Is Borderline Personality Disorder Treatment Resistant?

 
A Reader brought this situation to my attention and I feel that it’s important enough to address in its own post because it is a problem in the clinical community concerning Borderline Personality Disorder. The Reader stated…
“I put this question to a psychotherapist from the Community Mental Health agency who came to evaluate my teen BPD  at the residential treatment center. She said that in her 20 years of practice, she had not seen BPD patients get better with age. Many stayed the same, but some got worse. She said the problem came from not being able to challenge or push them to improve. They cannot handle the challenge, and just wanted to come in and whine to her and seek justification and validation for their actions and emotions. Even when confronting them with this observation, they continued on with the same behavior. Often she would be the one to say “don’t come back if you don’t want to work on pathways to improvement.” It amazed her to see patients in their 60s coming in and dealing with the exact same issues she read in their charts from 30-40 years earlier.”
It sounds like your psychotherapist that you spoke to was not equipped to handle someone with Borderline Personality Disorder. This is quite common. When someone does not have the right tools to understand and work with the problem they easily become frustrated with their patients. It’s a failing on the part of both the patient and the practitioner. However it is not an accurate opinion to say that someone with BPD will never get better. If she has not seen any progress in a BPD patient I would 1.) question how many BPD patients she’s treated for an extended period of time (not just a couple months, I mean a couple years), and 2.) I would question whether she’s had any actual training that focuses on the specific issues of Borderline Personality Disorder. Not all psychotherapist have the same fields of study and are therefore not as qualified to deal with some kinds of people.
We can handle challenges, but because of the nature of our disorder it takes a different approach than someone who does not have BPD. It’s true that many people with BPD do seek therapy because they need validation, but a good therapist that understands the treatment of BPD is willing to take the time and put in the effort to help these people see through their actions and overcome their behaviors while building a more productive set of life skills.
You also can’t ‘merely confront’ someone with BPD and expect them to be able to change. Characterological problems, personality disorders, are deeply ingrained issues. Basic cognitive behavioral techniques are  not enough to correct deep psychological issues. It’s akin to slapping a band-aid on an amputation. As I spoke about previously, the very nature of personality disorders means that the way we perceive the world, how we interact with the world, how we experience emotion and our very selves is quite different than your average Joe. By extension, how we are capable of utilizing, dealing with, and incorporating therapeutic technique is also going to be different. That’s not to say that we don’t want to work through things, obviously this may not be the case, but since our base functioning is different, we need to approach these problems from a different point of view.
There are many faulty Assumptions made by clinicians regarding Borderline Personality Disorder (Click here to read them all).
Assumption: With brief training, patients can access their cognitions and emotions and report them to the therapist.
Cue the broken record. Someone with a Borderline Personality Disorder does not experience emotions the way a normal person does, by definition. Sometimes the buildup of emotion is so frustrating and such a jumble of so many different things that it’s impossible to distinguish individual thoughts or feelings. Or patients may block disturbing thoughts and images in a cognitive or affective avoidance of disturbing memories and negative feelings. When you learn that by avoiding negative stimuli you reduce your susceptibility to pain, it becomes ingrained into your habits and lifestyle. Breaking an instinctive pattern that you’ve developed as a maladaptive coping strategy isn’t easy. To first face those things that hurt you in order to finally move past them takes courage and time to reach that place of strength. Or you have someone like me that is dissociative on top of my other issues. Where something should inspire intense emotions all I can describe is…. A blank. A void of feeling like speeding to the pinnacle of Mount Everest with emotions ramping up higher and faster only to divert into a dark cave before you hit the top and, stop. How do you navigate the void? 
Assumption:   Patients can change their problematic cognitions and behaviors through such practices as empirical analysis, logical discourse, experimentation, gradual steps, and repetition.
The problem here is that our problems are rarely so straight forward. Our issues have issues.  “Because characterological patients usually lack psychological flexibility, they are much less responsive to CB techniques and frequently do not make meaningful changes in a short period of time. Rather, they are psychologically rigid. Rigidity is a hallmark of personality disorders. These patients tend toward hopelessness about changing. Their characterological problems are ego-syntonic: Their self-destructive patterns seem to be so much a part of who they are that they cannot imagine altering them. Their problems are central to their sense of identity, and to give them up can seem like a form of death – a death of a part of the self.” Do you know what it’s like to want to be rid of something, to despise it so much, and fear the losing of it in the same breath? Or to feel in your bones that something is so, despite all evidence to the contrary? I do.
Assumption: The patient is presumed to have problems that are readily discernible as targets of treatment.
Fill my emptiness please. What? You don’t have a prescription for that? No definitive list of reasons why this may be? It’s hard to treat a problem when you don’t have a clear idea of what the problem even is. Vague senses are difficult to discern for anyone, especially someone who has trouble connecting with how they feel in the first place.
If she’s actually saying “don’t come back if you don’t want to work on pathways to improvement,” that’s a huge red flag that this woman does not have a fundamental understanding of what Borderline Personality Disorder is. And frankly does not sound like a good therapist. A therapist should never give ultimatums to their patients. This is an outright statement of rejection and abandonment which will only make the Borderline patient more confused and hurt. It’s insensitive and hurtful.
It’s a huge stigma in the clinical community that believes BPD is treatment resistant. This is often a problem in the therapeutic technique, not that someone with BPD is resistant. Some styles of therapy are not conducive to treating Borderline Personality Disorder or one technique is simply not enough. It’s often difficult for us to internalize some concepts because the nature of BPD is so transient. What may work for someone without BPD probably won’t work the same for us. Or what does work for us one minute, may not work for us in another because our moods shift so rapidly. All this means though, is that we need to focus on changing our overall mentality, not just on techniques to get us through a situational development (though these can be helpful!). We can’t just record, talk through, and repeat new behaviors and expect them to work right away because these are things that are ingrained in our character, not a learned behavior that we’re just trying to reverse. It might take a variety of integrated techniques, not just one, but treatment is absolutely possible!
Another clinical stigma is that someone with BPD will never get better. With this attitude many clinicians adopt an attitude of hopelessness for someone with a Borderline Personality Disorder. They won’t even bother to treat someone with BPD because they don’t have the knowledge of current treatments and options for the patient. Because it requires more effort to change characterological problems many won’t read updated information and therefore remain stuck in outdated modes of thinking. This is not the patients fault. This is the failing of the clinician.
Whoever this psychotherapist you talked to was, I would seriously take her opinions with a big grain of salt and seek out someone who is specifically equipped to handle Borderline Personality Disorder. Talk to a clinician that specializes in Schema Therapy or Dialectical Behavioral Therapy. In recent years there have been HUGE steps made towards progressively treating Borderline Personality Disorder. It’s not a quick fix. There is no quick fix. It does take time and effort, but it is absolutely possible to learn to deal with and overcome this disorder.

