right to have the role SI has played as a coping mechanism validated.
   No one should be shamed, admonished, or chastised for having self-injured. Self-injury works as a coping mechanism, sometimes for people who have no other way to cope. They may use SI as a last-ditch effort to avoid suicide. The self-injurer should be taught to honor the positive things that self-injury has done for him/her as well as to recognize that the negatives of SI far outweigh those positives and that it is possible to learn methods of coping that aren’t as destructive and life-interfering.
9. The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
   No one should be put in restraints or locked in a treatment room in an emergency room solely because his or her injuries are self-inflicted. No one should ever be involuntarily committed simply because of SI; physicians should make the decision to commit based on the presence of psychosis, suicidality, or homicidality.
10. The right to have self-injury regarded as an attempt to communicate, not manipulate.
    Most people who hurt themselves are trying to express things they can say in no other way. Although sometimes these attempts to communicate seem manipulative, treating them as manipulation only makes the situation worse. Providers should respect the communicative function of SI and assume it is not manipulative behavior until there is clear evidence to the contrary.

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In the hospital, ER doctors take a dim view of those who injure themselves, and a person who engages in self-injury will often avoid hospitals to avoid the inevitable judgment and lack of compassion these doctors (and nurses) will exhibit toward them. Most people in the medical community – doctors and nurses included – have little or no training in dealing with people who self-injure and, for the most part, feel that they want to deal with other patients first, since the patient caused their own issue. Also, they will likely send the person to the psyche ward, which is usually not effective because the person was using a tool for pain reduction. They’re not crazy, just engaging in a practice that has significant negative consequences.

What is important for a loved one to understand is that self-injury has a purpose and that purpose is usually pain relief, not self-punishment or attention-getting. The person who engages in this behavior may feel and describe a deep “itch” inside their body that they have to rid themselves of immediately.

While self-injury can provide relief from pain (through the release of endorphins, or natural, pain-killing substances within the brain), it can have risks and negative consequences. These include embarrassment, scars, infection and, in some cases, death. For the loved one,  focus on the negative consequences of the behavior, rather than focusing on whether cutting is bad or wrong. Judging the behavior as bad or wrong will just create more shame.

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Self harm by children on increase

The number of children admitted to hospital due to self harm has risen by a third in five years, according to National Health Service figures.

There were 11,891 in 2002/3, and 15,955 in 2006/7. In both periods, there were more than three times as many admissions of girls than boys.

Liberal Democrat health spokesman Norman Lamb, who requested the figures, said they were “shocking”.

He blamed a lack of specialist mental health treatment for children.

Gender differences

Admissions of children aged 10 to 18 following some kind of self harm rose by 34% between 2002 and 2007.

There was also an increase in children under 10 hurting themselves deliberately, from 157 to 169 admissions in the same period.

Triggers can be exam stress, bullying and feeling isolated and alone Sue Minto, ChildLine

Among under 10s committing self harm, boys outnumbered girls, unlike in older age groups.

In the 10 to 18-year-old category, there were 12,346 admissions of girls in 2006/7, compared with 3,440 boys.

In total, there were more than 70,000 admissions of young people to hospital for self-harm in the five year period.

Mr Lamb also requested NHS figures on the number of children admitted to hospital suffering from eating disorders.

The total figure was nearly 4,000, with cases having risen by nearly 10% in the five-year period.

‘Relieving distress’

Sue Minto, from ChildLine, said: “The rise in numbers of children and young people who have eating disorders or are self-harming is deeply worrying.

“Young people with eating problems or those who are self-harming are often trying to cope with other problems. Triggers can be exam stress, bullying and feeling isolated and alone with no one to talk to.

“Self-harm can be an attempt to relieve distress.”

Many children are languishing on long waiting lists or not getting treatment that meets their specific needs Norman Lamb Lib Dem health spokesman

The forms of self harm recorded by hospitals included drugs overdoses, attempted hanging and deliberate injury with a sharp object such as a knife.

Mr Lamb said: “These shocking figures are just the tip of the iceberg as most young people suffering from these illnesses will never make it to hospital.

“The underlying problem is the lack of specialist mental health treatment.

