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A little while ago, I posted an study about the over-lap between Major Depressive Disorder and Borderline Personality Disorder. The last sentence of this study was “In the meantime, the clinician treating major depressive disorder would be wise to assess for borderline personality disorder, even as currently defined.” That was because the study found a large correlation between the two disorders. Today, I was reviewing an article by Marsha Linehan called “Two-Year Randomized Controlled Trialand Follow-up of Dialectical Behavior Therapyvs Therapy by Experts for Suicidal Behaviorsand Borderline Personality Disorder” which I had planned to write something up about. I’ll have to do that later, but the reason these thoughts of MDD and BPD came to mind is that in the first paragraph of Linehan’s article she states:
“SUICIDAL BEHAVIOR IS A BROAD term that includes death bysuicide and intentional, nonfatal, self-injurious acts committed with or without intent to die. It is associated with severalmental disorders, including depression, substance dependence, and schizophrenia. Borderline personality disorder (BPD) is 1 of only 2 DSM-IV diagnoses for which suicidal behavior is a criterion.“
The emphasis is mine. I thought “what’s the other disorder that suicidal behavior is a criterion?” The answer: Major Depressive Disorder. So, today I am posting the DSM criteria for Major Depressive Disorder. It’s fairly long and I’ve included the “Major Depressive Episode” to clarify. If you’d like to get the full criteria, follow the “continue reading” link.
Continue reading Major Depressive Disorder and BPD →
Jessica Cahill tried to kill herself a month ago. She is 28 and has lived with severe anxiety and deep depression since she was 12. Cahill has been hospitalized nearly 30 times in her short life. One psychiatrist recently said she has borderline personality disorder.
Mental illnesses such as depression and anxiety disorders are complex and difficult to explain to those who haven’t lived through them. Cahill described her afflictions eloquently and with clarity over several hours of interviews.
She invites the Star’s readers inside her mind with the hope that it helps at least one person:
I want to talk about suicide because no one talks about it. Maybe if we talk about it, other people won’t feel so alone like I do right now.
I tried to kill myself on Nov. 1. My boyfriend was supposed to be gone all night, but he came back early. By then I had taken about a hundred pills and was unconscious. I was in a coma in the hospital and got out five days later.
I was even more down than usual that day. I usually wake up sad. Mornings are the worst. It takes a while to fall asleep because my mind is overactive. When I do fall asleep, I just want to sleep forever.
And I was just so tired of depression. Everyday I wake up sad and struggle to smile. Every day is the same. I can’t leave the house. I’m just not happy in my life. I felt hopeless and was done.
I wasn’t thinking properly. I was thinking about my parents, who worry so much. I wrote them a note and said I thought it would be better if I go so they can move on and not worry about me anymore.
But then they told me after that that’s ridiculous. I just think that I’m such a problem in their life. My mom is really involved. She wants me to get better, but I don’t know if she really understands I might not ever get better.
I got mixed up with OxyContin. I felt great when I was on Oxy. It numbs my feelings. It slows your brain down because it’s moving too fast otherwise. Millions of thoughts go through my mind — it’s overwhelming. And there are good thoughts mixed in with bad thoughts, but I always focus on the negative thoughts.
Those two months on Oxy were really fun, then it became problematic, and finally it’s hell and you have to have them. At that point, you’re sick when you’re off them and it’s a big fear if you don’t get your pill. You get muscle spasms, then you’re cold and you’re hot, and you got to find money for the next batch because you’ve got to get it.
I’ve been on everything, including Clonazepam. My mom hates Clonazepam. I love it, but I’ll abuse it. The relief I get when I take it is amazing. Within 20 minutes I’m a new person. I can be lying on the couch crying, take a pill and be up half an hour later.
It’s supposed to make you tired, but for me it gets me up, I can go out, talk to people and do everything I usually don’t do. I’m normal. That’s why I love it, but then I get a little anxious about losing that feeling, so I take more. I guess it’s ironic that I get anxious about running out of anti-anxiety pills while I’m taking anti-anxiety medication.
I just can’t take them properly, I pop them too close together and it builds up and I lose inhibition and go crazy.
My anxiety came early. I was a nervous child and really sensitive. I remember every remark and what other children thought. I cared more about what kids would say. In high school, a few boys would consistently make fun of me. They’d laugh at me when I had to speak in front of the class because I was nervous.
