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 Demi Moore and BPD? When I read the People Magazine article about Demi Moore, while I was waiting to get a haircut, I thought of Borderline Personality Disorder. I guess I wasn’t the only one. Here is an “open letter to Demi Moore” from Alisa Valdes, the author, about BPD and being lovable.
An Open Letter to Demi Moore
By Alisa Valdes
1/26/2012
Dear Demi,
I don’t know you. So I ask you to forgive my false familiarity. We have New Mexico in common, and I know of people who knew you growing up in Roswell. From what I’ve heard, you had a rough start in this world. So I guess I we have that in common, too.
When I heard that you’d been hospitalized after your friend called 911 because you were having seizure-like symptoms, I recognized that, too. When I heard that the symptoms were attributed by medical professionals to stress, I remembered something similar happening to me in the wake of my divorce.
But it was when I saw the quote from you in an interview with Harper’s Bazaar that I really felt my heart lurch with sympathy for you. In that interview, you said the following:
“What scares me is that I’m going to ultimately find out at the end of my life that I’m really not lovable, that I’m not worthy of being loved. That there’s something fundamentally wrong with me…and that I wasn’t wanted here in the first place.”
I am sorry to say I know how that feels, too.
As I said, I don’t know you. I don’t know your heart. But I know enough of your early life, and enough from those tragic, painful words, to suspect you and I have another commonality.
Last year, I was diagnosed with Borderline Personality Disorder. At first, I balked. Like many people, I’d heard terrible things about this mood disorder, which was supposedly popularized by Glen Close’s creepy character in Fatal Attraction. Borderlines were supposed to be among the worst people in the world, without their own identities and completely unhinged. Or at least that’s what I thought. I resisted the diagnosis for a minute, and then agreed to learn about it.
YOU ARE LOVABLE
What I learned floored me. Finally, there was an explanation for why I always went back to that lonely place, that conviction that I was unlovable, in moments of pain and crisis—and it was NOT that I was unlovable. And neither are you, Demi. You are lovable. You are amazing. You have accomplished so much. You are so talented, successful, beautiful.
Borderline Personality Disorder is partly biological, in that we are born with a tendency to overreact, emotionally. Lots of writers and actors and musicians have this ability. In my case, my emotional sensitivity has been my greatest gift, and my worst enemy, at the same time. It made me a writer. It also made me difficult.
What pushes people like me into BPD isn’t biology alone. The disorder is triggered, according to the literature, by living through a childhood that is “invalidating.” When my therapist told me this, I asked her what that meant. She said there was a range of experiences that could be invalidating, from obvious neglect and abuse to subtle undermining statements, such as telling a hungry child, “No, you’re not hungry, we just ate.” Anything that invalidates that child’s truth, repeatedly, can lead to this disorder.
What happens, Demi, is that people like us start at an early age to doubt our own perceptions of self. We say we’re hungry, but our parent says we’re not. We must be wrong about ourselves. This thinking progresses to deriving almost our entire sense of self from outside ourselves. It isn’t that the Borderline lacks opinions or identity, it’s that she wants so terribly to win approval and love that she goes along with whatever the people around her say and do.
When you do this, you end up requiring someone else to determine the boundaries within which you believe yourself to exist. Jackie O once said she had no opinions of her own, because her husband’s were good enough for two. What happens to a woman like that when the husband is taken away? She ends up feeling unlovable, as though she doesn’t exist, as though the very foundation of her world has disappeared and taken her with it. Continue reading Demi Moore and BPD →
 Substance Abuse and BPD Rage. Instability. Mood swings. Impulsivity. These characteristics make people with borderline personality disorder (BPD) prone to substance abuse as well as over-spending, promiscuity, eating disorders and other compulsive behaviors. In fact, studies suggest that 50 to 70 percent of those with BPD also have a co-occurring substance use disorder.
