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BPD: What’s the Cost?
In a recent article/review of Borderline Personality Disorder treatment options and management methodologies, the author quotes the Dr. John Gunderson in the New England Journal of Medicine May 26 issue: “…BPD is present in about 6% of primary care patients and persons in community-based samples and in 15 to 20% of patients in psychiatric hospitals and outpatient clinics,” writes John G. Gunderson, MD, from the Psychosocial and Personality Research Program, McLean Hospital in Belmont, Massachusetts. “Patients with BPD usually enter treatment facilities after suicide attempts or after episodes of deliberate self-injury. Such episodes result in an average hospital stay of 6.3 days per year and nearly 1 emergency room visit…
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Can therapy actually hurt borderlines?
A brief but detailed excerpt from the article “Progress in the treatment of borderline personality disorder” by Bateman and Fonagy indicating that some traditional approaches to therapy with borderlines can be harmful to the borderline: IATROGENESIS, PSYCHOTHERAPY AND BORDERLINE PERSONALITY DISORDER Pharmacological studies routinely explore the potential harm that a well-intentioned treatment may cause. In the case of psychosocial treatments we all too readily assume that at worst such treatments are inert. However, there may be particular disorders where psychotherapy represents a significant risk to the patient. Whatever the mechanisms of therapeutic change might be, traditional psychotherapeutic approaches depend for their effectiveness on the capacity of the individual to consider…
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Does the mode of “failure to mentalize” determine the ineffective behavior of the borderline?
A few days I got a comment on my post “How mentalization and attachment might explain ‘high functioning’ Borderline”. The comment was from a self-proclaimed “quiet borderline”. I have gone back and forth on this blog, through posts and comments alike, on whether the term “high functioning” or “invisible borderline” is a myth, a reality or a made-up category. As I said in “The Myth of the High Functioning Borderline,” I have yet to discover a researcher or clinician using these terms. Until now. Dr. Margaret Cochran guest-blogged on Randi Krieger’s “Stop Walking on Eggshells” blog and used both terms (invisible and high-functioning). I really don’t know what her familiarity…
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Book Review: Overcoming Borderline Personality Disorder
Overcoming Borderline Personality Disorder by Valerie Porr is perhaps the most up-to-date and complete book for family members of people with BPD published to date. When I read the book, I couldn’t help but think that Ms. Porr had the therapists and mental health professional more in mind than the family members. It appears as though she is trying to dispel many myths about BPD that exist not only in the family environment but also in the mental health community. This book is steeped in scientific research, including research involving the biological under-pinnings of BPD. It includes many skills for family members from both DBT and mentalization based therapy (MBT).…
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Development/Transmission of BPD: Genetic, Environmental or Cultural?
I was reading an article called “Social cognition in borderline personality disorder: evidence for disturbed recognition of the emotions, thoughts, and intentions of others” and noticed a line in the article that said this: “Thus, in addition to high heritability of BPD (Torgersen et al., 2008), these results argue that environmental factors (e.g., trauma) contribute to disturbed social cognition in BPD. In summary, for the current study we expected PTSD to be a negative predictor of social cognition.” That intrigued me on two levels. One was the “high heritability” part, because often I see comments about BPD and how many people believe that it is mainly caused by childhood trauma…
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Intention and Consequence
I have written quite a bit about the reason that people with BPD behave in a certain fashion. Much of the impulsive behavior is to stop the pain. Yet, the behavior can still be destructive to relationships, even when it is not the intention of the person with BPD to hurt the other person. Intention is often misread with BPD. Here is one message about that from the ATSTP list (written by me): MANY times emotionally sensitive people will read intentions and states of mind into the other that are not aligned with reality. They might say that you’re being mean or trying to ruin their life. Clearing up intention…