“The government has allowed child and adolescent mental health services to suffer drastic cuts over recent years. This means that many children are languishing on long waiting lists or not getting treatment that meets their specific needs.”

Mr Lamb requested the figures in a written parliamentary question.

A spokesman for the Department of Health denied that the government was not doing enough.

He said: “We are fully committed to improving Child and Adolescent Mental Health Services (CAMHS) and the actual reported spend on CAMHS has increased from £322m in 2003/4 to £461m in 2005/6.”

The spokesman also said that the majority of children did not have to wait more than four weeks for mental health care.

“As a matter of fact, services in some Special Health Authorities were able to respond to demand for hospital care quickly and lengthy waits of over six months were very rare.”

Story from BBC NEWS:

http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/7379901.stm

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(For those of you who don’t know who Pete Doherty is: he’s the lead singer of two British bands: Babyshambles and the Libertines. He dated Kate Moss and he is a regular in the tabloids in London for his erratic and criminal behavior.)

Self-Harm

Painting in one’s own blood seems to indicate self-harm. Here’s another article about Doherty’s self-harm.

Quotes from the self-harm article:

Graphic footage of rock star Pete Doherty deliberately harming himself will not appear in a forthcoming fly-on-the-wall documentary about the former Libertines’ singer, as had been feared by mental health charities.

The scenes of Doherty cutting himself with a broken bottle feature in a rough edit of the documentary, to be shown on BBC3 on Sunday 28 August. The images of Doherty slashing his chest, taken from the edit, were leaked to the national press last week, raising concerns about his mental health.

Substance Abuse

Well, duh… He’s been put in jail numerous times for drug offenses, including heroin and cocaine abuse.

Quotes:

He appeared at Ealing Magistrates’ Court to face charges of possessing heroin and cocaine.

The 26-year-old was arrested by police after he was spotted driving a speeding car in west London on 30 November.

The former Libertines singer has continually been in the headlines over his drug abuse and his relationship with model Kate Moss.

He is due to reappear at Ealing Magistrates Court on 8 February.

The prosecution said police pulled Mr Doherty over after he was spotted speeding and officers said he had a glazed look.

He was found to have three packets of heroin, with a weight of 0.875gm (0.03oz), and one packet containing 0.234gm (0.008oz) cocaine.

Inappropriate Anger

More quotes:

Babyshambles singer Pete Doherty has been fined £750 after he admitted assaulting a BBC reporter in March.

The star pleaded guilty at Thames Magistrates’ Court to kicking a microphone out of her hand outside the same court after a separate appearance.

In a statement, the 27-year-old said: “If I hurt this lady I’m sorry.”

The star, who is currently being treated for drug addiction, was also ordered to pay £250 compensation and another £200 in court costs.

Painful hand

He had previously pleaded not guilty to a charge of assault by beating after he kicked out at Radio 1 Newsbeat’s Trudi Barber.

His defence lawyer, Sean Curran, said Doherty changed his plea after watching television footage of the attack.

Indentity Issues

He’s turning to Islam? I wonder how long that will last.

Quotes:

One of Doherty’s friends said: “He’s been reading the Quran since he went into segregation. He’s got a lot of Muslim friends and they’ve been on at him for ages to study it. Now he’s on his own and he’s got time on his hands to study it.

“I’m surprised how much it has calmed him down as he was very on the edge inside. He definitely seems more chilled. He’s lapping it up and really interested in it. I think it’s helping him in there.”

Doherty has been having a difficult time since his 14-week sentence began for violating probation by taking drugs.

Volatile Relationships

The UK hottest couple, Pete Doherty and Kate Moss, split up, after the beautiful supermodel dumped Pete, arguing she cannot stand his way of life anymore, always worrying about him.

On July 22, 2005, Pete Doherty was involved into
a street fight. British newspapers The Sun and Daily Mirror reports that Pete and musician friend Alan Wass fought with a group of Somali youths after they shouted “crackhead” at him.

Farid Khan of Supersave store in Camden Town, said: “The singer ran in pursed by six man. There was a big fight. We got them out but they hurled a brick at the door.”