The Challenges Of Treating Addicts with Borderline Personality Disorder (link)
February 17, 2012
Rage. Instability. Mood swings. Impulsivity. These characteristics make people with borderline personality disorder (BPD) prone to substance abuse as well as over-spending, promiscuity, eating disorders and other compulsive behaviors. In fact, studies suggest that 50 to 70 percent of those with BPD also have a co-occurring substance use disorder.
Addicts with co-occurring borderline personality disorder are known as some of the most difficult patients to treat. Here are a few of the most common challenges, along with insights into the most effective research-based treatments:
Treatment Compliance
Addicts with BPD have been described as both treatment demanding and treatment resistant. Research shows more positive outcomes the longer an addict with BPD stays in treatment, yet keeping them in treatment is no easy task. In a study of patients in a detox program, those with BPD were significantly more likely to have an unplanned discharge than those without BPD.
While a number of treatments have proven effective for BPD, therapies for BPD patients with co-occurring substance abuse are less established. Studies suggest that the most promising treatments include dialectical behavior therapy, cognitive-behavioral therapy and psychodynamic approaches. A combination of support and management from an experienced dual diagnosis treatment center can improve retention rates, along with ongoing involvement in self-help groups such as AA and NA.
Therapist-Patient Relationship
Dropout rates among patients with BPD and substance use disorders are high largely because of the difficulties engaging this group in a therapeutic relationship. In one moment, the patient may view the therapist as a much needed source of support. At the first perceived sign of rejection, criticism or disapproval, the therapist becomes an enemy who cannot be trusted. The patient may become resistant, passive, or stop attending therapy sessions altogether, while the therapist may feel increasingly helpless and angry. Continue reading The Challenge of Treating Substance Abuse in People with BPD →
This is an excellent blog post with a letter included from an ex-addict suffering from BPD. I’ve written about opiod issues and borderline personality disorder before. The thing that struck me about this article was this line: “The opioid made me feel unlike I had ever felt– like I was “normal” in a way, and happy, which was unusual for me.” My wife has reported exactly the same thing. She doesn’t feel “normal” or “happy” (typically) without a small dose of opiates in her system. She reports that they make her feel “normal”. However, she doesn’t take them often, because she understands the danger of addiction.
Anyhow, here is the article:
Buprenorphine for BPD?
By J.T. Junig, MD, PhD
I would like to discuss a comment from a reader:
I have been a recovering addict for 12 years. I was addicted primarily to Lortabs (active ingredient is hydrocodone) and Ultram. I was never an extreme user but I was consistently trying to modulate my feelings and feel better. I also have been battling BPD (Borderline Personality Disorder) for a very long time which appears to be my primary issue. I have been married for 17 years and let’s just say our relationship is difficult due to my inability to be present and emotionally and psychologically sound.
As with most other addicts, I distinctly remember the first opioid I took, even though I don’t remember my first sexual experience. The opioid made me feel unlike I had ever felt– like I was “normal” in a way, and happy, which was unusual for me.
Since I quit using 12 years ago I have only had a few days, yes, days, where I have truly felt good, and that was after intense work with someone for hours and hours at a time to help me get through an intense emotional roller coaster ride. I will feel “normal and happy” for a few hours or maybe a day and then I feel the despair creeping back in. I cut my thumb the other day and the first thought that I had was, I wonder if this injury will be sufficient enough to allow me a Lortab? I just never feel right without an opioid in my system.
I have been researching drugs available to help me. I have tried many different antidepressants which were never helpful. I am wondering about a small dose of Suboxone (maybe 2 mg/day) which I have read may decrease some of the problems associated with BPD. I have been reading that persons with BPD have shown to have an opioid deficit and that 40% of those with BPD are addicts.
Over the last 12 years I have only taken a handful of narcotics (not at one time!) for legitimate pain. In fact, when I was using I really used a very small amount, like an average of 2-3 Ultram/day or 2 Lortab (5mg)/day. I was able to see how I could get my use out of control so when I found out that my brother was an addict I quit using. Continue reading Buprenorphine for BPD? →
“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.
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