Shame and Implicit Self-Concept in Women With Borderline Personality Disorder

* Nicolas Rüsch, M.D., Klaus Lieb, M.D., Ines Göttler, M.D.,
Christiane Hermann, Ph.D., Elisabeth Schramm, Ph.D., Harald Richter, Ph.D.,
Gitta A. Jacob, Ph.D., Patrick W. Corrigan, Psy.D., and Martin Bohus, M.D. *

*OBJECTIVE: *Shame is considered to be a central emotion in borderline personality disorder and to be related to self-injurious behavior, chronic suicidality, and anger-hostility. However, its level and impact on people with borderline personality disorder are largely unknown. The authors examined levels of self-reported shame, guilt, anxiety, and implicit shame-related self-concept in women with borderline personality disorder and assessed the association of shame with self-esteem, quality of life, and anger-hostility.

*METHOD: *Sixty women with borderline personality disorder completed self-report measures of
shame- and guilt-proneness, state shame, anxiety, depression, self-esteem, quality of life, and clinical symptoms. Comparison groups consisted of 30 women with social phobia and 60 healthy women. Implicit shame-related self-concept (relative to anxiety) was assessed by the Implicit Association Test.

*RESULTS: *Women with borderline personality disorder reported higher levels of shame- and guilt-proneness, state shame, and anxiety than women with social phobia and healthy comparison subjects. The implicit self-concept in women with borderline personality disorder was more shame-prone (relative to anxiety-prone) than in women in the comparison groups. After depression was controlled for, shame-proneness was negatively correlated with self-esteem and quality of life and positively correlated with anger-hostility.

*CONCLUSIONS: *Shame, an emotion that is prominent in women with borderline personality disorder, is associated with the implicit self-concept as well as with poorer quality of life and self-esteem and greater anger-hostility. Psychotherapeutic approaches to borderline personality disorder need to address explicit and implicit aspects of shame.

http://ajp.psychiatryonline.org/cgi/content/abstract/164/3/500

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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)

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Pain hurts. Frustration is painful. It’s bothersome but it is bound to be a part of life. Not getting what you want, or having what you like taken from you, not getting your way and the many other of life’s frustrations can make you suffer. Like I said earlier, pain avoidance or the immediate cessation of frustration is one of life’s biggest motivators. Unfortunately, some of life’s frustrations don’t have an immediate remedy. Sometimes you have to live in a frustrating situation for a period of time. While you might start to believe “I can’t take it anymore,” I would encourage you to ask yourself, “Really? Can I not take it anymore?” Why do I mention frustration tolerance here? Because the process of healing can be a long one with steps forward and steps back. There will be times in your life that you will have to endure frustration, whether it is related to your loved on with BPD or not. Understanding that you can and believing your ability to endure is important.

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Teen Moodiness, or Borderline Personality Disorder?
By THE NEW YORK TIMES
Dr. Alec Miller

When The Times’s Personal Health columnist Jane Brody wrote about borderline personality disorder in “An Emotional Hair Trigger, Often Misread,” hundreds of readers had questions about the diagnosis and treatment of the troubling condition, characterized by impulsive behaviors, shifting moods and often frequent thoughts of suicide.

Here, Dr. Alec Miller, professor of clinical psychiatry and behavioral sciences and chief of child and adolescent psychology at Montefiore Medical Center at the Albert Einstein College of Medicine in the Bronx, responds to readers’ questions about borderline personality disorder in teenagers. Dr. Miller has spent the past 15 years working with adolescents and adults with borderline personality disorder and borderline features in inpatient, outpatient and school settings. He is also director of Montefiore’s Adolescent Depression and Suicide Program and co-founder of Cognitive and Behavioral Consultants of Westchester in White Plains, N.Y.