It’s ALIVE!!!! – Borderline Personality Disorder in Movies and Cinema

Happy Halloween! This has been a very mellow season for me. Decided not to hit any major parties or do the costume thing. I’ve been too uncomfortable in my own skin to go out in crowds. I have, however, been watching Horror movies like they’re going out of style. Which as any die hard horror movie buff knows, will never actually happen. Horror movies are good year round. I’m pretty desensitized to the actually scary factor but that doesn’t stop me from loving them. I also have a bizarre fascination with campy bad B horror movies. Over the past few weeks I’ve watched Friday the 13th, Silence of the Lambs, Hannibal,
Red Dragon, Night of the Living Dead (the original), Poltergeist, documentaries on the making of American Horror films, had a Nightmare on Elm Street marathon, and approximately a million more. You name it, I probably own it. Friday Tech Boy and I went to see the remake of The Thing.
The Thing (remake): SPOILER: Do yourself a favor… rent the original. The original is truly terrifying. The remake was an abomination of CGI craptasticism. The only horror inducing aspects of this film was that it was remade in the first place. Shame on you Hollywood. Seriously. I’m offended. Fortunately Tech Boy was equally as uninterested in the film and we didn’t end up watching a whole lot of it ::wink::
Saturday Friend and I went and saw Paranormal Activity 3. (NO Spoilers). If you have any belief, even a mild suspicion or doubt about what else might be out there…. These will shock your socks off. I freaking love this series of movies. Rent them. Watch them. Be prepared to never sleep again. Throw Insidious into the mix while you’re at it.
That’s great Haven, but what does any of this have to do with Borderline Personality Disorder, other than you’re particular case of nuttery? The movies listed above = not much. However, it got me to thinking about movies depicting Borderline Personality Disorder and they have a tendency to be pretty scary in their own way.
A couple of them like Girl, Interrupted and the film Borderline (based on the book by Marie-Sissi Labreche) take more of a genuine look at what it is to have Borderline Personality Disorder. I have to say the film version of Girl, Interrupted didn’t portray the disorder quite as well as the book did – which was actually quite different. Still, they’re honest attempts at some understanding.
Here are some of the most notable movies with characters with Borderline Personality Disorder:
Fatal Attraction (1987) – In “Fatal Attraction,” the infamous femme fatale character played by Glenn Close displays the emotional instability and fear of abandonment that are symptomatic of someone with Borderline Personality Disorder. Her character also exhibits the BPD symptoms of self-harm, intense anger, and manipulation as she stalks her former lover and his family.
Single White Female (1992) – Jennifer Jason Leigh’s character in “Single White Female” exhibits the Borderline Personality Disorder symptoms of fear of abandonment, impulsivity, and mirroring as she attempts to take over the persona and life of her roommate (Bridget Fonda).
The Hours (2002) – The three main characters in “The Hours,” which include author Virginia Woolf, all struggle with Borderline Personality Disorder, depression, and suicide. The movie, which links women from different generations to Woolf’s book “Mrs. Dalloway,” stars Nicole Kidman, Meryl Streep, and Julianne Moore.
Monster (2003) – Charlize Theron transformed into the role of female serial killer Aileen Wuornos in “Monster.” Wuornos was diagnosed with Borderline Personality Disorder, which may have contributed to the unstable and angry behaviors that led to her killing at least six men.
My Super Ex-Girlfriend (2006) – One of the few comedy movies that features a character with Borderline Personality Disorder is “My Super Ex-Girlfriend.” In this movie, Uma Thurman portrays a woman with superpowers and a secret identity who also displays the BPD symptoms of impulsivity, unstable interpersonal relationships, and poor self-image.
Margot at the Wedding (2007)– Two alums of movies with Borderline Personality Disorder – Jennifer Jason Leigh and Nicole Kidman – pair up in “Margot at the Wedding.” Kidman’s character, who is the sister of Leigh’s, is said to be diagnosed with BPD and exhibits the BPD symptoms of impulsivity and lack of boundaries.
A Streetcar Named Desire – A Streetcar Named Desire is a is a 1947 play written by Tennessee Williams, later adapted for film, which tells the story of a woman who displays histrionic and borderline traits, who goes to live with her codependent sister and her narcissistic husband.
Mommie Dearest – Mommie Dearest is a 1981 biography of Hollywood Actress Joan Crawford, played by Faye Dunaway, who, according to the account in the movie, exhibited Obsessive Compulsive, Borderline and Narcissistic Traits.
Gia: Too Beautiful to Die, Too Wild to Live (1998) – Directed by Michael Christofer, starring Angelina Jolie as the tragic supermodel Gia Marie Carangi.
For my money, this biographical movie is the very best screen representation of a female Borderline, vastly more emotionally insightful than Fatal Attraction. Jolie is uncannily brilliant in this Golden-Globe-winning role (and has written about her own personal experience with self-injury).
And some more…..
The Fountainhead (1949)
Play Misty for Me (1971)
Poison Ivy (1992)
The Crush (1993)
Mad Love (1995)
The Cable Guy (1996)
Allein (Germany, 2004)
Swimming Pool (2003)
Chloe (2009)
Notes on a Scandal (2006)
Black Swan (2010)  <~~~~~ Here’s another must see movie if you haven’t already. I over-identified with this film. The emotion pressure felt by the main character is portrayed in a very intense and accurate manner.
I also found a note about one more movie displaying Borderline characteristics. The Wizard of Oz. Now, I’m not sure I agree with it. I think it’s more likely that some psychologist decided to overanalyze a work of fiction. But this is what it said.
The Wizard of Oz – The Wizard of Oz is a 1944 movie starring Judy Garland which is sometimes used as a metaphor to describe the disconnect between the dissociated reality of the personality-disordered individual (Oz) and the real world experienced by the Non-PD (Kansas). The metaphor is based on the iconic phrase: “Toto – I’ve a feeling we’re not in Kansas any more”.
Those are what I’ve found so far. Do you know any others that might involve BPD?
It all just got me thinking about how entrenched the stigma of Borderline Personality Disorder is. A few of these movies take an honest approach to the disorder or even a comedic one… but in general, the character with BPD is often the villain, and not one you’re able to sympathize with. These movies capitalize on the stigma and spotlight the worst characteristics. I guess that’s what makes money though. I suppose having emotionally conflicted villains is too grey area for the good guys wear white, bad guys wear black mentality that often splits the silver screen. I find that a bit ironic.