Kate reportedly told friends: “I can’t go on spending day and night worrying about Pete. He would disappear without a word and I would not hear from him for days. He has to change his lifestyle. Until that happens we are finished.”

Sexual Confusion

DOHERTY: ‘I WAS A GAY RENT BOY AND DRUG DEALER’

Troubled rocker PETE DOHERTY has shocked fans by boasting he worked as a homosexual prostitute and drug dealer to fuel his drug addictions, before he shot to fame in his former band THE LIBERTINES.

The wild singer confesses he was so desperate for money to fund his cocaine and heroin habits, he worked as a rent boy and once robbed a gay client after tying him up at his home.

Dangerous Driving

Babyshambles singer Pete Doherty has been fined £300 and disqualified from driving for two months.

The 27-year-old admitted two charges of driving without insurance or a licence at Thames Magistrates Court in London.

District Judge Jane McIvor warned the singer that he faces jail if he drives without a licence again.

The rock star was arrested in November 2006 by officers who spotted him driving his Jaguar erratically near his east London home.

Shame

So you’ve got this support act, some posh bloke with a discomfited smile, slowly eating himself from the inside out from pure embarrassment. One guy with a guitar strumming idle fancies like ‘The Blue Ridge Mountains Of Dakota’, incapable of holding a note or playing a tune, and, what’s worse, he clearly hates himself for it. Pretty soon, he’ll be dead. And then he’s joined by a nonchalant Doherty in trenchcoat and hat. The place breaks out into hysteria. I’m blinded by about twenty camera phones flashing, then I’m nearly sucked under by the wave surging forward. Even Doherty, the boy in the bubble, advises everyone to move back because there’s a girl in the front whose eyes are bulging.

Suicide Attempts

Pete Doherty tried to kill himself in rehab after discovering that Kate Moss was dating a new man. British tabloids tattled that the ‘Babyshambles’ singer downed an entire bottle of pills-he just ended up making himself ill.

“He saw an opportunity to take an overdose and took it. He told me he didn’t know what the pills were but thought ‘fuck it’ and took them all,” says a NOW insider.

“He doesn’t care what drugs do to him—in fact, he likes finding out.”

“To begin with Kate was ringing him up all the time, concerned for his well-being.”

“But when Pete started to quiz her about the new guy, she was evasive and it got to him. She messed with his head.”

Impulsive Behavior

Anthony Thornton, the reviews editor of NME and an authority on The Libertines, said: ‘Pete is at a lower point than he was a year ago. He’s hit depths he didn’t even know existed. He’s not aware of how bad a state he’s in, and the drugs make it worse. He’s incredibly impulsive, he doesn’t take on responsibilities, he’s unreliable and likely to do himself harm.

Unsafe Sexual Behavior

I think anyone who was a male prostitute qualifies in this regard.

So, ole’ Pete hit just about all the categories that I applied to other celebrites. While I am not a doctor and can’t officially diagnose anyone… Pete Doherty looks suspiciously like he may have Borderline Personality Disorder (or something very close to it). And everyone, you will notice that I used mainly news articles in this analysis (with a bit of blogging, didn’t have time to look up interviews for shame – although I’ve been told he says he hates himself and he is a bad person).

Here’s his Wikipedia entry.

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Here are the Amy Wino stories:

Her father wants her committed. Quotes from this article:

[her father]: “I’ve told them (medical authorities) she is a danger to herself. There is evidence of self-harming and she’s a danger to other people because she’s attacked someone.

“Obviously as her dad I will try and do what’s best for her. Unfortunately, what I think is best for her and what she thinks is best for her are two different things.”

It’s not the first time Mitch has expressed his desire to have Winehouse committed – he previously revealed his intentions in January, but hospital officials couldn’t help, because she wasn’t considered a danger to herself.

She got off the assault charge with a “caution.” Here are some quotes from that article:

A police spokesperson said on Saturday: “She has left the police station. She has been cautioned for common assault.”

Winehouse went voluntarily to the police station on Friday afternoon.

Her spokesman, Chris Goodman, said in a statement that the singer had “admitted to a common assault by slapping a man with an open hand and accepted a caution”.

The statement added: “Amy was fully cooperative with inquiries and apologized for the incident.”