Read More

Personality disorder often characterized by self-injury, suicide attempts

Debbie Jackson

Saturday, February 27, 2010

Q My 30-year-old daughter has had problems with drug use for years and recently has been diagnosed with borderline personality disorder. What can you tell me about this disease and its treatment? — A.K., Belton

A According to the National Institute of Mental Health, borderline personality disorder (BPD) is a serious illness. A person with BPD has “pervasive instability in moods, interpersonal relationships, self-image and behavior” (NIMH, 2001). About 2 percent of adults have BPD, and most are women. Self-injury is common and suicide attempts are high. The National Association of Mental Illness (NAMI) provides further descriptions of individuals with BPD: “intense emotional dysregulation, marked by feelings of emptiness and loneliness, inability to tolerate being by oneself, mood swings and great difficulty in controlling ragefulness.”

Read More

Life or death for killer? Shrinks weigh in

By MENSAH M. DEAN
Philadelphia Daily News

In the courtroom battle over whether Mustafa Ali should live or die for murdering two armored-car guards in 2007, attorneys on both sides turned to psychiatrists yesterday.

Read More

The effectiveness of joint crisis plans for people with borderline personality disorder: protocol for an exploratory randomised controlled trial

Borderline Personality Disorder (BPD) is a common mental disorder associated with raised mortality, morbidity and substantial economic costs. Although complex psychological interventions have been shown to be useful in the treatment of BPD, such treatments are expensive to deliver and therefore have limited availability and questionable cost-effectiveness.

Less complex interventions are required for the management of BPD. A Joint Crisis Plan (JCP) is a record containing a service user’s treatment preferences for the management of future crises and is created by the service user with the help of their treating mental health team.

Read More

UW Needs mental health reeducation

Opinion: Guest column
By Kara Bellowe

Wednesday, February 24, 2010 1:05 a.m.

“Did you hear Alex goes to therapy?” “But she seems so normal!” Yes, how strange, because according to common consensus, she is by no means normal. She might have a mental illness! And of course mental illnesses entail complete dissociation from reality, arms flailing in the air, fingers wound tightly around a knife, eyes glowing in a raging stupor. OK, maybe your image is a little more progressive than that, but let’s be honest, there is a definite sense that having a mental illness is not normal. You’re not sick, you’re sick (said with wide-eyed, fearful pity). Either way, mental illness is just not very chic, especially in college when we’re supposed to be drinking and partying and feeling on top of the world. But Alex is acting normal, so we just won’t mention it. Because that would just be awkward, right?

Read More

Enjoy! And Look for more next week (hopefully).

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http://www.novelrank.com/title/when-hope-is-not-enough-paperback

Related posts:

1. Why did I bother to write a book?

I wanted to post a couple of observations about the new edition as well as some of the experiences that I and others have had with the book. My basic feeling about the book is that it is NOT a book to be used for staying with someone with BPD. SWOE is a book about YOU and YOUR feelings. It is a book that placates the Non-BPD person. That is fine, since that is the audience of the authors (which is probably why it has sold so many copies that and because it has a great title), yet people must realize that SWOE can’t be used to engender a trusting, loving relationship with someone with BPD. The evidence of this is in the subtitle: Taking back your life when someone you care about has borderline personality disorder. This is what I have observed from users of SWOE and the methods contained therein:  sure, you take your life back, but the relationship with the person you care about with BPD is wrecked.

Why?

Because SWOE is all about you. It is understandable that the authors created a book like this. I mean, how many of us Nons have asked “what about me?” Probably all of us. That’s a very natural question.

Yet, if the relationship is going to work properly, one of the first things that one must accept is that the behavior of the person with BPD is not about you.

What New Harbinger did with this new version of SWOE is that they highlighted the “angry non” aspect of the book. How? Look at the following images from the new version of SWOE:

As you can see, New Harbinger highlights the aspects of:

• manipulation
• irrational rages
• that YOU are not crazy
• chaos
• standing up for yourself
• protecting yourself

…which again is all very well and good if your goal in the relationship is to punish the other person and to make them behave. What really happens though is that the relationship will come to a screeching halt (or just get worse and worse) if you take this approach.

