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Personality Disorders

Borderline Personality Disorder Treatments

Imagine that you’ve just been diagnosed with Borderline Personality Disorder. Although you familiarize it with Bipolar Disorder, you’re corrected and told that they are indeed different disorders. As a kid, you were diagnosed with Conduct Disorder and now as an adult, you have Borderline Personality Disorder. Among the research that you do, treatments are the main objective that you focus on. There are so many options, but which one is the best for you?

Borderline Personality Disorder (BPD) is a cluster B disorder. It is described as “an extreme sensitivity to perceived interpersonal slights, an unstable sense of self, intense and volatile emotions and impulsive behaviours” (Gunderson et al., 2018). BPD is fairly prevalent in society, but more so in the psychiatric community and it can be difficult to diagnose (Bryne et al., 2018). Borderline Personality Disorder is commonly developed during childhood and proceeds into adulthood. There are four categories of symptoms of Borderline Personality Disorder: interpersonal instability, behavioral dysregulation, cognitive and affective. Interpersonal instability is described as an individual having profoundly unstable relationships as well as avoidance behaviors pertaining to abandonment (Gunderson et al., 2018). Behavioral dysregulation as described by Gunderson and colleagues is characterized by an individual being impulsive and susceptible to harm (2018). Cognitive symptoms are described as the individual being paranoid or having identity disturbance, and affective symptoms are described as the individual having feelings of anger, emptiness, or instability of mood (Gunderson et al., 2018). In each sub-category of Borderline Personality Disorder, the symptoms are usually extreme and are harmful to the individual.

There are many treatments for Borderline Personality Disorder. Most treatments align with Cognitive therapy due to the fact that Borderline Personality Disorder is a pattern of thoughts and behavior. One of these treatments is Schema Therapy, which is characterized as the integration of “elements from cognitive behavioral therapy, attachment theory, and a number of other approaches, [to explore] emotions, maladaptive coping methods, and the origin of mental health concerns” (Santangelo et al., 2017). The basis of Schema Therapy is to target events and thoughts that cause the individual to perform harmful actions and to replace them with good thoughts and actions. The role of the therapist is to be an almost parental-like figure and to provide emotional stability and validation. Schema therapy can include imagery, chair work, flash-cards and diaries. The effectiveness of Schema therapy is thought to be well supported and is backed by several articles. One study lasted 30 weeks and out of the 16 participants in the experimental group, 15 reached Borderline Personality Disorder remission compared to the 75% of participants in the control group. Another study comparing Transference Focused Psychotherapy (TFP) and Schema Therapy concluded that Schema therapy worked better with an average of 29% more participants in remission.

Mentalization-based therapy (MBT) is another treatment. It is based on the attachment theory, which suggests that there is a critical time period in an individual’s life to make attachments and if not made, it can negatively affect that individual’s life and development such as by reducing intelligence and increasing anger.  MBT focuses on creating diverse meaningful perspectives along with the individual’s own perspectives to create a coherent self that is reimagined through these techniques (Bryne et al., 2018). A study found that MBT compared to general treatments was effective in improving depression and anxiety, and decreasing self harm in individuals.

Lastly, there is no way to automatically know which treatment will work best, rather it operates on a case-by-case basis, but knowing available options tends to ease the obscurity of an unknown future for those with Borderline Personality Disorder.

References

Byrne, G. & Egan, J. (2018) Clinical Social Work Journal, 46, 174. https://doi.org/10.1007/s10615-018-0652-y

Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018, May 24). Borderline personality disorder. Retrieved from https://www.nature.com/articles/nrdp201829#management

McLeod, S. A. (2017, Feb 05). Attachment theory. Retrieved from https://www.simplypsychology.org/attachment.html

Santangelo, P.S., Koenig, J., Funke, V. Parzar, P., Resch, F., Ebner-Priemer, U., & Kaess, M. (2017). Journal of Abnormal Child Psychology, 45, 1429. https://doi.org/10.1007/s10802-016-0249-2

 

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Personality Disorders

A Matter of Life and Death

Imagine: you work or go to school full-time, maybe you do both. You may come home and study, do laundry, clean, cook dinner and, on top of it all, take care of your family too. Now imagine your full plate of work and daily errands while also waking up each day and having near constant thoughts of suicide running through your head. Could you handle it? Would it be a heavy weight on your shoulders to have those thoughts with all that you already have to get done in your busy week? For someone struggling with Borderline Personality Disorder (BPD), this is their life almost every day.

The National Alliance on Mental Illness discusses the many symptoms that accompany Borderline Personality Disorder. Some of the most dangerous symptoms of BPD include “impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse or reckless driving, self-harming behavior including suicidal threats or attempts” and unstable moods. These three symptoms can be major factors when it comes to a sufferer of BPD contemplating, attempting or even completing death by suicide.

