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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.



A recent CDC report shows that the percentage of adults with serious psychological distress who are uninsured has dropped from 28.1 percent in 2012 to 19.5 percent in the first nine months of 2015.



Look at a map of states president-elect Donald Trump won in November alongside a map of states with the highest rates of opioid prescriptions, and you’ll see they mostly overlap. Look more closely at the data, as one Penn State professor recently did, and you’ll find that Trump outperformed his Republican predecessor Mitt Romney the most in counties where opiate and suicide mortality rates are highest.

It’s little wonder, then, that mental health and substance abuse issues have become a key talking point for Trump, who has promised to crack down on drug cartels and called America’s mass shootings an issue of mental health—not guns.

He’s not the only Republican to adopt behavioral health as a priority. House Speaker Paul Ryan pushed for mental health legislation in the wake of the San Bernardino shooting. Senate Majority Leader Mitch McConnell, whose home state of Kentucky is a leader in opioid deaths, recently penned an op-ed titled “More Must Be Done on Heroin – soon.” And the Republican-authored 21st Century Cures Act, signed into law in December, will set aside $1 billion over two years to fight opioid abuse.

And yet, late last week, Senate and House Republicans set in motion the first steps of a plan that researchers warn could cut mental health and substance abuse treatment off at the knees: the repeal of Obamacare.

“I don’t think there’s anyone in the mental health community who thinks withdrawing the Affordable Care Act would be good for behavioral health,” says Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, who advised the George H.W. Bush, Clinton, and Obama administrations on health policy. “It’s hard to even conceive of how that would be true.”


Trumpcare Will Be Catastrophic For People With Mental Health Issues

Experts in behavioral health and lawmakers who have been fighting for mental health awareness vehemently oppose the legislation.

Trumpcare Will Be Catastrophic For People With Mental Health Issues

House Republicans on Thursday passed an updated version of the American Health Care Act, which could affect the millions of people who live with a mental health or substance-use disorder.

Analysis of the GOP bill by various organizations shows a grim outlook. Not only would people dealing with mental health conditions or drug dependency have to pay higher premiums, many may not even be covered.

This could have serious consequences, with the country in the throes of one of history’s worst opioid epidemics. Drug overdose is the leading cause of accidental death in America.

And, according to experts, if Trumpcare becomes law, it may undo years of progress on behavioral health.

How the bill can affect those with mental illness and addiction

The legislation threatens to gut protections for the majority of people with pre-existing conditions, which could include mental illnesses and addiction. This means the GOP legislation could allow insurers to make coverage more costly for people with existing health issues.

Premiums are likely to skyrocket. A person around the age of 40 with a drug dependency could see increases as high as 500 percent, according to the liberal think tank Center for American Progress. Those with bipolar disorder or major depressive disorder may see a 200-percent rise in surcharges.


Professor who developed therapy for uncurable mental illnesses wins 2017 Grawemeyer Award in Psychology

The institute’s mission is to transfer the principles of dialectical behavior therapy to more practitioners and to aid current practitioners with the burnout that can come with working with heard-to-treat patients.

Professor who developed therapy for ‘uncurable’ mental illnesses wins 2017 Grawemeyer Award in Psychology
By MELISSA CHIPMAN | December 3, 2016 6:00 am

Marsha Linehan, director of University of Washington’s Behavioral Research and Therapy Clinics, Center for Behavioral Technology, has been selected as the 2017 Grawemeyer Award winner in Psychology.

Disorders like borderline personality and suicidal ideation have long been considered nearly impossible to treat, but Linehan has developed dialectical behavior therapy, which has shown positive effects during studies. The treatment is a type of cognitive behavioral therapy that teaches four skills to clients: mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation.

“In addition to being considered the state-of-the-art treatment for chronically suicidal individuals, dialectical behavior therapy has been found to be effective for other behavioral disorders, including eating disorders, addiction, anxiety related disorders, post-traumatic stress disorder and depression,” said Professor Woody Petry, award director, in a news release.

Linehan is a Zen master and is credited for bringing Zen-informed practices, like “being fully present in the moment,” into mainstream psychotherapy.

“At a young age, I vowed to get myself out of hell and then to go back and get others out,” said Linehan, who acknowledged publicly in 2011 her own longtime struggle with suicidal ideation and behaviors similar to those found in borderline personality disorder.