You know that butterfly feeling you get when you’re nervous? I have that all the time, although it’s not that bad in my stomach. Much of my anxiety seems to be trapped in my throat, like that frog-in-your-throat kind of feeling. It’s probably also from so much crying.
Since high school, I spent a semester at college, dropped out and have had about 30 jobs. I’d quit or miss shifts and get fired. I just don’t want to leave home. I’m on welfare and feel like a complete drain on society. I want to get a job.
I try to have a little hope. I’m supposed to start school in January at George Brown College. I hope it works out. But I’m worried already that I’ll have to take substances to go. Or I’ll miss class and fall behind. I’m just worried about everything all the time.
It’s hard to even walk down the street. I think people are looking at me, judging me and I feel uncomfortable. It’s scary. I’m lightheaded. And I’m always crying, even outside, even on the bus. And a lot of people don’t get it. They think I’m weak, but I just can’t help it. It’s me. I’ve become anxiety. I’ve become depression.
lcasey@thestar.ca
Q-factor analysis of adolescents who have attempted suicide may shed light on personality subtypes of attempters.
Personality Type Might Help Identify Teens at Suicide Risk
Leslie Sinclair
Q-factor analysis of adolescents who have attempted suicide may shed light on personality subtypes of attempters.
Studies of adolescents who have attempted suicide usually focus on identifying how they differ from their nonsuicidal peers. Researchers at Emory University, however, have begun to identify how adolescents who attempt suicide differ from one another.
Their work adds to previous studies that have reported personality subtypes within samples of adult suicide attempters and completers. “Overall, assessing adolescents’ risk of suicide attempt should include not only a list of risk factors but also a deeper understanding and consideration of personality,” wrote lead author Dorthie Cross, a doctoral student in the Department of Psychology at emory University, and her colleagues in the October Journal of Nervous and Mental Disease.
The researchers used a Q-factor analysis to identify subtypes based on the Shedler-Westen Assessment Procedure-II for Adolescents (SWAP-II-A), a 200-item measure of personality pathology administered by clinicians that was codeveloped by Drew Westen, one of the authors of the new study.
“Q-factor analysis is also called inverted factor analysis because it aggregates patients rather than variables, identifying people with similar profiles across a set of items instead of items with similar content across cases,” the researchers noted. “the goal of Q-factor analysis in this study is to identify groups of adolescent attempters with shared personality characteristics that distinguish them from other adolescents who have attempted suicide,” they explained.
The researchers recruited 950 psychiatrists and psychologists with at least three years’ postlicensure experience from membership rosters of the American Academy of Child and Adolescent Psychiatry and the American Psychological Association. Participating clinicians were asked to provide data on a single randomly selected adolescent patient currently in treatment of “enduring maladaptive patterns of thought, feeling, motivation, or behavior—that is, personality.” they were asked to select a patient without a particular diagnosis, yielding 267 patients with a history of suicide attempt. Publications detailing the sampling procedure and the rationale for using clinicians as informants in basic science research, also coauthored by westen and published in the American Journal of Psychiatry, were referenced.
Q-factor analysis of the 267 patients with a history of suicide attempt resulted in six subtypes: externalizing, internalizing, emotionally dysregulated, high functioning, narcissistic, and immature. Continue reading Personality Type Might Help Identify Teens at Suicide Risk →
PROUD mum Pamela Bowmaker final memory is a haunting one. On a night in September 2008, Vikki McGovern made a desperate call to NHS 24, screaming that she was going to kill herself. She repeated the words over and over again until a fire alarm went off in the NHS building. The worker on the other end of the line gave Vikki a telephone number and said she could phone again in ten minutes, before ending the call.
Tragic Vikki’s mum can’t forget court recording of girl’s last call
Published on Monday 28 November 2011 07:13
PROUD mum Pamela Bowmaker remembers how her daughter loved singing Spice Girls songs on her karaoke set. She once adored her Barbies, lived to play practical jokes and dreamt of becoming a children’s nurse.
But her final memory is a haunting one. On a night in September 2008, Vikki McGovern made a desperate call to NHS 24, screaming that she was going to kill herself. She repeated the words over and over again until a fire alarm went off in the NHS building. The worker on the other end of the line gave Vikki a telephone number and said she could phone again in ten minutes, before ending the call.
Vikki, 19, never rang back.
