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Article that mentions BPD and Anna Nicole Smith….
Doctor: Anna Nicole Smith medication ‘overkill’
By LINDA DEUTSCH (AP) – 3 days ago
LOS ANGELES — A hospital psychiatrist testified Friday that medication given to Anna Nicole Smith by a doctor now on trial was “overkill” for the kind of pain she was describing.
Dr. Nathalie Maullin said she believed Smith had “a borderline personality disorder” and was addicted to prescription medications.
Maullin said she was on staff at Cedars-Sinai Medical Center in April 2006 when Smith was brought in pregnant and in withdrawal from anti-anxiety drug Xanax and the pain killer Methadone. The celebrity model told her she had gone “cold turkey,” discontinuing her medications all at once because she was concerned for the welfare of her expected baby.
By doing that, Maullin said, she had actually endangered the baby and herself. The doctor said she quickly resumed her medication with Methadone and began weaning her off Xanax, both of which had been prescribed by Dr. Sandeep Kapoor, a defendant in the drug conspiracy case.
“My thoughts were these were very hard core medications to be giving for the kind of pain she was demonstrating,” said Maullin. “She was on medication that seemed like overkill for the type of pain she was in.”
She said it was difficult to get a medical history from Smith because she was “putting on a show” and was deferring questions to her lawyer-boyfriend, Howard K. Stern, who was with her at all times.
Kapoor, Stern and Dr. Khristine Eroshevich have pleaded not guilty to conspiring to provide excessive opiates and sedatives to Smith. They are also charged with prescribing drugs to an addict, but are not charged with causing her 2007 overdose death.
Maullin said Stern told her Smith had been suffering from back pain for five years. She said the former Playboy model also complained of pain in her upper back and arm.
Another doctor who testified earlier this week said Smith suffered from chronic pain syndrome all over her body.
Maullin said she conferred with Kapoor by phone, gave him her plan for weaning Smith off Xanax and any drugs known as benzodiazopines which can be addictive. She said he agreed and told her he would leave the prescribing of Methadone to her.
“Did you see any pain that needed treatment with opiates?” asked the prosecutor.
“No,” Maullin said.
The problem was that Smith showed no enthusiasm for the plan, the doctor said.
“It was like pulling teeth to get some response from her,” she said. “She was compliant but not really interested. She was not wholehearted.”
Five days after Smith checked in to the hospital, Maullin said she received a page at midnight from a nurse that said Smith’s eyes had rolled back in her head.
That sounded like a drug reaction and a one-time dose of Benadryl was prescribed, Maullin said. However, the next day, she received another call saying Smith was having hallucinations.
“The nurse said that she was flossing her teeth with no floss and was out of it,” Maullin said. “This was a radical change.”
Under questioning by Deputy District Attorney David Barkhurst, Maullin said she did not consider this an emergency and she tended to other patients before going to see Smith five hours later.
“In psychiatry, we are used to seeing patients do strange things,” she said.
Upon her arrival, Stern told Maullin that Smith “was generally acting goofy.” Smith was angry and made no eye contact but seemed lucid, Maullin said.
The psychiatrist said she suggested that Smith go into an inpatient facility that deals with addicts. But Smith wasn’t interested and told Stern she wanted to leave the hospital.
Maullin said she informed Kapoor and he said he would go to her house.
“I thought that was unusual,” she said. “Physicians generally see patients in the office or the hospital. There was no reason she could not leave her home to come to see him. Just in terms of proper boundaries with patients, you see them in your office.
“She needed to participate in her care,” Maullin said. “It’s not a home delivery service.”
 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.
Continue reading Lindsay Lohan and possible BPD (more detail this time) →
 Anti-depressants and Depression I believe that it has. Why? Well, there are a number of reasons that depression is a catch-all diagnosis. One certainly is the influence of the pharmaceutical industry given that billions of dollars are spent on anti-depressants each year. Also, doctors who are not mental health professionals (like GP’s) are prescribing anti-depressants if their patients are “depressed”.
Unfortunately, sometimes depression is not accurate. Many times when people say “I’m feeling depressed” they are really expressing that they are feeling emotional pain. Sometimes emotional pain is normal, sometimes a great deal of emotional pain is not normal and becomes problematic. When someone is feeling too much emotionally, it is not depression.
Depression is usually a problem when someone is feeling a strong lack of emotions – causing a lack of interest in the usual activities (including sex) that once gave us pleasure. Although many configurations of “depression” exist (because it is a non-specific term nowadays), the configuration in which one lacks emotions is alexythimia, although if one lives without pleasure it’s called anhedonia. I suspect that most people, when they describe being “depressed” are really describing a combination of anhedonia (where they can’t enjoy anything anymore) and social anxiety.