When bigotry invades mental healthcare: Women, sexual minorities are most vulnerable to harassment

From being slapped to being shamed, members of marginal communities have few places to seek help for mental illnesses.

When bigotry invades mental healthcare: Women, sexual minorities are most vulnerable to harassment

Prateek Sharma

“I was talking about my nightmares to my therapist and while in the middle of that I accidentally told him that I am a bisexual and out of nowhere he just slapped me and asked me to go away. The incident did make me badly depressed, took a toll on my health and everything. I already have ADD and OCD and that’s what I was seeing the therapist for. So the depression just doubled from there and although now I have overcome it slightly, it still keeps on running in my head.”  – Vinay (Name changed)

There are about 4,000 psychiatrists, 1,000 psychologists and 3,000 mental health social workers in India. This stark inadequacy, given the population of this country, is compounded by the widespread social stigma attached to mental health, both acting together to prevent individuals from accessing the care they need. If these were not enough, we have to contend with the bigoted attitude of mental health professionals towards sexual and gender minorities, which are more exposed to getting sexually transmitted diseases too, as reported by specialists of STD testing in Minneapolis, women and members of other marginalised groups.
It is time we talk about this unnerving situation where a therapist denies treatment to a person or shames them for having contradictory views about society or politics, gender roles, identities, or sexual orientation. Such prejudice targets many marginalised communities, and continues to take a big toll on LGBTQIA+ people as well as on cis or heterosexual women.

The recently passed Mental Health Care Bill holds out an element of hope. Clause 21(1)(a) states, “there shall be no discrimination on any basis including gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class or disability”. But the problem lies in in pervasive prejudice among healthcare workers.

Carelessness can also be observed. Being told to look at the less fortunate lives to overcome the ongoing depression or propagating religiosity as treatment to surpass stress are some of such widely performed ill treatments. The following experiences by narrated by two women speak volumes..

“I have borderline personality disorder. Got diagnosed at a very young age and was taken to several psychologists and psychiatrists. While some gave me heavy doses of medication without hearing me out properly, others gave me huge lectures on morality about how my lifestyle and opinions are very wrong for a “girl” and how I am difficult and should be more passive. I had been in an abusive relationship for a long time and my previous psychologists slut-shamed me for having sex with that person out of marriage and kept calling me a “psychotic” all the time” – Shruti (Name changed)


Healing with paint: How the pioneer of art therapy helped millions of mental health patients

Lisa Buttery, a 25-year-old artist who works at Brighton University, shares Molloy’s experiences. She has been dealing with borderline personality disorder since her teens, and has used art in therapy and as a creative outlet.

Healing with paint: How the pioneer of art therapy helped millions of mental health patients

Edward Adamson was the first artist to be employed in a UK hospital. Kashmira Gander explores how his studio was an oasis of calm in a harsh twentieth century mental hospital, and how his legacy lives on.

Kashmira Gander @kashmiragander Wednesday 7 September 2016

It is the late 1990s and once again Gary Molloy’s severe bipolar disorder has hospitalised him. Unbeknown to Molloy, though, this stint will be the one to transform his life. “I saw these wonderful paintings on the ward. They were quite abstract. I was mystified and inspired, ” recalls Molloy, now 47, of his stay in a hospital in east London where he was born and raised.

Gripped, he needed to find out more, and discovered the works were created at Core Arts, a nearby centre for people with mental health illnesses. This is how Molloy, who was deterred from creativity by his teachers because of his gift for maths, says he discovered art.

“I found something magical in painting, writing and poetry. It eased the symptoms,” says the civil servant turned artist who is now a trustee and volunteer at the centre. “Ever since, I’ve been managing my condition by being creative, and building my self-esteem. It was a catalyst.” The impact on Molloy is undeniable: he hasn’t been hospitalised for 17 years.

Art as therapy was first used in the early and mid-20th century. Patients were often forced to deal with archaic and brutal practices, but they were also first to experience pioneering treatments. This duality, as well as how mental health has been approached over the centuries, and what the future might hold, is being explored at the Wellcome Collection’s latest exhibition: Bedlam: the asylum and beyond.