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“Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.” – from the interview
Bon: I found an interview with Dr. Leland Heller about Borderline Personality Disorder. He does a good job explaining the pain associated with the disorder… Here are some excerpts. The entire interview can be read here.
Diagnosing Borderline Personality Disorder And Finding Treatment That Works
Dr Heller: Good evening, It’s great to be here. I have a way of explaining the Borderline Personality Disorder in layman’s terms that might be useful. It’s how I explain it to patients and their families.
Imagine you had a pet dog and it runs into the street and by accident it’s hit by a car. The dog’s leg is broken and it limps off into an alley to lick it’s wounds. A friend of yours sees the dog and comes over to help. The dog is now feeling trapped and cornered – a “wounded animal” – and misinterprets the friend’s attempts to help. The dog snaps at the friend’s hand who is trying to help. The BPD (Borderline Personality Disorder) is a malfunction in the brain’s trapped or “cornered” animal area. Under stress, a seizure develops in that area. That’s why under stress, while raging, a borderline will say to him or herself: “Why am I doing this” – yet be unable to stop it. It’s a seizure – nerve cells firing inappropriately and out of control.
David: And the cause of Borderline Personality Disorder?
Dr Heller: The BPD has many causes including head trauma and brain infections, but it appears that emotional hurts literally damage the brain. Most likely the brain’s support cells – the 90% of brain cells called “glial cells” – are damaged by traumas, causing the person to overreact to stress once puberty strikes. During puberty the brain’s limbic system goes into “overdrive” and adolescents are at their highest risk of seizures in their lifetime. “Sticks and stones may break my bones…but names cause brain damage.” So does incest, abuse, severe trauma, head injuries, attention deficit disorder, and other causes.
David: From my understanding, one of the biggest difficulties facing individuals who have BPD is maintaining stable relationships. This is a great cause of consternation for those people who are on the other side of the relationship. What causes this?
Dr Heller: There are a number of problems. The three most significant are 1) inappropriate mood swings; 2) misinterpretation of motives; and 3) remembering those misinterpreted motives as real. Oftentimes self-fulfilling prophecies occur, and self-hate eventually leads to a significant other coming to the same conclusion – that the individual isn’t worth being with.
…
janet: Would you please tell us more about the self-hate characteristic and how that damages the BPD or his/her relationships?
Dr Heller: Much of it comes from self-destructive behaviors that are used to stop the horrible pain of dysphoria; anxiety, rage, depression and despair. When an individual behaves out-of-control, in a manner that’s inconsistent with their beliefs or normal choices, terrible self-hate develops. Additionally many individuals had low self-esteem and related problems since childhood and are in an environment that causes self-hate to flourish.
crazy32810: How is self-injury related to BPD?
Dr Heller: We all injure ourselves to stop noxious neurological sensations. Interestingly we do it in a linear manner, ripping the skin. A common noxious neurological sensation is the toxins released with an insect bite. BPD dysphoria is about as bad as it gets. The pain is horrible. Many individuals have broken major bones and declared the pain of the fracture was nowhere as severe as dysphoria. When an individual with the BPD discovers that self-mutilation, or other techniques of self injury, work to temporarily stop the pain of dysphoria – they’ll do what it takes to stop it. This is no different than the individual with a fracture wants pain medication. I broke my shoulder last December and I tried to deal with it without taking narcotics. I was foolish and wrong. The pain was so bad it needed to be treated medically. Once individuals with the BPD have their chronic symptoms stabilized, and have safe medication options that work for dysphoria, the self-destructive patterns are no longer needed to stop their pain.
On the BPD Cafe page on Face Book, the owner of the page posted a link to downloadable versions of various CBT worksheets, including some from REBT and DBT. These are really nice to have. There are a lot of them, so I joined the SugarSynch page that allows me to download them en masse. One note about that: if you do that, you’re going to have to “un-select” one of the documents, which appears to be stuck in “synching” mode. The document that is stuck is called PsychosisSelfHelp.pdf. Also, if you want ALL the documents, you have to scroll down to the bottom of the list to make them all load.