As I said above, another configuration that is referred to as “depression” is when the emotional pain becomes too overwhelming. In this case the person is feeling too much and would possibly beg for anhedonia because, while the pleasure would not be present, at least the pain would go away. I think that BPD probably involves more of this kind of “depression” than other disorders. The constant emotional pain leads people to doing anything to stop it (thus, this site’s name), including substance abuse, sexual promiscuity, risk-taking, self-injury and other seemingly self-defeating behaviors.
How can this be explained? How can someone be in such emotional pain all the time? One explanation comes from the study of u-opiods in the brain. A recent study by Stanley and Siever showed that people with BPD have too few u-opiods (the precursor for natural pain-killing neuro-chemicals) AND have over-active u-opiod receptors. This combination provides a baseline of pain and, when opiods are added, the brain feasts on these pain-killing substances with the over-active receptors. This is why some people with BPD can ingest large quantities of pain killers to seemingly little effect (or less effect than those without the disorder). I have heard people with BPD say they only feel “normal” while taking pain killers.
So, the question here is two-fold: First, are anti-depressants an appropriate treatment for emotional pain that is not really “depression”? And secondly, if not, what is? Low-dose pain-killers?
In case you missed my note from January of 2009 on the prevalence study of almost 35,000 adults (yep, that’s right 35,000!) by the NIAAA, here’s the abstract (emphasis is mine BTW):
Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.
Full Abstract
OBJECTIVES: To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of borderline personality disorder (BPD) among men and women. METHOD: Face-to-face interviews were conducted with 34,653 adults participating in the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Personality disorder diagnoses were made using the Wave 2 Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: Prevalence of lifetime BPD was 5.9% (99% CI = 5.4 to 6.4). There were no differences in the rates of BPD among men (5.6%, 99% CI = 5.0 to 6.2) and women (6.2%, 99% CI = 5.6 to 6.9). BPD was more prevalent among Native American men, younger and separated/divorced/widowed adults, and those with lower incomes and education and was less prevalent among Hispanic men and women and Asian women. BPD was associated with substantial mental and physical disability, especially among women. High co-occurrence rates of mood and anxiety disorders with BPD were similar. With additional comorbidity controlled for, associations with bipolar disorder and schizotypal and narcissistic personality disorders remained strong and significant (odds ratios > or = 4.3). Associations of BPD with other specific disorders were no longer significant or were considerably weakened. CONCLUSIONS: BPD is much more prevalent in the general population than previously recognized, is equally prevalent among men and women, and is associated with considerable mental and physical disability, especially among women. Unique and common factors may differentially contribute to disorder-specific comorbidity with BPD, and some of these associations appear to be sex-specific. There is a need for future epidemiologic, clinical, and genetically informed studies to identify unique and common factors that underlie disorder-specific comorbidity with BPD. Important sex differences observed in rates of BPD and associations with BPD can inform more focused, hypothesis-driven investigations of these factors.
Author information
Author/s: Grant, Bridget F (BF); Chou, S Patricia (SP); Goldstein, Risë B (RB); Huang, Boji (B); Stinson, Frederick S (FS); Saha, Tulshi D (TD); Smith, Sharon M (SM); Dawson, Deborah A (DA); Pulay, Attila J (AJ); Pickering, Roger P (RP); Ruan, W June (WJ);
Affiliation: Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA. bgrant(-atsign-)willco.niaaa.nih.gov
Grants: NIH0010171221 (Agency:PHS HHS) ; Z01 AA000449-04 (Agency:NIAAA NIH HHS)
Journal and publication information
Publication Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural
Journal: The Journal of clinical psychiatry (J Clin Psychiatry), published in United States. (Language: eng)
Reference: 2008-Apr; vol 69 (issue 4) : pp 533-45
Dates: Created 2008/05/29; Completed 2008/06/16; Revised 2009/05/06;
PMID: 18426259, status: MEDLINE (last retrieved date: 5/7/2009)
A story about the wrong-way driver, Diane Schuler, who struck an SUV head-on in her minivan, killing eight people
 Diane Schuler's Fatal Accident including herself. Apparently, she was intoxicated at the time. I can’t help but think she must have been in a lot of pain to have started drinking that early in the day. I feel for the victims. Such a sad situation.