I know this because I tried it, as did several other husbands of wives with BPD and found (almost universally) that things get better for a while. SWOE CAN modify the BP’s behavior, but only through threats and punishment (which SWOE calls “boundaries”). Threats and punishment WORK, but only for a short period of time. When I applied the things in SWOE to my relationship, things got better for about a month or so. Then things got decidedly worse. The reason is that my wife was responding initially to the threat of punishment. However, those threats did not change her feelings or thoughts in any way. Only through positive reinforcement did she start to behave better. SWOE doesn’t teach positive reinforcement. And even positive reinforcement doesn’t change the way someone with BPD feels. That is done through a change in thinking patterns. You can take step one toward building a trusting, loving relationship with my book When Hope is Not Enough. Although the SWOE crowd don’t place much stock in it, it really works toward building a better relationship.

When Hope is Not Enough
Get the Non-BP book
that has helped hundreds!

Additionally, if one wants to really change the relationship and build it into a more trusting, loving one, what ultimately has to change is the way one thinks (both the person with BPD and the Non-BPD). Approaching the relationship with a “I’m not crazy, you’re the one that’s crazy” attitude, which IMO SWOE advocates, will never improve the interpersonal relationship. If you want to know how to take step two and change the thinking, try my eBook Beyond Boundaries:

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.

I think one has to ask oneself – what is the goal of what I am doing? If the goal is to make yourself feel better and more in control, regardless of what the other person feels, SWOE is a good candidate for you. If you want to build a relationship built on mutual understanding and trust, you will have to look elsewhere.

If you still want to give the new version of SWOE a whirl, have at it…

Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder

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DSM-5 Type and Trait Cross-Walk

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Some kids hurt themselves to feel better

By Theodore Beauchaine, Special to CNN

STORY HIGHLIGHTS

• Theodore Beauchaine says he sees rise in youth self-injury, such as cutting, burning
• Syndrome crosses culture, class; it’s linked to suicide, yet research funding lags, he says
• Kids say they self-injure to help deal with negative emotions, he says, but studies are sparse
• Beauchaine: U.S. must boost funding for study of self-injury

Editor’s note: Theodore Beauchaine is the Robert Bolles and Yasuko Endo Associate Professor of Psychology at the University of Washington, where he is also director of the Child and Adolescent Adjustment Project. He is editor of “Child and Adolescent Psychopathology,” associate editor of the journal “Psychophysiology” and a contributing author to the upcoming “Oxford Handbook of Suicide and Self-injury.”

Seattle, Washington (CNN) — They come from all walks of life. One teenage girl cuts her thighs after piano lessons to avoid the crushing pressure for perfection. She sees a therapist twice a week, but she never gets better.

Another young woman makes dangerous cuts to her arms and wrists when she is anxious. She is on her fourth foster placement because no one can handle her behavior. Another burns her fingers with a cigarette lighter when she hears her parents fight. She’s been hospitalized twice in the past year.

Stories such as these are heard daily by those of us who study and treat self-injury — that is, any activity resulting in intentional bodily damage to oneself. It is a syndrome found across cultures and socioeconomic classes (although it tends to be a bit more common among the more well-off), and it appears to be on the rise.

Though cutting the skin with sharp objects is the most common method used, especially by girls, other means of self-injury including head banging, overdosing, burning, hanging, drowning and shooting.

Given its potential for death and serious injury, this phenomenon has received increasing media attention, with a number of movies, such as “Secretary” in 2002, portraying the phenomenon.

From my perspective, this is an urgent public health issue, yet funding for research and treatment lags well behind funding for other behavioral disorders, such as autism.

Self-injury is troubling for several reasons.

First of all, almost 400,000 adolescents and young adults were treated medically for self-inflicted injuries in 2006, the most recent year for which these injuries were counted.

One recent study revealed that the number of children and adolescents in the U.S. who were hospitalized for depression, which is sometimes accompanied by self-injury among youth, increased by 27 percent between 1997 and 2007.