Anyway, I was reviewing a document about the general principles of CBT (called SelfHelpCourse.pdf), and it outlines an important point about events, thoughts and emotions. I have pointed out in several articles and in my book about the behavioral chain:
Event -> Thought -> Emotion -> Action Impulse -> Behavior
The document says this about the different reactions a person may have to an event:
For instance, if someone you know passes you in the street without acknowledging you, you can interpret it several ways. You might think they don’t want to know you because no-one likes you (which may lead you to feel depressed), your thought may be that you hope they don’t stop to talk to you, because you won’t know what to say and they’ll think you’re boring and stupid (anxiety), you may think they’re being deliberately snotty (leading to anger). A healthier response might be that they just didn’t see you.
 DBT iPhone App Are you in DBT? Do you want to know more about it? The creator of the new DBT iPhone application has graciously provided me with a coupon code for a free version of the app. If you’d like to receive this coupon code and want to download the app to your iPhone for free, please send me a direct message on twitter @bondobbs. I only have one, so I expect it to go fast.
UPDATE: You can also claim this code by commenting on this post and providing your email address (which is not shared). I will email you the code and instructions if you have problems redeeming it.
UPDATE 2: Code is gone! Sorry. However, if you’re still interested in the app go to www.diarycard.net
UPDATE 3: I got another code. The last one went fast. If you want it comment on this post.
UPDATE 4: Sorry the second code is gone. Yet, if you want the app for free, comment here. I will not post the comment, I’ll just ask for more codes and email them if I can get them. The codes are limited. Act fast!
UPDATE 5: OK, I’ve given away several codes. I have one more… the final one for me. If you want the final code, please comment on this thread. I will not post the comment, but will send you the code.
FINAL UPDATE: All codes are now gone. Thanks to Sammy for providing them to my readers!
A new DBT diary card app for the iPhone. I personally don’t have an iPhone, so I haven’t tested it, but the images look group. Here is the text of the About page (most of it) from the www.diarycard.net page:
This app was developed by Dr. Sammy Banawan in Durham, NC. Dr. Banawan maintains a full-time private practice in Durham where he also did his internship and post-doctoral fellowship at the Duke University Medical Center. During his post-doctoral fellowship, he worked directly with Dr. Marsha Linehan and her colleagues in continuing to adapt DBT for a variety of psychological conditions.
While this app was developed by a mental health professional, it is not intended to replace a therapist. You will get the most from the app with the aid of a DBT-trained psychotherapist. Remember that if you are actively suicidal or engaging in self-injurious behaviors, you need to be working with a therapist.
This application was created in an effort to bring psychotherapy practices up to 21st century standards. As more and more people carry around mini-computers in the form of smartphones, having to use sheets of paper to record something like behaviors or emotions seems a little ridiculous. It was also designed with the utmost in customizability in mind since no two people are working on the same sets of issues or with the same sets of treatment targets.
Over years of experience treating patients using Dialectical Behavior Therapy, we started to get a sense of what most people need to track and what types of coaching is useful and that’s where the app starts. As you use it and add more of your own information into it, the app will start to be even more helpful to you.
Recently read an article in Psychiatric Times in which the author of the article argued that the new DSM-V “dimensional” approach to borderline personality disorder specifically and personalty disorders in general would be much too time-consuming to implement than the criteria of the ICD-10. Here are the ICD-10 criteria:
F60.3 Emotionally Unstable (Borderline) Personality Disorder
A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or “behavioural explosions”; these are easily precipitated when impulsive acts are criticized or thwarted by others. Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.
Impulsive type:
The predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.
Includes:
- explosive and aggressive personality (disorder)
Excludes:
- dissocial personality disorder
Borderline type:
Several of the characteristics of emotional instability are present; in addition, the patient’s own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).