Diane Schuler, Wrong-Way Highway Driver Who Killed 8 Had 10 Drinks, Was High
Toxicology Report in Taconic Crash Shows Marijuana, Double Legal Limit of Alcohol
By LEE FERRAN
Aug. 4, 2009 —
A New York mom had at least 10 drinks and smoked a large amount of marijuana before driving five children the wrong way down a highway and crashing head on into an SUV, investigators said today.
Diane Schuler, 36, was killed in the July 26 collision on New York’s Taconic State Parkway that also took the lives of her 2-year-old daughter and three nieces who were riding in her van as well as all three men who were in the SUV. Her 5-year-old son was the lone survivor of the crash.
Schuler had a blood alcohol content of .19, more than double the legal limit, and was also “impaired by marijuana,” according to a statement released by state attorney Janet Difiore citing a toxicology report by the Westchester County medical examiner.
Investigators could not determine if Schuler had been drinking while she was driving, but alcohol was in her stomach at the time of the autopsy and a bottle of vodka was found at the crash scene, New York State Police Major William Carey said at a press conference.
It was not clear exactly how much or when Schuler smoked marijuana; the toxicology reported “high” levels of THC, the active ingredient in pot, Westchester director of toxicology Betsy Spratt said.
But “there were approximately 10 drinks still in her,” Spratt said, that had yet to be metabolized.
The combination of alcohol and marijuana “intensified” the effects of each, Spratt said.
“With that level of alcohol we talk in ranges. She would’ve had difficulty with perception, judgment and memory. Around that level you get tunnel vision,” Spratt said.
Carey said, “There’s no indication there will be any criminal charges forthcoming.”
Police initially said they had no indication Schuler was impaired while driving, Carey said.
“We did not have people that morning describe Diane Schuler as anything other than to say she was fine,” Carey said.
The crash was ruled a homicide last week before the toxicology report was completed, Westchester medical examiner Dr. Millard Hyland told ABCNews.com.
“It was ruled a homicide in terms of people being killed because she was driving in the wrong direction,” Hyland said, and did not take toxicology into account.
The full report was completed Monday, Hyland said.
Roseann Guzzo, daughter of Michael Bastardi and Guy Bastardi, both crash victims, told New York’s The Journal News that while the report explains the once mysterious accident, it does not justify it.
“This wasn’t an act of God. This was her choice. She made the wrong choice,” Guzzo said. “This isn’t an accident. This is murder.”
The co-owner of the upstate N.Y. campground said she knew Diane Schuler well and saw her off on the day of the accident.
“If she had alcohol on her breath, I sure didn’t smell it,” said Scott. “The last thing I said to her was ‘have a safe trip home’ and she said, ‘We will’ and that was the end of it.
Woman Takes Deadly Turn
Schuler was driving home from a New York campground on the Taconic State Parkway, a route she knew well, when she somehow ended up driving the wrong way in the fast lane into oncoming traffic.
During the drive, Schuler called her brother to tell him she wasn’t feeling well. He asked her to pull over immediately. Schuler did not pull over, but her brother was worried enough to call the police.
Two hours after the call to her brother, police believe Schuler turned onto the parkway, heading down an exit ramp with signs clearly stating that she was heading the wrong way.
She drove in the fast lane, straight into traffic. Oncoming cars swerved to miss her.
Surviving Driver: She Was ‘In Control’
One of the drivers in her path, Richard Rowe, managed to avoid a crash with Schuler who he said seemed “in total control.”
“I don’t understand. She was in total control of the car,” Rowe said. “Maybe initially she was confused, but she had lots of time to correct her mistake. If we had been 30 seconds later, we would have been hit by her.”
Three men in the SUV from Yonkers, N.Y., could not avoid Schuler. All three were killed in the head-on collision.
While this article is not specifically about BPD, there is some mutilation in it (not self, but of a boyfriend), so it may be triggering to some. Here is long article on it and here is a link to a shorter article with pictures (be warned!).
‘Blackburn woman tattooed lover with Stanley knife’
8:50am Saturday 31st January 2009
A WOMAN used a Stanley knife to carve her name on the shoulder of her lover while he was asleep, a court heard.
Dominique Fisher, 22, of Blackburn, has gone on trial accused of unlawfully wounding Wayne Robinson, with whom she had a drink-and-drug fueled four-day fling after meeting in a nightclub.
As well as her name on his right shoulder, Fisher carved a star on his back and ‘body art’ on his left arm.
Mr Robinson said he woke up covered in blood to find himself cut, with Fisher ‘snoring her head off’ next to him.
Fisher had told him: “I’m a tattooist. I thought you’d like it”, the court heard.
But Fisher denies the charge and has told the jury she carried out the carvings with Mr Fisher’s consent.