The caution means that the matter will remain on her record and could count against her should she be charged with a similar offence.

Related posts:

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2. Media Reports the Amy Winehouse may have had Borderline Personality Disorder
3. Amy Winehouse found dead at 27

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http://www.thisislondon.co.uk/showbiz/article-22525591-details/Doherty’s+blood+paintings/article.do

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Singer reported to have self-harmed in restaurant

Amy Winehouse reportedly stubbed a cigarette out on her own cheek in a restaurant.

The troubled singer was apparently having a crafty fag as she sat with pals in a London eatery last week.

But when a waitress asked her to stop smoking, it’s claimed she pushed the burning ciggie into her own skin.

‘She was so out of it she didn’t feel the pain,’ an onlooker tells The Sun.

‘Everyone else looked completely stunned. The waitress covered her mouth in shock and just walked off to tell the manager. It was a horrible sight.’

Last week, Amy, 24, was snapped with a swollen infection on her face, which her spokesman said was impetigo.

Meanwhile, jailed husband Blake Fielder-Civil, 25, is in a bad way himself.

It’s claimed he’s been self-harming in Pentonville Prison, where he is being held on charges of assault and conspiracy to pervert the course of justice.

A cry for help perhaps? Or just an impulsive action to show her disapproval for having to put out the butt? Usually, people with BPD use self-harm for pain relief, but this doesn’t seem to be the case with Amy Winehouse.

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Troubled mind
The discoveries added to the puzzle surrounding Kazmierczak.

While friends, family, educators and investigators remain baffled and shocked at the gunman’s acts, a closer look reveals that Kazmierczak’s friendly exterior masked a troubled mind.

University Police Chief Donald Grady said, without giving details, that Kazmierczak, 27, had become erratic in the past two weeks after he had stopped taking his medication.

A former employee at a Chicago psychiatric treatment center said Kazmierczak’s parents placed him there after high school. She said he used to cut himself, and had resisted taking his medications.

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5. Angelina Jolie (if you want a more detailed analysis of Angeline Jolie go here)

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

4. Courtney Love (to see all of the posts on Courtney Love go here)

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

New! An eBook that can help you in your relationship with someone with Borderline Personality Disorder. Beyond Boundaries is the next step in the evolution of the Non-BPD/BPD relationship.

3. Lindsey Lohan (Here is some more info on Lindsay Lohan go here)

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

2. Britney Spears (more on Britney try this link)

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

1. Amy Winehouse (for more on Amy Winehouse try this)

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

Think someone in your life that has Borderline Personality Disorder? Buy the book that has helped hundreds of people like yourself. When Hope is Not Enough: a how-to guide for living with and loving someone with Borderline Personality Disorder really is a how-to, step-by-step for loved ones of people with BPD to communicate more effectively.

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

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Inconsistency also seems like a harbinger of BPD. I think that
with wildly swinging emotions, people with BPD are widely
inconsistent. My wife can be manic and organized and get things done
one moment of one day and then depressed, crying and avoidant the
next. Now, you might think she is bipolar – but her moods last hours
(and sometimes minutes), not days or weeks.

A lot of her moods are governed by her medication schedule. She
recently (last week) switched off Xanax (whew!) and is
now taking Ativan, which she says “doesn’t work”. She of course
takes high doses and mixes it with alcohol, and has periods of
dyscontrol. We went to a neighbor’s birthday party on Saturday and my wife did something embarrassing.
I just took her home and went back to the party. But the
key here is that she is highly unstable in her moods. She uses the
drugs and alcohol to try and quell the pain, but they cause even
more instability.

I think that is why we often make mistakes
in “self-diagnosis”. For all I know, half the people (or more)
viewing the messages in my group are not dealing with BPD at all, but instead
something else. That is one of the reasons that a couple of months
ago, I specifically asked a mother on an email list whether her
daughter was diagnosed with BPD and how old the daughter was -
because the behavior that she described could be attributed to
many “disorders” (including the disorder of being a teenager).