So what are you favorite scary movies?

A rose by any other name…

Still dies, rots and decomposes like anything else, I suppose.
  
Last week I talked about where Borderline Personality Disorder got its name. It may not stay that way forever though. Borderline Personality Disorder renamed? For some time now clinicians have been calling for the label of Borderline Personality Disorder to undergo official change. There are a number of different names used around the world and under consideration for the same disorder:
Borderline Personality Disorder (BPD) – Current
Emotional Regulation Disorder (ERD)
Emotional Dysregulation Disorder
Emotional Intensity Disorder (EID)
Emotionally Unstable Personality Disorder (EUPD)
Emotion-Impulse Regulation Disorder (EIRD)
Impulsive Personality Disorder (IPD)
Impulse Disorder
Post Traumatic Personality Disorganization (PTPD)
Complex Post Traumatic Stress Disorder
The most commonly used name today is Borderline Personality Disorder – or BPD – as defined in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR).
The term “Borderline” is a historic term coined to describe people who were diagnosed to be on the borderline between a neurotic and psychotic disorder. It is commonly felt that the “Borderline” label is misleading and stigmatizes the disorder. From the beginning the term Borderline Personality Disorder has been stigmatized and this has only been compounded by decades of misunderstanding. It implies that the entire person is flawed instead of looking at BPD as a medical problem. By renaming Borderline Personality Disorder it will be easier to move away from those stigmas that are automatically associated with the label. Originally it was termed Borderline Personality Disorder because it was thought to be on the ‘borderline’ of multiple diagnoses but not falling into any one category. However this is no longer believed to be the case. It isn’t on the border of anything. It is its own distinct problem; a disorder characterized by intense emotional experiences and instability in relationships, behavior, and emotions. Some clinicians don’t even want it labeled as a Personality Disorder because it implies that there is no hope for a cure when in FACT it has been proven that with psychotherapy and the aid of medication there is the ability to heal and live a life free from the symptoms that categorize BPD. They want it renamed and removed from Axis-II designation and placed firmly in the Axis-I category because of the high rate of comorbitity with other Axis-I disorders (as previously mentioned here).
Rumor has it that the fifth version of the Diagnostic & Statistical Manual (DSM-V) is likely to rename Borderline Personality Disorder (BPD) as Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD). Indeed, Emotional Dys/Regulation Disorder is the most popular alternative for Borderline Personality Disorder. It’s felt that this more accurately describes the expression of the symptoms encompassed by BPD as it is just that, a disorder of regulating emotions.
Another term is post traumatic personality disorganization (PTPD) or complex post traumatic stress disorder, reflecting the condition’s status as (often) both a form of chronic post-traumatic stress disorder (PTSD) and a personality disorder in the belief that it is a common outcome of developmental or attachment trauma. I’m not sure I entirely agree with this because there are many people with BPD that don’t report any kind of traumatic event.  Personally, maybe, MAYBE, some arguable attachment traumas when I was a toddler, but even I don’t think this was so much environmental trauma as a predisposition to reacting the way I did. As I’ve mentioned in a previous post, I don’t agree that PTSD is an accurate diagnosis for me at all. I’ve had plenty of traumatic events to speak of but not until after my BPD began to present at a young age.  
Emotionally Unstable Personality Disorder…. Really? REALLY? Yeah, I see that diminishing the stigma that Borderline already has. Why don’t they just name it I-Am-Insane-And- Potentially-Violent-It-Is-In-Your-Best-Interest-To-Remove-Your-Children-From-My-Presence-Duck-And-Cover Disorder. IAIAPVISIYBITRYCFMPDAC Disorder is rather a mouthful though.  How about simply, BitchPleaseI’mCrazy Disorder. Seriously.
