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Borderline Personality Disorder: Not Just an Adult Condition

Many start engaging in high-risk behaviors, such as substance abuse or self-harm, to help deal with the emptiness. The picture of BPD begins to emerge.

Borderline Personality Disorder: Not Just an Adult Condition

Batya Swift Yasgur, MA, LSW
November 20, 2017

To shed light on this ongoing controversy and its therapeutic implications, Psychiatry Advisor interviewed Carla Sharp, PhD, professor and director of clinical training in the Department of Psychology at the University of Houston, Texas. Dr Sharp is the co-editor of the Handbook of Borderline Personality Disorder in Children and Adolescents2 and the co-founder of the Global Alliance for Early Prevention and Intervention for Borderline Personality Disorder (GAP) Initiative.

Psychiatry Advisor: What is the controversy surrounding the diagnosis of BPD in adolescents?

Dr Sharp: Ever since the first descriptions of BPD and specification of its diagnostic criteria in the DSM [Diagnostic and Statistical Manual of Mental Disorders], there was no restriction placed on diagnosing it in adolescents. Nevertheless, in our training programs, we were taught that one does not make a personality disorder diagnosis before age 18 years, even though the DSM allows for it.

One of the major arguments raised against diagnosis prior to age 18 is that, since the personality is still forming and identity is still being consolidated, a personality disorder cannot be accurately diagnosed.

A strong research base2 has been mounting, especially in the past 10 years, supporting the concept of a diagnosis of BPD in teens. It has been found that personality traits are as stable in children and adolescents as they are in adults. In other words, we have overestimated the stability of personality traits in adults. We used to see them as fixed and stable and postulated that they would be less stable in children and adolescents. But in reality, this is not the case. Traits wax and wane in both age groups.

Psychiatry Advisor: Adolescence is often a time of angst, stormy emotions, moodiness, and confusion. How do BPD traits differ from those of normal adolescence?

Dr Sharp: The first clue that a teenager may not be experiencing “normal” adolescent angst is that these traits likely began before adolescence and even in childhood. Children come into the world with a given temperament, and in the case of these children, they are unusually sensitive. I compare this type of child to a burn victim. When you touch the skin of a burn victim, he or she experiences pain that is far greater than the pain that might be experienced by an ordinary person from the same type of touch.

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Why Aren’t There More Resources for Adult Self-Injurers?

Even getting adults to commit to group therapy can be a challenge. Adults are burdened with more responsibility than adolescents and may have trouble finding the time and effort to make the commitment for their own healing, even when resources are available.

Why Aren’t There More Resources for Adult Self-Injurers?

By Renée Fabian 03/21/17
Over time, self-injury itself can become a habitual, nearly addictive behavior, and 8.7 percent of self-injurers are also addicts.

Erin Hardy, a Wisconsin-based therapist, found herself in a quandary when an uptick of people who self-injured came to her about five years ago. This was a new area to her practice, so Hardy sought consultation with her colleagues on resources, but they came up empty. An internet search left Hardy with unsatisfactory results.

“All the sudden I had this flood of individuals that were engaging in self-harm,” says Hardy. “There is really nothing [online] about self-harm other than the theme of, ‘Anybody who self-injures has borderline personality disorder,’ and … ‘there’s no cure, nobody can get better.'”

Undeterred, Hardy kept searching until she found S.A.F.E. Alternatives, an organization co-founded by Wendy Lader and Karen Conterio in the mid-1980s dedicated to self-injury recovery with the belief, “people can and do stop injuring with the right kinds of help and support.” Through their S.A.F.E. Focus program, Hardy got the training and materials she needed to lead a dedicated self-injury support group in her city.

Today, a similar internet search for self-harm resources yields information focused on adolescents. As one PsychForums member put it, “I have been online searching for several hours today regarding finding help for self-harm, and I’m 40. I have been seeing that it is mostly in young people, and feeling pretty embarrassed and ashamed that I’m an adult dealing with it. I feel like I should have grown out of this long ago.”

The pervasive idea that self-injury is a behavior relegated to emo teenagers is simply false. Self-injury affects 4 to 5.5 percent of adults, yet the stigma persists, leaving millions of self-injurers to struggle in silence and feel invisible.

Defined as intentionally harming the body without suicidal intent through behaviors such as cutting, burning or hitting oneself, self-injury serves as a maladaptive coping skill to deal with difficult emotions, experiences and feeling states.

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CBT most effective treatment for repeat self-harm

CBT seems to be effective in patients after self-harm. Dialectical behavior therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm.

CBT most effective treatment for repeat self-harm
Hawton K, et al. Lancet Psychiatry. 2016;doi:10.1016/S2215-0366(16)30070-0.

Recent findings showed cognitive behavioral therapy after self-harm was effective while dialectical behavior therapy did not reduce repeat self-harm but reduced frequency of self-harm.

“Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in young adults aged 15 to 35 years, often repeated, and strongly associated with suicide. Effective aftercare of individuals who self-harm is therefore important,” Keith Hawton, FMedSci, of the University of Oxford, and colleagues wrote.

To assess efficacy of psychosocial interventions for self-harm in adults, researchers conducted a Cochrane systematic review and meta-analysis of 29 randomized controlled trials with three independent trials of the same intervention for adults with recent self-harm.

http://www.healio.com/psychiatry/suicide/news/online/%7Ba5986951-5515-4dee-802a-a0ecbf453f3a%7D/cbt-most-effective-treatment-for-repeat-self-harm

There is much to learn about self-injury

Rejection and Pain

Rejection and Pain

Of note is that Non-Suicidal Self-Injury (NSSI) people say they actually feel better after hurting themselves.

There is much to learn about self-injury

Michael Kulla, For the Poughkeepsie Journal 12:56 p.m. EST March 4, 2016

This article is about young people who cut, scratch, burn, carve, interfere with wound healing or bang their heads against a solid object.

Tattooing and piercing are usually not considered maladaptive because they are culturally sanctioned forms of expression. The intent of harming oneself per se is not suicidal and is referred to as Non-Suicidal Self-Injury (NSSI). NSSI is especially prevalent among adolescents with approximately 1 in 6 engaging in this behavior at least once. About 15 percent of college students have participated in it. Overall about 1.3 percent of kids 5 to 10 self-inflict, though rates climb greatly if the child has marked anxiety or chronic mental stress. Reported self-abuse among adults is about 5 percent.

Previously it was thought to be a behavior engaged in by young women, but recently NSSI was found to be equally prevalent among young men. Women, though, may be more likely than men to cut themselves, while men are more likely to engage in burning their skin.

Individuals with a history of NSSI report more borderline personality disorder (BPD) characteristics than those without a NSSI background. BPD is marked by such tendencies as emotional instability, unstable relationships and chronic feelings of emptiness.

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Self-Injury: Raising the Profile of a Dangerous Behavior

“By applying one type of pain,” he says, “they get rid of a different type of pain,”

Self-Injury: Raising the Profile of a Dangerous Behavior

A Rutgers researcher appeals to the medical community for better treatment tools and insurance coverage

By Rob Forman

Self-injury so often occurs in private, an important reason why solid statistics are hard to come by. But researchers estimate between 10 and 40 percent of adolescents, and up to 10 percent of adults, harm themselves physically – usually by cutting or burning their skin.

Yet, the condition – known as nonsuicidal self-injury – is not officially recognized by the American Psychiatric Association (APA) as a mental disorder, which means insurance may not cover treatment.

“The mental health system is failing patients who have a clear problem for which they need help,” says Edward Selby, an assistant professor of psychology in Rutgers’ School of Arts and Sciences in New Brunswick.

Selby, who recently published a paper in Clinical Psychological Review on the topic, is among a growing number of psychologists who believe that non-suicidal self-injury should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard compilation of psychiatric disorders used by mental health practitioners and insurers.


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Her brain tormented her, and doctors could not understand why

The young woman — and her family — were exhausted and confused by the barrage of treatments and medications. How were they supposed to cope with her nightmarish outbursts, her self-mutilation and suicide attempts, her destructive behavior?

Her brain tormented her, and doctors could not understand why
By Aleszu Bajak September 14 at 2:38 PM

“I hate myself, and my brain,” Pam Tusiani wrote in her journal while under 24-hour watch on the fourth-floor psychiatric ward of Baltimore’s Johns Hopkins Hospital. “Nothing is worse than this disease.”

When Tusiani wrote those words in 1998, doctors had little understanding of the disorder that was troubling her, and all these years later they have little more.

Trying to understand how the illness works — in hopes of finding a cure — strikes at the heart of psychiatry, indeed medicine in general. How does one replicate at the basic research level what one sees in a patient? How do you find the chemical root of a disease, especially one as complex and multifaceted as borderline personality disorder, or BPD?

Just as a smile takes dozens of facial muscles to execute, a particular emotional response to a stimulus requires a web of brain activity. The brain isn’t a series of one-way streets. It’s a hive of superhighways, and we can barely make out the cars, much less figure out where they came from, where they’re headed, what they’re carrying and why they’re on the road. We barely understand a healthy brain, so how are we to understand one haunted by psychoses?

Some days Tusiani, a New Yorker who was attending Loyola University in Baltimore when she was hospitalized, would cut herself, usually on the arms and hands, not so much to inflict pain but rather to relieve inner turmoil. “Bleeding enough that I felt good,” she wrote. One day she’d be curled up in the fetal position, unable to eat or speak; the next, she’d be pacing her house, berating anyone within reach and seeking drugs and alcohol — or a razor — for relief.

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