The next morning she was found dead in her hostel bedroom. She had taken a fatal dose of methadone. That dose had been given to her by a criminal who knew she wanted to kill herself.
“They played that tape in court three times,” says Pamela. “Vikki kept saying the call better not be traced or she’d run away and hide. She said she wanted to kill herself over and over. I think she was hinting at them to find her, it was a cry for help. Then the fire alarm went off and she was told to call back.
“That’s the last time anyone spoke to her.
“To hear that recording over and over again,” she says, before trailing off.
“It was unlucky what happened, but I think the NHS could have called back. I felt they had enough time to trace the call. Vikki phoned from the hostel’s office phone – from a place for people struggling with mental health. Vikki never got what she needed.”
Heartbroken Pamela visited her daughter’s grave last Wednesday to lay flowers – and let her know the “nasty piece of work” who gave her methadone during her desperate hours had finally been caged.
In Dundee High Court last Tuesday, with Pamela watching, James Whitson was convicted of culpable homicide after giving Vikki the lethal dose of the class A heroin substitute just days before her death in September 2008.
“In court, that lad smirked at us, although his smirk started to drop as the trial went on. It’s the second time he’s gone to court over this. He got off on appeal [in 2009]. When he was sentenced back then he got ten years. I hope he gets longer this time,” she says.
For Pamela, his imprisonment offers some comfort. She says his conviction will give her an opportunity to grieve.
A picture of Vikki as a baby takes centre stage on the living room wall in her Piersfield Place home, surrounded by pictures of her four happy, healthy siblings: Douglas, 19, Dionne, 16, Robert, 14, and Dale, 11.
Vikki, she says, was a girl who had “snapped” after the death of a close family friend – a grandfather figure – when she was 16.
“When she was growing up she was a typical wee girl. She grew up around a big family and she was a lovely girl. Her siblings adored her, they wouldn’t leave her alone.
“But when she was 16 our neighbour died. Vikki had been so close to him, she would tell him everything and she would visit every single day.
“The day he passed away, something snapped in her. She didn’t really react to the death, she just went into herself. She refused to go to the funeral, which I thought was strange.
“She said she wanted to remember him how he was before he died.”
Soon after his death, Vikki started self-harming. The increasingly nervous teen would wear long tops, which she’d pull over her knuckles to hide cuts to her wrists and hands. Vikki’s brother, Douglas, was the first to guess what was going on when he noticed bits of paper covered in blood scattered around his sister’s room.
“After that I’d regularly ask Vikki if I could see her arms,” Pamela says sadly. “But she got good at hiding the marks. She’d cut her legs instead.”
Frustratingly for Pamela, Vikki would try to hide as much as possible from her mother. “When she turned 16, that was it,” she says. “Vikki wanted to be independent and everything was confidential, the doctors would tell me nothing. When we heard in court that she’d tried to kill herself 13 times, I had no idea.
“Vikki was so quiet. She didn’t drink, she didn’t smoke, she didn’t do drugs. It was so hard to get her to accept help. I told her ,‘Shout, Vikki, shout when you get angry’, but she whispered back that she couldn’t.”
Soon afterwards, Vikki moved out of her home to a supported flat in the Meadows. Next, she moved to Cranston Hostel, then to St John’s Hill Hostel, where Pamela says “the problems really started”.
“One night when she was staying in Cranston, Vikki phoned me from the ERI. She’d been cutting herself too much. She told me she had to leave Cranston for her own safety.”
In a rare moment, Vikki confided in her mother that doctors had diagnosed her with borderline personality disorder.
“It made sense when she said it,” says Pamela. “Vikki could switch from telling everyone she wanted to die and was going to kill herself, then a minute later would be talking about her favourite music and what to get her brother for his birthday. I read that people feel very alone even when they’re not, and that makes me so sad.
“My concerns for Vikki got worse when she went to St John’s. Vikki was isolated there and it was full of people addicted to drugs and alcohol. I don’t believe it was the right place for her.”
Pamela also believes that a lot of the fellow residents used to bully her daughter, marching her to the bank so she could withdraw cash they would then spend and taking items of clothing. On the day Vikki died, the tearful mother claims that Vikki’s bag containing her mobile and belongings – things she would “never be without” – was stolen from her room.
“We’ve still never found it to this day,” she reveals. “My last visit to the hostel, about four days before Vikki was found, I remember my exact words to her support worker were: ‘I don’t feel my daughter is safe living here’.”