The court heard the two had met by chance in the Syndicate nightclub in Blackpool on June 12 then spent a night together in a room at the Cliffs hotel where cocaine was taken before going their separate ways in the morning.
The next day there was further contact between them and Mr Robinson travelled by taxi from his home in Fleetwood to her Blackburn flat.
Steven Wild, prosecuting, said the man stayed with her for two nights and the pair drunk alcohol and took valium, not prescribed to either of them.
He told the court: “What the Crown say happened is that around 2.30am on the Sunday morning Mr Robinson woke and found he was covered in blood.
“He found a design carved into his left arm and the name Dominique into his right shoulder and a star carved into his back.”
Mr Robinson, 24, told the jury at Preston Crown Court that they took around 30 valium tablets between them that weekend.
He said “I watched a bit of telly, laid on the bed, drinking vodka, chatting. That is basically all I can remember.”
He woke up the first morning and she said they had had sex.
Mr Robinson said he presumed that on the Saturday he took more valium.
His last recollection was being “laid on the bed”.
Mr Robinson discovered the tattoos in the early hours of Sunday.
“I had been cut up, there was blood and Dominique was snoring her head off. I had slashes, cuts on my arms and back.”
He refuted defence claims that he had consented to the tattoos, that he had asked her to do it and had mopped up the blood. “I was comatose”, he added.
Mr Robinson’s wounds went onto heal, but has been left with visible scarring, the court heard.
In her evidence, Fisher, who the court was told was a woman of good character, said they sat chatting about the seven tattoos she had then.
She said he asked her to put ‘a tribal one’ on him. She told the jury she had never done it before and did not have a clue how to go about it.
Fisher, of Roebuck Close, in the Galligreaves area, said: “He was asking me questions like had I got anything sterile.
“I said I had Stanley blades because I had been decorating.
“He wanted to put his name into me and I said no. We were both awake, knew what we were doing and talking about.
“He was sat on the end of the bed, baring his arm. Both of us wiped the blood away.
“I was asking him did it hurt. He said ‘no, carry on’.”
It took a few hours to write the name Dominique and then the tribal tattoo.
Fisher said she could not remember doing the star on his back.
She later added in evidence: “I’m sorry for what I have done”.
The trial continues on Monday.
 Mindy McCready, of whom I have recently written regarding BPD, attempted suicide again…
Newsday.com
Mindy McCready in hospital after another suicide try
BY ROBERT KAHN
December 18, 2008
Anguished country crooner Mindy McCready has been hospitalized after what appears to be her second suicide attempt this year.
McCready, who was treated at a Texas rehab center this summer after an attempt to kill herself, was taken to a Nashville hospital yesterday morning with wounds to her wrists, according to local police officials.
The attempt comes at the end of a tumultuous year for the 33-year-old singer, who went public in April with claims that she was the other woman in an adulterous affair with superstar pitcher Roger Clemens. Clemens has never acknowledged such a relationship took place.
-Click here to see photos of Mindy McCready through the years
Nashville police last night said that McCready, whose legal first name is Malinda, called her assistant, Brent Young, at 7:50 a.m. to say she needed him to come over, because “she had done something bad.” Young arrived at 10:15 a.m. “and discovered that she had cut her wrists and taken several pills.” McCready was taken to Centennial Hospital, according to the report.
McCready’s attorney, Lee Offman, told Newsday last night that he was “still trying to gather details.” A call to Clemens’ agent, Randy Hendricks, was not immediately returned.
As recently as last month, McCready was publicly discussing the alleged affair with Clemens. “Carrying on a relationship with him is not something I’m proud of,” McCready said on the syndicated program “Inside Edition.”
McCready met Clemens at a Florida karaoke bar when she was 15 and he was 28. She has said her attraction to the athlete was instant.
“He treated me like a princess,” she said. McCready says the relationship did not become intimate until several years later. Her mother has said she believes the pair shared a “platonic” friendship.
Clemens has only apologized for “mistakes” in his personal life. Congress this year held hearings on the baseball pitcher’s alleged use of performance-enhancing drugs. Even as she attempted to refocus on her music career, McCready was interviewed by FBI agents for Clemens’ perjury investigation.
McCready suffered what she called a “nervous breakdown” in July and entered into rehab. After her release in September, she told reporters she was excited about recording a new CD.
The singer, who was once engaged to ” Superman” actor Dean Cain, has written a song about the tumultuous past few years in her life, “I’m Still Here.”
A prescription drug problem has landed her in jail twice. She most recently served time for violating probation after a drug arrest. Last month, she told “Inside Edition” she was optimistic about her future. “Redemption is out there for everybody to get, and just watch me. I’m gonna show you how to do it.”