Includes:
- borderline personality (disorder)
Medications to treat mental health disorders is soaring among U.S. adults, according to data released Wednesday by Medco Health Solutions, a pharmacy benefit manager.
One in five U.S. adults takes medication for a mental disorder
By Shari Roan, Los Angeles Times / For the Booster Shots blog
9:53 AM PST, November 16, 2011
Medications to treat mental health disorders is soaring among U.S. adults, according to data released Wednesday by Medco Health Solutions, a pharmacy benefit manager.
Twenty percent of all adults said they took at least one medication to treat a mental disorder. Among women, 25% said they took such medication and 20% said they were using an antidepressant.
The survey analyzed prescription drug trends among 2.5 million insured Americans from 2001 to 2010.
Medco researchers also found that adults ages 20 to 44 had the greatest uptick in use of anti-anxiety medications, atypical antipsychotics and drugs to treat ADHD. The number of women on ADHD medications was 2.5 times higher in 2010 than in 2001.
The number of children under 10 taking antipsychotic medication, which is reserved for the most severe mental illnesses, doubled from 2001 to 2010.
There was a stark drop in use of antidepressants among those 19 and under, however. Usage has fallen since a 2004 warning from the Food and Drug Administration that the drugs could increase suicidal thoughts. Prescriptions for anti-anxiety medication among people 65 and older also fell over the last decade.
Reasons behind the growing popularity of medications for mental illness is debatable. Understanding the upswing “is the next critical goal,” Dr. Martha Sanjatovic, a professor of psychiatry at Case Western Reserve University School of Medicine, said in a statement released by Medco.
Said Dr. David Muzino of the Medco Neuroscience Therapeutic Research Center: “[W]hat is not clear is if more people — especially women — are actually developing psychological disorders that require treatment, or if they are more willing to seek out help and clinicians are better at diagnosing these conditions than they once were.”
But, he noted, it was a tough decade: the 9/11 attacks, two wars and a deep recession.
The report is entitled America’s State of Mind
This question often is the first question that my group is asked. Many family members of those with BPD believe that therapy is the answer. And for some with BPD therapy CAN be the answer. However, there are some complications when it comes to therapy and borderline personality disorder. They are:
- Sending someone to therapy is not like having your car repaired. It involves a lot of hard work on the part of the patient/client and on the part of their loved ones and supporters.
- Therapy as usual (referred to as TAU in the studies) can actually make BPD worse in some individuals. There are several BPD-specific therapies, such as DBT, Schema-focused therapy and Mentalization-based therapy.
- Therapy requires the buy-in of the patient/client. If he/she doesn’t want to admit he/she has a problem or doesn’t trust the therapist with his/her feelings, therapy will likely not have a lasting effect.
Unfortunately, you can’t force someone to go to therapy if she doesn’t want to go (except through a court order). What I suggest is that you use the tools I offer for a while. After you do that for some time, the borderline might begin to gather some self-awareness or to share her inner thoughts and feelings with you. It is likely that these thoughts and feelings will be filled with shame, self-hatred and worry. At that point, you can say something like, “Boy, it must feel awful to feel that way about yourself. What do you think you can do to feel better?” or “That’s so painful to feel that way. Maybe therapy can help?”
My wife has resisted going to DBT because it identifies her as a borderline and she “doesn’t want to be that person.” She also resists because DBT seems like a therapy of last resort to her and, if she fails at it, she feels that she will have to be committed to a mental institution. I occasionally do reinforce to her that there are people who are trained to help her feel better and encourage her to look into it. She is in therapy, but not in DBT. My daughter does see a DBT therapist. She decided to go because she was so angry all the time, and she felt terrible. She wanted to learn how to feel better. At some point, her emotional pain reached an intolerable level.