I’m against renaming Borderline Personality Disorder.  Renaming it doesn’t actually change a thing. Anyone with half a brain is going to know that ERD/etc is the same thing as BPD just with a new name, IF they even knew what BPD was to begin with. The symptoms are The. Same. Damn. Things. I mean, yeah it’ll take away the general stigma of BPD but then again, it may work to perpetuate others. BPD is already stigmatized as a female disorder. “Emotional this/that Disorder, Post Traumatic Something Disorder, those will all only perpetuate if not increase that particular stigma. It’ll make it more difficult for men to be diagnosed and make women an even easier target for ridicule. I can just imagine anytime a woman speaks her mind or has a strong opinion because she has an actual voice and isn’t a doormat, some douchebag guy is going to replace “is it that time of the month?” with “Emotional Disorders are treatable, get help for that shit”. It’s all ridiculous. In that way, Borderline is safer because a good majority of people don’t even know what it is so they can’t jump to asinine conclusions. So while, yes, ERD, encapsulates the fact that it is a disorder of emotional regulation, at the same time it almost trivializes the severity of what this disorder is. That is not okay.
Personally? I’m not sure I want it to be renamed. I like the term Borderline Personality Disorder. I like the idea that something can overcome the stigma and be understood for what it is; kind of civil rights activation for personality disorders, haha (for that matter I don’t like that there will be a full re-categorization of PDs from 10 to 5 in the new DSM V). I still don’t like admitting that I have a disorder of emotions because I was lead to believe that I needed to repress them for so long. At least Borderline doesn’t directly state a disorder of emotional problems (though obviously it is) since it doesn’t have Emotion in the title. It doesn’t stamp CRAZY BITCH on my forehead right away. Someone hears Borderline Personality Disorder and they may cock their head and ask, ‘what’s that?’. Someone hears Emotional Dysregulation Disorder and they’re going to start creeping backwards because this person is OBVIOUSLY emotionally unstable.
Idk, maybe I have no logical reason for it. Mostly it’s probably due to my attachment issues. I have a hard time giving anything up that I’ve become accustomed to and this label is one more example of that. I like the name, I don’t want it to change. I’m familiar with it. I mean… BPD is a disorder characterized by abandonment! Don’t make us abandon our label! It’s mine. I’ve embraced it. Don’t take it away from me! (Jokes. Sort of). And quite frankly, all the other names for it are kind of lame.
While I’m on the topic of continued designation of things; please return Pluto to its previous planetary status; “Dwarf planet“ is just insensitive.  

Borderline Between What and What?

MRS KAYSEN: So what is this borderline business you mentioned on the phone?
SUSANNA: What borderline business?
MELVIN: See, the mind…
SUSANNA: Borderline what?
MELVIN: …is the…
SUSANNA: Borderline between what and what? Melvin!
MELVIN: It’s a condition, Susanna. And it’s called Borderline Personality Disorder.
MELVIN: It’s not uncommon. Especially among young women.
MRS KAYSEN: What causes it?
MELVIN: We’re, we’re really not sure.
Cut*.
The name “borderline” comes from a school of thought that was common in psychiatry in the 1930s. These patients were then thought to be midway, or borderline, between psychotic patients and those who were simply “neurotic,” or had problems that could be easily helped by psychotherapy. In fact, the “borderline” patients at this time often seemed to get worse with psychotherapy. Many people would like the official name of the disorder to change to something that better reflects the actual difficulties people with it experience.
Borderline between neurotic and psychotic. Those are some disquieting diagnoses to fall between.
Don’t know why I haven’t posted this sooner. Oddly this explanation of borderline was surprisingly difficult to find when I first started looking for it. I wonder if that was intentional. It’s clearly where the stigma surrounding BPD originated.
You know what I think would be interesting. Uncovering how the treatments for Borderline have evolved throughout the decades. Dismissed, institutionalized, medicated, misdiagnosed… Curiouser and curiouser. Perhaps a post for a different day.
*I hate referencing Girl, Interrupted. It feels so cliché. However, I may write a Book Review because it’s actually more insightful than the movie.