There is a movement within the psychiatric community to change the
name of BPD. Some also want BPD to be classified as an Axis I
disorder. So, it could be that “borderline personality disorder”
will not exist anymore and BPD will not be a “personality” disorder
anymore. The point of saying this is that I think the traits of
which you speak are shared among many different disorders,
personality or otherwise.

In the CBT community, one of the things they talk about
is “cognitive distortions” – basically thinking in a way that
doesn’t match the “objective” facts. At times everyone, disordered or not, does some of these
things. In the case of BPD, many of these distortion can into play.
But these distortions are shared with other disorders and
with “normal” thinking.

Self-harm is sort of a sure sign of BPD (although not all
self-harmers have BPD) versus, say, PTSD. And the basic self-image
thing is also key. In fact, one of the things that many “nons”
don’t “get” about people with BPD is that the borderlines hate
themselves. The nons come to the table saying “this person (the
borderline) is SO selfish!” and they are angry about all the
behavior (which they have every right to be angry, the behavior is
quite frustrating). However, they don’t understand that behind this
maddening behavior is a deep, painful self-loathing. If that self-
loathing (and shame) is NOT there, then it is not BPD. From my
experience, there are not people with BPD that are OK inside. They
are not evil (let’s not bring up Hitler again, please – I’m sticking
with Princess Di as my BPD historical figure), they are
just “broken” inside.

As for impulsiveness and extreme emotional liberation (especially via drugs or alcohol), I have seen
studies that say that those things can be transmitted biologically.
As you know, I have a 9 year old daughter (who has a fraternal twin
sister), who is specifically impulsive and subject to stormy
emotions. Over the weekend, she told me and her twin that she would
not want to run for student counsel because (in her words) she
gets “overtaken by anger” and would be really “furious” if people
didn’t vote for her. She also got angry and pushed my 3 year old son
over and he smacked his head on a bookcase (he’s ok though). When I
came in and spoke to her about it, she lied to me. So here’s a girl
that’s 9 years old and exhibits the signs of emotional unstability
and impulsiveness. But has she been abused? No. Has she been
invalidated? Yes, many times.

The reason I bring her up is that I think that BPD has a biological
base as well. There was a really interesting article that [a member of the list]
posted about biological and social contributors to BPD. Maybe I can
dig it up.

I brought up an unstable personality because, when mixed
with shame, causes extreme personalization – but it is
not unique to BPD (the unstable personality or the personalization).
The shame, however, IS (I think). I saw a study that showed that
people with BPD reported feeling shame 14 times a day.

SHAME is considered the core emotion
by some psychotherapists. That just tells me that I’m not completely crazy if I
say, “if there’s shame, there’s BPD – if not, it’s probably
something else”. But hiding shame is the natural reaction to it. So,
we nons may not see it initially.

My wife has BOTH BPD and PTSD – because of childhood sexual abuse
(the PTSD). However, as I said before, I think there is also a
biological component to BPD and I’m not sure that you HAVE to have
been abused to have BPD; whereas with PTSD, trauma is necessary
(it’s built into the name for heaven’s sake). On the flip side,
Marsha Linehan said “not everyone who is sexually abused gets BPD”
(I’m paraphrasing) – so it seems to be her belief that there must be
a biological pre-disposition there. So, if we look at her biosocial
model, we see that there are biological components in combo with
an “invalidating enviornment” (not necessarily abuse). So it could
very well be that shame is 1) built into some people (my 9 year old
feels a lot of shame herself BTW) or 2) that the “invalidating
environment” is not strictly abuse or 3) both. If I look at my 9
year old’s shame, it seems awfully unfounded to me. You can
attribute my wife’s shame to her being sexually abused (and a large
portion of BPs have been abused in some way), but my 9 year old, she
feels very shameful about the way she feels. She feels shameful in
her skin. She has already expressed suicidal ideation (at 9!).

As for cutting or “blood letting” – geting something out of your system – that’s quite wise. I don’t
know if you’ve ever read Jim Carroll’s books about his heroin
addiction (“The Basketball Diaries” and “Forced Entries”), but there
is a scene in one of them, Forced Entries I think, in which Carroll
lances and drains his infected needle sight on his arm. I know it
sounds yucky (and it is), but he really translates it in a wonderful
metaphor for getting all the filth out of his system and liberating
himself from the pain he is in.