I have tried to model these skills in my life and, by doing so, shown my wife that I can more adequately cope with emotional situations, both personal and interpersonal. This modeling encourages my wife to consider DBT (or another emotional training program) to help her feel better. My suggestion is that you practice effective tools, master them and use your mastery over emotional situations as a beacon for your borderline’s healing.
Here is an article about medical mistakes costing people their lives. A brief quote from the article about BPD:
Six patients committed suicide while in hospital. A near-miss occurred when a patient with borderline personality disorder was placed in seclusion and had to be revived after trying to strangle himself. A nurse was delayed in reaching the patient due to difficulty finding a key to the seclusion room.
I don’t know why they’d put a suicidal person with BPD in seclusion. Wow.
Here’s an interesting article from a woman diagnosed with Borderline Personality Disorder and her struggles to escape the stigma of the diagnosis.
Coming out of the Borderline Personality Disorder Closet (Without Hitting my Head on the Door Jamb)
By SONIA NEALE
Six years ago I was officially diagnosed by a psychiatrist in a psychiatric hospital as having…drum roll please…BORDERLINE PERSONALITY DISORDER. He said it to me in the same way he would announce he had a plague of rats infest his kitchen, discovered I had a sexually transmitted disease or that he had just found out I supported Tea Party candidate Sarah Palin. It was delivered with revulsion, disgust and contempt.
Today I proudly come out of the BPD closet and out myself as having one of the most reviled and hated personality disorders ever constructed by the most esteemed and eminent fundamentalist gentlemen writers of the Psychiatric Bible the DSM – Diagnostic and Statistical Manual.
If mental illness is stigmatised and discriminated against within the general community, then Borderline Personality Disorder is stigmatized and discriminated against within the mental health industry.
I was diagnosed as a BPD by a psychiatrist who had spent less than an hour talking with me around about the same time my clinical psychologist (of eight years at the time back in 2005) told me I was a schizoid personality disorder. These two personality disorders are diametrically opposed. One is excessive emotion (think Roseanne) and the other is no emotion at all (think Sheldon Cooper – Big Bang Theory).
I have had four psychiatric hospital stays over 15 years, the first when I was on Zoloft and had three children under five with post natal depression. The second was after dexamphetamine withdrawal; the third after a kidney cancer diagnosis and subsequent overdose of valium; and the last suffering with the excruciating side effects of akathisia from Zyprexa.
After the last visit, I decided pills were part of the problem, so I decided psychotropic medication was no longer an option for me. Previous to my diagnosis I researched BPD and discovered that I did fit somewhat into the nine symptoms, which include emotional dysregulation, abandonment issues, relationship problems, impulsive behaviour, suicide ideation, splitting into black and white, identity disturbance, emptiness and paranoia. But my clinical psychologist admitted she too suffered from much of the above at some point in her life but to a lesser degree, one which does not cause psychiatric issues in her life. Continue reading A Borderline Comes out of the Closet →
Behavioral Research and Therapy Clinics (BRTC) on the University of Washington campus is accepting applications for a Dialectical Behavior Therapy (DBT) Family & Friends Skills Group. Here is some information from their webpage:
The BRTC is primarily a research clinic, offering treatment to members of the community as part of our clinical trials. We are not currently recruiting for any clinical trials, but we periodically have openings for new clients in our Treatment Development Clinic (TDC). Through TDC, clients receive Dialectical Behavior Therapy from doctoral students under the supervision of licensed psychologists.
TDC is currently accepting new clients in our FRIENDS AND FAMILY DBT Skills group. This group is designed for family members, friends, and caregivers of people with chronic mental and physical health problems like borderline personality disorder, bipolar disorder, and Alzheimer’s disease. For more information on this group, please call 206-543-3765.
I would urge all family members to consider attending this class (or a similar class). These DBT-FST (Dialectical Behavior Therapy Family Skills Training) are invaluable in understanding your family member with borderline personality disorder and creating a healing environment in the home.
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