-Click here to see photos of Mindy McCready through the years
Copyright © 2008, Newsday Inc.
 I’m not much of a country music fan, but I have stumbled upon Mindy McCready, who I suspect has BPD (again, I’m not a doctor or have I ever met her so this is an arm-chair analysis). Here are some possible clues:
Suicidal Tendencies
In May 2005, McCready’s ex-boyfriend, Billy McKnight, was arrested and charged with attempted murder after beating and choking McCready. The following July, McCready was found unconscious in a hotel lobby in Indian Rocks Beach, Florida after attempting suicide. She was hospitalized for a drug overdose after washing down a large amount of undisclosed drugs with alcohol. That September, McCready, who was then pregnant with McKnight’s child, attempted suicide for a second time by overdosing on antidepressants.
Substance Abuse
In August 2004, McCready was arrested in Tennessee for using a fake prescription to buy the painkiller OxyContin. Although she initially denied the charge, she pleaded guilty and was fined $4,000, sentenced to three years probation, and ordered to perform 200 hours of community service.
In May 2005, she was stopped by Nashville police for speeding and then arrested and charged with driving under the influence and driving with a suspended license. A jury later found her not guilty on the charges of DUI, but guilty of driving with a suspended license. That July, she was charged in Arizona with identity theft, unlawful use of transportation, unlawful imprisonment, and hindering prosecution.
Difficult Relationships
In May 2005, McCready’s ex-boyfriend, Billy McKnight, was arrested and charged with attempted murder after beating and choking McCready.
Inappropriate Sexual Behavior
In April 2008, the New York Daily News reported on a possible long-term relationship between McCready and baseball star Roger Clemens that began when she was 15 years old.
Clemens’ attorney Rusty Hardin denied the affair and also stated that Clemens would be bringing a defamation suit regarding this false allegation. Clemens’ attorney admitted that a relationship existed, but described McCready as a “close family friend”. He also stated that McCready had traveled on Clemens’ personal jet and that Clemens’ wife was aware of the relationship. However, McCready confirmed the relationship as being sexual in nature.
On November 17, 2008, McCready spoke in more detail to Inside Edition about her affair with Clemens. She stated that their relationship lasted for more than a decade, and that it ended when Clemens refused to leave his wife to marry McCready. However, she denied that she was fifteen years old when it began, saying that they met when she was sixteen and the affair only became sexual “several years later”.
 So, when I read about the movie “Rachel Getting Married” I heard a lot of my wife as a young adult in the Anne Hathaway character. Here’s a review that agreed that the character is probably BPD:
The story is simple enough: two big, intelligent, loving, and interesting families gather at the big, comfy, casual Connecticut home of the bride’s dad for the wedding of a sweet daughter of one to the gorgeous and loving son of the other. Immediately, though, you know there’s trouble. Another daughter, Kym, (played by Anne Hathaway, looking the part – no glam here) is getting a weekend pass from rehab in order to attend. Aside from her substance abuse problems, Kym is a classic borderline personality (Google “borderline personality disorder” for more info on this diagnosis), addicted also to drama and crisis. She has guilt but almost no ability to resolve things in her own mind. Without trying, she creates squirmingly difficult situations. How others react to her made me squirm – it feels so familiar. Debra Winger is the mom, divorced from the good-guy dad. She is perfect – you know her. The bride-to-be is loving, patient, but you sense a simmering underneath. The script rings true. The camera work (director Demme made “Silence of the Lambs”) made my friend a little sick – there’s a lot of handheld, closeup, herky-jerky filming. Sit toward the back of the theatre and it won’t have that effect. The rehearsal dinner and the wedding go on a little too long – not unlike actual events. I loved this movie, I think the inner state of Kym is shown with burning accuracy. The music and dancing is a thrill to hear and watch. The people are real-people beautiful. It’s great that way. The competitive loading-the-dishwasher scene (not a spoiler here) reportedly really happened years ago between screenwriter Jenny Lumet’s dad Sidney Lumet and Bob Fosse, and Lumet used it in this terrific movie.
Anyone seen it? I haven’t yet.
I stumbled across this article from 2006 in the Health section of the NY Times regarding treatment and BPD. I think it illustrates that certain treatments can be more traumatic on the patient than others (or no treatment at all). Personally, I think it also could make the case for CBT/DBT (or another behavioral treatment) because those treatments are generally focused on effective skill-building for the here and now, rather than dredging up the past right away, which could cause more trauma to the patient.
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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