The suicide gestures are usually impulsive with BPD.

Of course, I could take suicide out of the equation, because I
could make the same statement about cutting (or burning oneself) -
that is, 95%+ of the borderlines I have come into contact with
(through their parents mainly) cut (or burn) themselves. My wife
cuts herself. She also picks her nails until they bleed. My 9 year
old with the emotional “issues” picks her nails until they bleed.
Her twin (and just to clarify, they are fraternal) sister does not.

A trained professional that works with borderlines
every day can diagnose BPD. You might remember the case that happened on another
list (ATSTP) in which the guy’s girlfriend sounded about as borderline as
possible, but when she went to U of Washington to get evaluated,
they said, “No, you have PTSD.” I don’t know how they told the
difference, but I suppose it had something to do with the
distinguishing charactersitics of BPD that are mentioned here: self-
injury, toxic shame and self-loathing, uncontrollable impulsiveness
and “emotional liberation” with mind-altering substances. Still,
those last 2 might show up in other disorders as well.

No related posts.

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Amy Winehouse and her husband basically got into a fist fight last night which left them both bloodied and bruised. Apparently Amy’s husband walked in on her cutting herself and about to do drugs with a prostitute when he intervened. The Daily Mail reports:

At around 2.30am, said guests, the fight sounded like it had restarted – then Miss Winehouse was seen sprinting down the corridor to the lift, pursued by her badly bleeding husband. One guest who got into the lift to reception at the same time said they started shouting at each other. “Amy was in floods of tears. This guy was screaming at her. She was cowering in the corner and I thought he was going to hit her. When the lift door opened, she took off across the lobby at a real pace. He was chasing after her and was about five paces behind by the time she got to the main hotel entrance.”The couple then dashed into the street. An eyewitness said: “Just after 3am, Amy came sprinting out and down the road. She was in a real state of panic. Blake was running after her, but couldn’t catch up.”

And like a good wife, Amy defends her husband, saying he was saving her life by beating her up:

“Blake is the best man in the world. We would never ever harm each other… I was cutting myself after he found me in our room about to do drugs with a call girl and rightly said I wasn’t good enough for him. I lost it and he saved my life.”

So not only did a 60 pound Amy Winehouse beat this guy up, she also outran him. Careful people, we may be dealing with the toughest man on the planet here. I hear he tames bears just by looking at them. Seriously though, this guy seems about as athletic as a grilled cheese sandwich. If you gave him a gun he’d almost be able to take on a girl scout.

as reported by the sperficial.com
Actual Story

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• Diana, Princess of Wales
• Colin Farrell
• Fiona Apple
• Johnny Depp
• Courtney Love
• Angelina Jolie
• Amy Winehouse (RIP)
• Pete Doherty
• Lindsay Lohan
• Darrell Hammond (recently added because he came out and said he cut himself)
• and others

I wonder if any of these people are also borderlines. No star is willing to come out and publicly say they are. I have updated the link to go to the appropriate page.

http://self-injury.net/media/famous-self-injurers

When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

A Bright Red Scream: Self-Mutilation and the Language of Pain

Cutting: Understanding and Overcoming Self-Mutilation

Helping Teens Who Cut: Understanding and Ending Self-Injury

Stopping the Pain: A Workbook for Teens Who Cut & Self-Injure

Scars That Wound, Scars That Heal: A Journey Out of Self Injury (Live Free)

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2. Self-injury Report
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I’m going to make a feeble attempt to explain this need to self injure. Have you ever had a bad itch, like poison ivy, that you just have to keep itching. I have. I recently had one ankle itch so bad that I took the heel of my shoe and itched it as we drove along in the car. I itched it so hard I scraped all the skin off. The wound was so bad it was scabed over for weeks. But it didn’t hurt when I did it; it did help relieve the itch. Well, borderline emotional pain is like that. When we experience rejection, or abandonment, or change, it hurts inside so bad that we have to do something to soothe that pain. We can’t itch it, we can’t rub it or massage it away, so we self injure to help take our minds off it.

http://www.angelfire.com/biz/BPD/story.html

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