Second, self-injury is associated with crippling psychiatric distress. Girls who engage in such behaviors score lower than their peers on almost all measures of positive psychological adjustment, such as sociability, and higher than their peers on almost all measures of negative psychological adjustment, such as depression and delinquency.

Third, adolescent self-injury is linked to adult borderline personality disorder — a chronic and difficult to treat mental health condition characterized by impulsive behaviors, difficulties self-regulating emotions, mood instability and high rates of suicide.

Finally, self-injury is the single best predictor of suicide. Intentional self-injurers are about 75 times more likely to kill themselves than others in the population, an especially alarming statistic.

Scientists are not sure why rates of self-injury appear to be on the rise, or how to stop the trend.

When teens who self-injure are asked why they do it, most say the behaviors help them regulate overwhelming negative emotions, including anger, sadness and rejection. This emotion-regulating function may occur because injuries trigger the release of endogenous opioids, chemicals produced by the body that relieve pain. Over repeated episodes of self-harm, the endogenous opioid system may become more efficient at reducing physical and psychological pain.

Recent studies conducted at high schools and universities reveal that almost 20 percent of individuals self-injure at least once, and about 11 percent self-injure repeatedly.

Given how common the behavior is — and the alarmingly high risk of eventual suicide — one might expect self-injury to be a major public health priority. One might also expect considerable investment into basic science aimed at understanding the brain mechanisms involved and treatment-outcome research aimed at developing effective interventions.

Unfortunately, this has not been the case. Little is known about the brain mechanisms of self-injury, particularly in adolescence, and traditional approaches to treatment usually involve inpatient hospitalization, which is more cost-effective than individual care.

However, when treated in groups, as is often the case in hospitalization, self-injuring girls often become worse, not better, an effect known as contagion. (Note that this can also occur through access to Web sites and Web postings in which self-injurers share strategies.)

Nevertheless, there has been some progress toward understanding and treating adolescent self-injury.

On the basic research side, Christina Derbidge, a graduate student in my lab, is conducting a study in which the brains of adolescent girls who engage in self-injury are imaged as they cope with negative emotions.

On the treatment side, Dr. Marsha Linehan’s Dialectical Behavior Therapy at the University of Washington is signs of hope. The therapy is a variant of cognitive therapy and an effective treatment for adults with borderline personality disorder. It has been adapted to adolescent patients with encouraging results.

Despite these positive developments, a much greater investment is needed. For fiscal year 2010, the National Institutes of Health –far and away the primary source of funding for health research in the world — projects spending $41 million on suicide and suicide prevention (NIH does not report specific funding figures for self-injury).

In contrast, NIH expenditures for autism are expected to be $141 million in 2010. Corrected for the higher prevalence rate of suicide, this translates into a six-fold greater investment per person with autism.

Indeed, across the past five years, NIH has spent more than $700 million on autism research, with impressive results in terms of treatment effectiveness and our understanding of the genetic and neural underpinnings of the disorder. Given the urgency of preventing suicide among our youth, a similar investment is needed in self-injury research.

Related posts:

1. Pre-teen Girls Suicide Rates Go Way Up
2. Another article on Self-Embedding
3. Self-embedding: a new trend in self-harm?

New "Beyond Boundaries" eBook

I published a new eBook called Beyond Boundaries: the advanced guide for loved ones of people with BPD. This 72 page eBook is packed with information and tools for you to gain a more effective and calmer relationship with someone with BPD. It is the culmination of what I have done in When Hope is Not Enough as well as what I have been working on since. It explains (rather tersely) what you can do and how you can get your relationship to be more of a trusting, loving relationship. It also explains when boundaries are helpful and when they are not.

The cost of the new eBook is $18.00. I think you will find that it is worth it. People in NY will have to pay sales tax. Sorry, blame the NY State legislature.