Judging Me: Stigma of Borderline Personality Disorder

 Please, don’t judge me before you know me.
I’ve mentioned this in various posts but I wanted to pull it all together. I’m talking about the stigma that accompanies Borderline Personality Disorder.
What is a stigma: a mark of disgrace or infamy; a stain or reproach, as on one’s reputation; a distinguishing mark of social disgrace; any sign of a mental deficiency or emotional upset.
Stigmas are a negative judgment based on a personal trait.
What is a stigma: a mark of disgrace or infamy; a stain or reproach, as on one’s reputation; a distinguishing mark of social disgrace; any sign of a mental deficiency or emotional upset.
Stigmas are a negative judgment based on a personal trait.
These are a very real problem for anyone with a mental illness/difference/disorder Personality disorders especially and notably for someone with a Borderline Personality Disorder. Compared to many other disorders it seems to have a surplus of stigma.
1) theories on the development of the disorder, with a suspect position placed on parents;
2) frequent refusal by mental health professionals to treat BPD patients;
3) negative and sometimes pejorative web site information that projects hopelessness;
4) clinical controversies as to whether the diagnosis is a legitimate one, a controversy that leads to the refusal of some insurance companies to accept BPD treatment for reimbursement consideration.
Many clinicians and people believe that Borderline Personality Disorder is not a characterological problem and merely a learned response to environmental factors. This thought process leads to an inability to treat patients properly. To believe that someone with BPD is just acting our or trying to get attention. Tragically it is often believed that these environmental factors are the parents fault (though in many cases this may absolutely be a contributing factor: Nature vs. Nurture). What’s truly horrible about this is that parents may be afraid to get their children help or may alienate their children once diagnosed for fear of being judged themselves.
All Borderlines are ‘angry, violent, and explosive’, in other words, very hard to cope with. All of us. Instead of getting to know a patient individually we are judged on the behavior of a few. Clinicians will discriminate against someone with BPD because of what others have said, not what they have experienced. Yes, the moods of someone with BPD can be all of these things. Hell, my behavior can be all of these things at time, but I’ve never brought it to therapy. However this is not the most predominant mood. These occurrences are much more rare (if they occur at all) compared to the day to day operating mode of someone with BPD.
“People take a couple of bad examples then deems everyone else with the same disorder through one very narrow perspective and then tells all of their friends of this belief who continue to pass it along but it seems like no one stops this communication to actually take the time to understand the disorder so all of this false information is allowed to saturate through society until everyone takes it as common knowledge and then uses it to judge others”
Extension to above: Borderline Personality Disorder IS characterized by mood swings between anger, anxiety, depression, and temperamental sensitivity to emotional stimulus. We can be destructive and prone to self-destructive behavior. Because of this, it is one of four related pathologies classified as Cluster B (“dramatic-erratic”) in the DSM IV. This is hallmarked by disturbances in impulse control and emotional dysregulation. Someone with BPD is often very sensitive and reacts strongly. They may have love/hate relationships with everyone and themselves, substance abuse, and impulsive behavior, or a multitude of other problems. Because of these potential qualities many professionals will not treat someone with BPD as they may not be comfortable doing so, and this is their prerogative. So while it is not as severe a stigma as the last one, it is still a problem. It does not make them bad doctors or therapists, it just makes them not right for the person suffering with a personality disorder. I can understand this. We do have a lot of things to deal with and some people simply are not equipped to handle as much as we tend to bring with us.Extension to above: Borderline Personality Disorder IS characterized by fluctuations between anger, anxiety, depression, and temperamental sensitivity to emotional stimulus. We can be destructive and prone to self-destructive behavior. Because of this, it is one of four related pathologies classified as Cluster B (“dramatic-erratic”) in the DSM IV. This is hallmarked by disturbances in impulse control and emotional dysregulation. Someone with BPD is often very sensitive and reacts strongly. They may have love/hate relationships with everyone and themselves, substance abuse, and impulsive behavior, or a multitude of other problems. Because of these potential qualities many professionals will not treat someone with BPD as they may not be comfortable doing so, and this is their prerogative. So while it is not as severe a stigma as the last one, it is still a problem. It does not make them bad doctors or therapists, it just makes them not right for the person suffering with a personality disorder. I can understand this. We do have a lot of things to deal with and some people simply are not equipped to handle as much as we tend to bring with us.
Since there is no medical treatment professionals think there is no hope. I hate this. I think it’s a lazy attitude because especially with recent development in therapy it has been clearly shown that there IS hope. Medication may not work to cure all of our problems, but that does not mean we can’t learn to cope and recover from our problems. We just need a different approach than throwing drugs at it.
Those with BPD are treatment resistant. This is often a problem in the therapeutic technique, not that someone with BPD is resistant. Some styles of therapy are not conducive to treating Borderline Personality Disorder or one technique is simply not enough. It’s often difficult for us to internalize some concepts because the nature of BPD is so transient. What may work for someone without BPD probably won’t work the same for us. Or what does work for us one minute, may not work for us in another because our moods shift so rapidly. All this means though, is that we need to focus on changing our overall mentality, not just on techniques to get us through a situational development (though these can be helpful!). We can’t just record, talk through, and repeat new behaviors and expect them to work right away because these are things that are ingrained in our character, not a learned behavior that we’re just trying to reverse. It might take a variety of integrated techniques, not just one, but treatment is absolutely possible!
Someone with BPD will never get better. With this attitude many clinicians adopt an attitude of hopelessness for someone with a Borderline Personality Disorder. They won’t even bother to treat someone with BPD because they don’t have the knowledge of current treatments and options for the patient. Because it requires more effort to change characterological problems many won’t read updated information and therfore remain stuck in outdated modes of thinking.
.
Someone with a Borderline Personality Disorder is intentionally manipulative. This is one of the worse stigmas in my opinion. Borderlines are just manipulative, “bad” and hurt other people on purpose. The truth is we don’t always know that we do these things. We don’t know what the behavior itself is that comes to this conclusion, let alone know how to change these behaviors (more on this in a separate post).
Everyone with BPD is a self-injurer.
1.) All people with Borderline Personality disorders engage in self-harm practices, and
2.) That it is merely a cry for attention so it should be ignored and the person will stop doing it.
First, I know of quite a few people with BPD that do not cut, burn, bang, or engage in these kind of tendencies. BPD presents in a huge variety of ways and this is only one potential aspect. Second, many of us that do have these self-harm/cutting tendencies do not tell people about it at all. It is a way to take control of our lives, emotions, stress, or a dozen other things. Yes, some people may do it for attention, but ignoring it is never a good answer because this is harmful and in some cases could lead to death.
Because of all of these things someone with BPD may not even consider finding treatment. If they’re pre-judged by the mental health industry, if their attitudes are already set, what hope is there of getting effective help? It’s a defeatist attitude that bleeds into the thoughts of the patients themselves. If the psychiatrist, the psychologist, the therapist have no hope, what hope can we have for ourselves? I was aware of most of these stigmas when I was diagnosed. I was already seeing my therapist when my psychiatrist diagnosed me with BPD. I was actually very reluctant to tell my therapist about the diagnosis because I was afraid she’d drop me as a patient. This fear is not okay. Especially for someone that is so afraid of rejection! Without the ability to be open and honest with the person that is trying to help you it makes it almost impossible, at least very difficult, to get effective treatment. This is a very sad thing to me. Hopefully with understanding and new therapeutic developments this mentality will begin to change. Pulling these things together and taking a good look at them will be beneficial. That’s the goal at least. 