According to the National Institute of Mental Health, suicide is a top leading cause of death among multiple age groups. More so, in 2015, it claimed over 44,000 lives in the United States. The prevalence of suicide attempts a year later, in 2016, was a total of only .5% among adults in America. With those facts in mind, Meghadeepa, a contributor on The Mighty,  explains that a staggering 70% of people suffering from BPD will face a suicide attempt. She also adds that people suffering from BPD will be about 50% more likely to die by suicide than the general population. This information has been supported by countless amounts of studies to show that the suicides faced by people with BPD outweigh the amount faced by the general population. This notion that BPD sufferers conquer a major portion of suicides in the United States is one that must be investigated and mended.

Unfortunately, professionals are aware of the symptoms that accompany a disorder like BPD and therefore may mislabel contemplations or attempts of suicide as being “manipulative” or  are “just threats.” Mislabels, such as these, is one of the biggest stigmas associated with BPD, where sufferers are believed to be manipulative, lie, or exaggerate for the sake of getting attention. These are dangerous assumptions for professionals to make given that the prevalence and rates of suicidal behaviors among BPD sufferers are so high. Therefore, to know that these professionals, at times, can’t take sufferers serious in their claims or aren’t prepared to counteract their claims, can have deadly consequences on those struggling.

However, while professionals need to be sure to maintain their awareness of sufferers’ emotions and actions in regard to suicidal behaviors, they can’t be entirely blamed for these high percentages. Additional support must be made available to those suffering from BPD and those with suicidal ideations/behaviors. Michelle Berk and colleagues conducted a study to evaluate risk factors that may be present for suicidal BPD sufferers. In the study, they talk about reducing the access sufferers have to lethal means, especially when they have a history of attempting suicide or self-harming from that mean. This is an effective intervention for suicide and self-harm behaviors. In addition to this, monitoring those struggling is necessary at all times, and creating safety plans to help them keep themselves safe even in the event that they did make an attempt to die by suicide. Lastly, BPD and suicide is a legitimate matter of life and death, which is why we need to learn the warning signs and how to do a simple risk assessment to detect if someone is at imminent risk. With these simple changes, we can help to make an impact on the amount of people dying by suicide with BPD and in the general population.

References:

Meghadeepa (2016, December 1). The Implications of Suicide Statistics for Someone With BPD. The Mighty.Retrieved from https://themighty.com/2016/12/suicide-rate-borderline-personality-disorder-bpd/

National Institute of Mental Health (2018, April). Suicide. National Institute of Mental Health.Retrieved from https://www.nimh.nih.gov/health/statistics/suicide.shtml

Pompili, M., Girardi, P., Ruberto, A., Tatarelli, R., et al. (2005, February 25). Suicide in Borderline Personality Disorder: A meta-analysis. [Figure 1 graph of number of suicide recorded within a number of studies]. Nordic Journal of Psychiatry. Retrieved from https://www.researchgate.net/figure/Distribution-of-suicides-among-patients-with-BPD-compared-with-the-general-population-of_fig1_7026467

National Alliance on Mental Illness (2017, December). Borderline Personality Disorder. National Alliance on Mental Illness. Retrieved from https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder

Berk, M. S., Grosjean, B., & Warnick, H. (2009, May). Beyond Threats: Risk factors for Suicide in Borderline Personality Disorder. Current Psychiatry. Retrieved from https://www.mdedge.com/psychiatry/article/63558/beyond-threats-risk-factors-suicide-borderline-personality-disorder

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Personality Disorders

BPD: Different Stigma for Different Genders

When it comes to a physical illness such as a heart attack, gender differences can be undeniably obvious. According to Harvard Medical School, some of these differences include the average age of a first heart attack to the survival rate to treatment. Even symptoms of a heart attack differ between genders in that, women report more throat discomfort, pressing on chest and vomiting, where men report more right-sided chest discomfort, dull aches, and indigestion. As it can be seen, it’s possible for there to be vast differences in the same illness between males and females. When it comes to mental illnesses, these differences can be found too. Unfortunately, with the stigma associated with mental illness, the differences in a disorder such as Borderline Personality Disorder can be traumatic.

Until a few years ago, most have believed that Borderline Personality Disorder (BPD) mostly affected women. It was believed that it was three times as common in women as in men, but with recent studies, it was found that the difference of the prevalence in BPD is minimal between genders, if at all. This misunderstanding of the prevalence alone has created a stigma for men who are diagnosed with BPD. This has created a cage around sufferers, making them feel like they are isolated and weighed down because they don’t have the support of other men.

Pete Miller is a mental health professional who has also experienced what it is like to be a male diagnosed with BPD. According to Miller, “In [his] Psychology practice, [he] [does] see BPD more often in female patients than in male patients. In [his] experience about 8 females to every 2 males. Also, when males do attend therapy, they tend to have only a few sessions rather than complete a full intake, diagnosis, and treatment.” Miller later adds that while he does see more women in his practice, he doesn’t believe there are more women affected by BPD than men. Miller believes that due to the stigma associated with BPD, especially being a man with BPD, it is a stressful thing to ask for help and to actually follow through with it.