The eBook is available through Google Checkout below:

Beyond Boundaries

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Understanding Borderline Personality Disorder

Monday, January 25th, 2010

By: Maiken Scott
mscott@whyy.org

“I hate you – don’t leave me” is the name of a popular book on Borderline Personality Disorder. The title only begins to describe the intense, rapidly changing emotions and fear of abandonment that people with this mental illness experience.

By her own admission, Talya Lewis was a strange child – as early as kindergarten:

Lewis: Like I remember one day I came in with white sticky tape wrapped all around my arm, and I told everyone that it was a cast and I had broken my arm.

Desperate for attention, she convinced her mother she couldn’t see, and got prescription glasses. By age 8 – her behaviors were self-destructive:

Lewis: I had a game, and I called it TP, and TP actually stood for taking pills. I would rummage in my parents’ medicine chest and I would take their pills.

This was only the beginning. Over the next years, Talya knocked her front teeth out with a hammer, started taking drugs, cutting herself, her behavior out of control in school. Her parents, whom she describes as distant socialites, didn’t seem to notice. But then came the wake up call.

Lewis: I overdosed on a bottle of sleeping pills in my high school, in the front lobby, and that was the beginning of what ended up years of long-term confinements in a private psychiatric hospital.

Talya was diagnosed with Borderline Personality Disorder, or BPD. Philadelphia therapist Edie Mannion describes it as a severe and complex mental illness with many symptoms:

Mannion: Difficulty regulating emotion, like a broken emotional thermostat, and difficulty controlling impulses, and what I see as mostly a profound amount of emotional pain

For people with this disorder, small problems explode into catastrophes, friends become enemies, love turns to hate – often with breath-taking speed. Relationships crumble, jobs rarely last. And their families are along for the ride. Camille Myers describes life with her daughter, who is in her 30s and has BPD.

Myers: You know, at times, she doesn’t want to live, she hates me at times, her world falls apart, at times she’ll walk into a room with my friends and family, and havoc breaks loose

Myers says relationship with her daughter is an exhausting roller-coaster.

Edie Mannion says the disorder has a bad rap among therapists, and many of the are reluctant to work with those who suffer from it

Mannion: People were taught that people who have this are manipulative, and split people, and all of these kinds of stereotypes, that make people not want to work with people who have this

A very high suicide risk also scares therapists away. Paradoxically – that’s what attracted the field’s premier researcher to this disorder. Marsha Linehan of the University of Washington set out to test treatments for highly suicidal patients – and found herself working with borderline patients:

Linehan: They have a ten percent suicide rate, so they are the highest rate of any group that I know, and really they are really incredibly interesting to work with.

Linehan has developed what many hail as the most successful treatment for this disorder. It’s called Dialectical Behavioral Therapy, and is an intensive, long-term intervention that tries to end the destructive cycle of intense pain and strong reaction.

Linehan: The first thing you have to do is radically accept that you ARE hurt, and be mindful of that emotion, but also, you then have to move to trying to regulate the hurt and regulate actions related to hurt

Patients learn these skills in individual and group sessions, during phone coaching, and the therapists have a strong support system.

Part of the treatment is to teach family members how to de-escalate situations. Camille Meyers has taken the course and gives an example. Recently her daughter asked her for help with directions, but got very angry when Camille printed out maps for her:

Meyers: I don’t want to read maps, I don’t like maps, maps don’t help me!!!!!!!!

Camille remembered not to fan the flames:

Meyers: Previously my reaction would have been okay, I can’t believe you’re telling me this, you asked me to help you, I spent all of this time … if you think they are not going to be helpful to you, I understand, maybe maps don’t work for you

Her daughter has started Dialectical Behavior Therapy, and is doing well so far.

Talya Lewis, meanwhile, says she’s in recovery after many turbulent years. She works as a therapist, helping people understand Borderline:

Lewis: With this disorder I want people to have a wall of compassion, where you protect yourself, but at the same time, you can deal with the person in this kind of ongoing way, and empathetic manner.

She says her disorder didn’t go away, but she works constantly to manage the symptoms. It is, she admits, exhausting to be her.

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