It was on September 20 that Pamela got the final knock on the door. “CID were standing there and straight away I knew. I remember I wouldn’t sit down because I didn’t want them to tell me Vikki had passed away.
“We later found out in court that the nasty piece of work at the hostel had been wanting to sell methadone. He’d asked Vikki if she wanted to buy it. I don’t know if he gave it to Vikki or she was too scared to say no, so she bought it. She kept saying she wanted to kill herself. Other people were laughing at her, saying she couldn’t even do that properly.”
Her bullies were referring to a previous attempt to kill herself with methadone the month before. In August she ended up in the ERI, where she sent her mother a text message saying she was sorry and that she wouldn’t do it again.
Tragically, Vikki did do it again. But Pamela doesn’t believe her daughter meant to do it. She is furious that methadone got anywhere near her tormented child’s hands.
“Vikki had been having a hard time before she died, but one of the support workers, Shirley, told Vikki on the Friday night that they were going to have a girly day the next day. Shirley found her dead at 9.30am.”
Vikki was buried on October 7 in Piershall Cemetery, just around the corner from where her heartbroken mother lives.
“The main thing is, I don’t feel like I’ve ever had a proper chance to grieve for Vikki. I just hope that now he’ll accept his sentence and let us move on as a family,” she says quietly.
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.
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. Continue reading I’m going to jump – Suicide Prevention and influencing factors →
Out of the darkness
Young student raising awareness
by Kevin Mertz
Published: Wednesday, September 28, 2011 8:21 AM CDT
MILTON — Seven-year-old Kiflyn Hockenbrock sat quietly by her mother Dawn Hockenbrock’s side, grinning from ear-to-ear, as Dawn spoke on the pride she has for her daughter, who has launched a fundraising effort to support a worthwhile cause.
Kiflyn, a second-grade student at Baugher Elementary School, will be participating in the Out of the Darkness Community Walk, to benefit the American Foundation for Suicide Prevention, Sunday, Oct. 16, at Lycoming College in Williamsport. She will be joined at the walk by a team of friends and family.
To raise funds for the walk, Kiflyn is spearheading a Chinese auction, to be held starting at 11 a.m. Saturday, Oct. 8, at the New Columbia Civic Center, located on Third Street in New Columbia.
Prevention of suicide is a cause close to Kiflyn’s heart. Her father, Cody Lahr, passed away as the result of a suicide in November 2009.
Dawn said her daughter has been traveling with her to a number of local businesses seeking donations for the auction.
“(I’m) very proud,” Dawn said of Kiflyn. “She’s shy. For her to go out to do this is amazing.”
Dawn said Kiflyn is also growing as a person by heading up the fundraiser.
“She’s learning there’s a lot of people who have the same issues, people who lost people to this issue,” Dawn said. “She’s not alone.”
She said Lahr had been diagnosed with a borderline personality disorder. In the days leading up to his suicide, a number of bad things had happened in his life, including a death in the family.
“It was too much (for him),” Dawn said.
She said Kiflyn is learning that it’s OK to talk about suicide and she hopes others realize that as well.
“(Suicide) is not something that’s really talked about,” Dawn continued. “It’s hush hush sometimes when something like this happens. It’s OK to talk about it. It’s OK to miss her dad or whomever it happened to.”
She said one of the goals of the American Foundation for Suicide Prevention is to get the word out that help is available for those who may be considering suicide and need support in their life.
Dawn said her daughter has had a strong support system since her father’s death.
Anonymous community members made a blanket for Kiflyn using fabric from T-shirts which had been worn by Lahr. A similar blanket was also crafted for Kiflyn’s younger sister, Laney Lahr.
Dawn said the blanket “means a lot” to Kiflyn.
“She slept with it the first couple of nights,” Dawn said. “It’s nice to have that constant reminder.”
She’s thankful for the community members who made the blanket. Members of the United Methodist Church in New Columbia also made pillows made out of Lahr’s jackets for his children, Dawn said.
She and Kiflyn are thankful for the various community members who are assisting in Kiflyn’s efforts to raise funds for the American Foundation for Suicide Prevention.
The family recently received notification that the Local 38 Union will be donating $500 to the cause.
“When we got the call about the $500, we about fell over,” Dawn said. “It is amazing. When I’ll go out and ask people for donation, people will say ‘I knew someone’ (who was a suicide victim).”