Morals of the Psych ER Saga

I was actually very reluctant to post this experience.
So why am I telling you this? Because this is the ugly side of having a Borderline Personality Disorder. It’s not just the therapy and the research or relatively harmless. It’s explosive and uncontrollable. It’s frantic impulse, threats, self-harm, and actual suicide for some. In that moment I felt crazy. I was in tears, feeling hollow and abandoned, worthless. With nothing to hold onto. My mind screaming, thoughts rattling around until I couldn’t tell the difference between reason and reality. When you can’t see the next minute because your entire world is dissolving in the one you’re in; there is no next minute. Just the one you’re living in.
It is meant to scare you. It is meant to make you think. To help you understand how extreme the emotions can be, and the things they can make us do. How difficult it is to control and not get swept away in the maelstrom that is the borderline mind. This is my reality.
I really didn’t belong there. It’s certainly not something that I’m proud of. I absolutely made a very bad choice. The reason I was there was a death threat even though there was absolutely no way I would have ever done it. I do not believe in suicide as an answer. As long as you’re alive, there’s a chance. A chance that things can change. Change is a powerful thing. As long as there’s change there’s hope for something better. This is my belief.
A belief that my ex knew very well that I held. I later found out that he’d been in my position for this kind of situation too. He made a dumb impulsive decision that he had no intention of acting out and had to take the consequences. There was a little vindictiveness in his refusal to listen. That’s what I get I suppose.
I wanted attention. I certainly got it from this. Not in the way I wanted though. These things never really turn out how you want them to. Everything about it is unhealthy. This type of behavior is part of why Borderline has such a stigma for manipulation. I’ll talk more about this some other day, because I’m really just now beginning to understand what this means in terms of BPD.
I wasn’t afraid of anything that happened to me in there, though maybe I should have been. This was a very dangerous situation to be in. There is no predicting who you will be kept with. No predicting how monitored you will be. No predicting what could happen to you. Most people would not have been so calm in the face of a huge guy about to rampage. Mostly I was annoyed and inconvenienced by the whole thing.

Not to mention I lost an entire evenings worth of sleep. I ended up being awake for almost 40 hours because I couldn’t rest once I got home. No sleep is never good for me. This usually deteriorates my mental state even more. 

I was afraid that this would come back to bite me in the ass though. That it could potentially leak out, and bar me from future employment, make it impossible to get a job. This was my biggest fear.

That and the fact that my landlords were not pleased. I could have lost my apartment, which I had just moved into.
It doesn’t just affect me/you either.  I felt like utter shit once I thought to consider the other people in my life. The people that care about me. I scared my roommate. I terrified my family. I had no right to put them through that. I never stopped to consider that this could affect them too. It’s something I won’t forget again.
The consequences of things like this hit you from all sides.
Like the bill. The whole experience, most of which was just sitting around, cost $2000. No extra zero there. Two thousand dollars. The nurses that have to watch you, the psych that has to be on call, the blood work they had to do, all of it is very, very expensive. This gave me something of a heart attack. Fortunately, I was on unemployment at the time so I could get this waved, but still. Very, very expensive. In money, time, and sanity.
Always, there are consequences to my actions. I reiterate. Actions that I will never indulge again. Mistakes that I have learned from. Having been through it once, believe me, once is enough. I am not altogether unhappy that I had this experience. It has made me consider the impulsive decisions that I am prone to, want to make, and rein them in. I take full responsibility for the mistakes I’ve made, but sometimes you need a swift kick in the ass to make you remember that, had I not been so impulsive in the first place, the whole thing could have been prevented. Prevention is something I work very hard on. It has helped me control my impulses. It has helped me consider my actions. It doesn’t necessarily stop the thoughts, but it has made me work harder to control them, get help for them. I don’t want to be controlled by these kinds of thoughts and behaviors. I’ve never wanted this, but now I have a little more motivation to really work to overcome them. It’s the nature of having a Borderline Personality Disorder to act this way, but we still have a choice in the matter, and the ability to change.
All these things are what I hope people see and understand. If this experience can help someone not make these kinds of poor choices than it was worth putting this story out there. I hope it helps someone. It sure opened my eyes. 

Axis I vs. Axis II: Controversy in BPD- Part 4

Where does Borderline Personality Disorder belong?
I’m referring to the DSM criteria for Axis I and Axis II designation. Let’s start off with, what’s the difference between Axis I and Axis II.
* Axis I: major mental disorders, developmental disorders and learning disabilities. Axis I disorders are predominantly mood disorders.
 * Axis II: underlying pervasive or personality conditions, as well as mental retardation. Axis II disorders are personality disorders.

For or Against?
[For Axis 2] Personality disorders are classified as Axis II disorders.
Personality disorders in general have their own list of general criteria that must be satisfied. They’re a class of personality types and behaviors that the American Psychiatric Association (APA) defines as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”.
“These behavioral patterns in personality disorders are typically associated with severe disturbances in the behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in the client adopting maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress and depression in clients.”
The behaviors cause serious interpersonal and social difficulties as well as general functional impairment. I don’t think anyone can argue that BPD fits this criteria, which is a large part of why it is considered Axis II. It also has a sub-designation as Axis II, Cluster B which is characterized by dramatic, emotional or erratic behavior. No argument there either.
Debate:
[For Axis 1] Both Axis I and Axis II are psychiatric disorders. Only personality disorders and mental retardation are segregated onto Axis II. All other psychiatric disorders are Axis I. Does it really make sense to segregate these if they are essentially the same type of thing?
[For Axis 2] However Axis I disorders are generally treatable with medication. While some presenting symptoms of Axis II disorders may be treatable with medication, it’s not shown that medication can ‘cure’ a personality disorder and correct all presenting symptoms.
 [For Axis 1] Moving BPD to Axis I would have economic benefits. Many insurance companies don’t recognize BPD as a treatable condition and use it as an excuse to withhold payments. I know for a fact that my therapist classifies me as Major Depressive when billing my insurance company. I am pretty certain my psychiatrist does as well. This is certainly true, but not completely accurate.  I’m not going to complain though.
I think the major debate lies here:
[For Axis 2] Axis II BPD is pervasive to a person identity, characterlogical in nature.
[For Axis 1]: But…There’s some debate about whether BPD should be considered a ‘personality disorder’ at all because it has such a high rate of co-morbid symptoms that fall into the Axis I designation.
Axis I disorders are primarily for mood disorders that are reactions to atypical situations which are not part of a person’s character. “Mood disorder is the term designating a group of diagnoses in the DSM IV TR classification system where a disturbance in the person’s mood {not their character} is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in ICD 10.”

[For Axis 1] There are many disorders that are just as pervasive as BPD such as bipolar, anxiety, and depression that are not caused by atypical situations, and are classified as Axis I disorders.
Two groups of mood disorders are broadly recognized (though not limited to these two); the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as manic depression and characterized by intermittent episodes of mania or hypomania, usually interlaced with depressive episodes.”