Items that will be a part of the Chinese auction include Vera Bradley items, a night’s stay at the Comfort Inn in New Columbia, a lottery tree and at least 50 gift certificates to local businesses.
Team members participating in the walk with Kiflyn and Dawn include: Stephanie Kreps, Jose Castro, Kristy Dreisbach, Kristy Foster, Courtney Haas, Millie Hockenbrock, Michelle Kashuba, Amanda Kiessling, Laney Lahr, Teresa Lahr, Jessica Reich, Donna Schaffer, Becca Stevenson and Genie Ficks.
For more information on the walk or the American Foundation for Suicide Prevention, visit http://afsp.donordrive.com.
Here is a quote from Infinite Jest about “depression” or the “Great White Shark of Pain”. I think it helps illustrate the difference between the chronically depressed and those in emotional agony. I see that people with borderline personality disorder are more likely to be in the second category. I have bolded some key points here. The “suicide contract” is exactly the same as a “behavior contract”. With a person in this much pain, it ain’t gonna work.
That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this depression clinical depression or involuntary depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton’s melancholia or Yevtuschenko’s more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.
It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.
It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain [(the big reason why people in pain are so self-absorbed and unpleasant to be around)], a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.
The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnosis can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it’s a closed circuit: the current is both applied and received from within.
The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death suddenly seems more appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who jump from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.
But and so the idea of a person in the grip of It being bound by a ‘Suicide Contract’ some well-meaning Substance-abuse halfway house makes her sign is simply absurd. Because such a contract will constrain such a person only until the exact psychic circumstances that made the contract necessary in the first place assert themselves, invisibly and indescribably. That the well-meaning halfway house Staff does not understand Its overriding terror will only make the depressed resident feel more alone.
By (author) David Foster Wallace
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Article about a University of Missouri swimmer who committed suicide. She had BPD. Sad, sad.
Missouri swimmer’s suicide might draw attention to disorder
By DAVID BRIGGS
Sunday, July 3, 2011
Sasha Menu Courey loved college life at Missouri.
She was a swimmer with Olympic ambitions but rarely missed a chance to set free a laugh so booming that it seemed to rattle the ceiling of teammates a floor below at Johnston Hall. The sophomore greeted friends — everybody counted as one — as if they were just the person she was hoping to see.
“It was always, ‘Heyyy!’ ” said MU swimmer Caitlin Connor, who met Menu Courey before a home football game their freshman year when she and her roommate from 233 Johnston searched out the source of the bursting cheer in Room 333. “She would talk to you like she had known you her whole life.”
In the classroom, Menu Courey earned a 4.0 GPA her first semester and was already planning for graduate school. The aspiring psychologist had lined up a prestigious internship this summer researching treatment for alcoholism.
“Everything she touched,” said her mother, Lynn Courey, “she was doing great.”
But this spring, Menu Courey fell into the grip of an illness she had kept hidden from the world.
Menu Courey committed suicide June 17 in a suburban Boston hospital. She was 20.
When a series of events one friend described as the “perfect storm” reached a crest, she slipped into a deep depression from which she would never escape.
Menu Courey left the team on March 21. She spent the next 10 days under watch and treatment at the MU Psychiatric Center, where her parents said she was diagnosed with borderline personality disorder, an illness characterized by extreme emotional instability.
Lynn flew in from the family’s Toronto home to be with her daughter when she was released. By then, however, she said she no longer recognized Sasha. Though Sasha often put on a cheerful front to keep friends and family from worrying, she bore an emotional pain too great to endure.
“We have difficulty understanding, as well, what happened,” Lynn said. “My daughter really had a great will to live, and suddenly she had a will to die.”
Now, Menu Courey’s family is celebrating a life that brought joy to so many while searching for answers and striving to raise awareness of a disorder they knew little about until it was too late. Continue reading Missouri swimmer’s suicide might draw attention to disorder →
In a recent article/review of Borderline Personality Disorder treatment options and management methodologies, the author quotes the Dr. John Gunderson in the New England Journal of Medicine May 26 issue:
“…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.
I’ve had conversations with several BPD “experts” about borderline behavior. There seems to be an assumption that many people with BPD are “silent” or “high-functioning” and do not engage in dangerous and/or ineffective behavior often attributed to the “typical” borderline.
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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