People with Borderline Personality Disorder almost always have a history of long term, pervasive depression.  I’ve never heard of anyone that didn’t, but I’m not a clinician. Hypomania is not always present. If you have manic phases though, that is the definition of Bipolar and while you can have bipolar disorder and BPD, I think you would then have both Axis I and Axis II designations, not just one or the other. From here it could be argued that the mood regulation disorders are the underlying cause for all the other disorder manifestations.
[For Axis 1] There’s also the stigma that a personality disorder just means that a person has a flawed personality that can’t be changed.  Except there has been plenty of research to support the idea that this is an emotional regulation disorder.  Which means it would technically be a mood disorder and qualify it for Axis I.
I can see how the mood disorder aspects can affect a lot of the behaviors and symptoms of BPD. I’m not sure it can explain all of them though. Things like a tendency towards impulsive behavior, identity disturbance, fear of abandonment, etc… these are not necessarily dependent on mood alone.
I certainly don’t believe that a personality disorder just means you have a flawed personality. Calling it a flaw implies that it’s a minor issue, easily corrected. BPD is not minor, nor is it easily treatable. You might not be able to change everything about who you are (or want to), but if there is an aspect of your life that you do not value; if you are willing to put in the effort; if you have hope of living a better life or just a life different from what you currently experience– it is absolutely possible to make changes in yourself. Without hope for change there can only be resignation to the inevitable. But people do have control over their lives, what choices they make, how they want to live. It may not be easy, maybe everything can’t be ‘fixed’, but it is possible to heal from those things that we are willing to work to change.

Borderline Personality Disorder Facts and Stats Part 4


Continuing on, here are some more relevant statistics concerning BPD. I’ll most likely take a more in depth look at some of these in future posts. 

– 50% experience Clinical Depression 

Surprise? Personally I think this statistic is low.  Well, depression is different from Clinical depression, so maybe it’s not incorrect. I think the statistics for people suffering from depression are much, much higher. Clinical depression is long term. It doesn’t last a few days, or a few weeks. It last for months and years. Never seeming to dissolve into something normal and pleasant. Fortunately for those that suffer with depression there is medicinal help. Thus far there is no prescription cure all for Borderline Personality Disorder, however it is possible, and recommended, to work on the specific symptoms. I’ve had pretty decent success with the medication I’ve tried in regards to helping regulate my depression and anxiety. I have had trouble balancing the beneficial effects of anti-depressants and anti-psychotics with the resultant side effects. The current medication I’m on does seem to be helping, without any unpleasant side effects, though my psych and I are still working to figure out the proper dose.

– BPD is treatable with medication initially and psychodynamic therapy complimented with dialectical behavior therapy (DBT). Therapy without proper medications is not recommended by many Drs. in this field.

From my own experience, one without the other has not been incredibly effective. That’s not to say that if only one is available it won’t help at all, something is always better than nothing. As I just stated, there is no medical cure for BPD. However BPD generally consists of a lot of co-morbid symptoms. While the overall issue can’t be medicated, things like depression and general anxiety are a result of synopsis in the brain that may not be functioning properly. With medication it is possible to lessen these problems if not correct them completely. While it’s not a total cure, it does make working on the other problems much more manageable. Part of what is absolutely necessary for treating BPD is learning to manage the deeply ingrained psychological behaviors. Especially if there is a history of trauma and abuse, learning to heal from these events and developing mechanisms to allow you to cope in the future is very important. This is the whole point of therapy. Learning and understanding the base motivators for our actions provides the tools to prevent or counteract these problems in the future. Without understanding ourselves, it makes it very difficult to function in a world that doesn’t experience the way we do.  I’m not currently doing DBT, my therapist focuses more on Cognitive Behavioral Therapy, but that doesn’t change the fact that the work we do is a necessary compliment to my medication.

– Many clinicians refuse to treat BPD/ERD.

People with Borderline Personality Disorder have the stigma of being very uncontrollable and very unpredictable. This coupled with the tendency to display many co-morbid symptoms makes BPD seem like a larger task that will require a greater amount of treatment that may seem insurmountable. But let’s face it, if a clinician is not prepared, incapable, or unsympathetic to the needs of someone with BPD, they are clearly the wrong medical professional for the job. We deserve someone that understands this problem and is not going to stigmatize us as individuals because we may present a challenge or there is general prejudice. It makes me angry that those of us that may need the most help, may also have the hardest time finding the help they need.  

I can’t speak for this though. I have had none of these problems, and to me, that is VERY encouraging. From my experience I know that it is very likely and absolutely possible to find doctors and therapists that are more than willing to work with those with BPD.  My psychiatrist diagnosed me relatively quickly but was not deterred in the least. He immediately dove into my options, and while recognizing that there was not one overarching medical cure, he is optimistic that we can treat many of the major symptoms. He also strongly recommended that I work with my therapist, whom I see twice a week. I will say I was hesitant to tell my therapist that my psych diagnosed me with BPD. On the one hand I didn’t want to influence her own opinions, and on the other, I was a little worried that she would not want to continue working with me. In the end I recognized that it doesn’t help me, or allow for her to provide me with the best options, if I held back. Again, she was also not deterred. She knew about every single one of my issues and symptoms from the start so adding one more label to things didn’t change anything as far as she was concerned. I haven’t seen my current therapist for too terribly long, but I am confident that I have found people that are willing to work with me and see me through this ordeal. So don’t be discouraged! There is help out there =)