Farahnaz Mohammed, a writer for Quartz, wrote an article about David O’Garr, a man that struggled with the diagnosis and the stigmas of BPD. Mohammed wrote about some of the stigmas associated with men struggling with BPD, the biggest that they are “abusers, selfish or incapable of love.” This is a bold and extremely false claim that has fueled a fear in men with BPD. This, then, creates further hesitation in getting help for their BPD and the aspects of their life affected by the stigma of BPD. Mohammed goes on to explain that for men that have a significant other or a family it may be exceptionally hard for them because they are preoccupied with a traditional idea of masculinity (as many men are) of being the head of the household. Thus, these men want to earn a living and support their family, and if they are diagnosed with BPD, treatment will require a lot of involvement of the family leading the sufferer to be in a vulnerable place emotionally. This may also require an abundance of time, in order to help him with treatment.

These stigmas against men suffering from BPD are unfair. In a world where we fight for equal rights for all genders, races, we should also be advocating for men with mental illnesses like BPD. In order to put an end to these stigmas, we need to educate ourselves and the people around us to show them that men with BPD are not abusers or in any way different than any of us. They are their own person – they are not their disease and therefore, should not be considered incapable of love for what they are struggling with. We need to accept a mental illness, in men and women, the same way we accept a physical condition like a heart attack between genders. We need to learn to embrace their diagnosis to demonstrate that they are okay and to demonstrate that asking for help is okay. In doing these, we can only hope that more men suffering from any mental illness will realize the falseness to the stigma associated with having a mental illness and will reach out for more help unapologetically and with little fear.

References:

Harvard Medical School. (2016, April). The Heart Attack Gender Gap. Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/the-heart-attack-gender-gap

Hitti, M. (2005, February 18). Men vs. Women: Confusion Over Heart Symptoms. WebMD. Retrieved from https://www.webmd.com/heart-disease/news/20050218/men-vs-women-confusion-over-heart-symptoms#1

Meyers, S. (2013, August 22). Understanding Borderline Personality Disorder: Men and Women. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/insight-is-2020/201308/understanding-borderline-personality-disorder-men-and-women

Mohammed, F. (2018, February 13). Modern Medicine is Failing Men by Diagnosing Them with Borderline Personality Disorder. Quartz. Retrieved from https://qz.com/1202985/how-modern-medicine-fails-men-with-borderline-personality-disorder/

Sansone, R. A., & Sansone, L. A. (2011), Gender Patterns in Borderline Personality Disorder. Innovations in Clinical Neuroscience, 8(5), 16-20. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767/

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Personality Disorders

With Love, BPD

Borderline Personality Disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity. Individuals with BPD make frenzied efforts to avoid real, or imagined abandonment. Their perception of impending separation, or rejection can lead to dramatic changes in the perception of self, affect, cognition and behavior.  This being said, diagnosed individuals are very sensitive to environmental circumstances, and have a pattern of unstable and intense relationships. These intense relationships can be chaotic and complex, but can be especially so in romantic relationships.

The DSM-V describes features of the disorder, claiming individuals may “idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, or is not ‘there’ enough.” This becomes detrimental, however, as individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. The DSM goes on to state that these individuals are prone to sudden and dramatic shifts in their view of others, who may alternatively be seen as beneficial supports or as cruelly punitive. These shifts are commonly “disillusioned with a caregiver, or another individual whose nurturing qualities had been idealized or whose rejection or abandonment is expected.”

Dr. Barbara Greenberg, a clinical psychologist who treats patients with Borderline Personality Disorder explains that people with BPD “feel empty, and are always trying to fight off what they perceive as rejection and abandonment, so they see rejection and abandonment where it doesn’t necessarily exist.” Often, this is the result of early childhood trauma, due to lacking healthy, and secure attachments. This overwhelming fear can deeply disrupt their relationships later on in life, and can result in pushing partners away rather than pulling them closer.

“When they are in relationships they get very intensely involved way too quickly. [People] tend to really like [people with BPD] at first, because they are very intense, and very passionate. But then what comes along with it, a couple of weeks later, is: “Why didn’t you call me back immediately?” “Are you out with somebody else?” So [people with BPD] get attached very quickly, give [the relationship] their all, but then get disappointed very quickly. They start out thinking, “I love this guy, he’s the greatest,” but if he does a minor thing that disappoints them, they get deeply disturbed. Everything is done with passion, but it goes from being very happy and passionate to very disappointed and rageful.

Those with BPD will have symptoms that include frequent fluctuations between sudden withdrawal, and strong clinginess and dependency. In addition, some symptoms of the disorder, including suicidal gestures and extremely impulsive behaviors, can create fear and tension between romantic partners, and establish additional stress in the relationship.

Research on romantic BPD relationships confirms the difficulty of maintaining a healthy relationship. One study demonstrated that women with BPD symptoms report higher levels of chronic relationship stress and frequent conflicts with their partner, resulting in partners reporting less satisfaction in the relationship, the more severe a person’s BPD symptoms are. One woman with BPD explained her actions in a romantic relationship, “I’ll be the first to step up to the confessional and admit that what I do is irrational,” she says. “It’s funny that my non-borderline partners think I am attacking them because I feel the same way. Most of my actions are done in self-defense to protect myself from some perceived threat. Here are several behaviors I have displayed in romantic relationships and the reasoning behind them.” The individual then goes on to describe instances in her romantic relationships that were the result of BPD, as she looks back and tries to analyze the root of the action.

She discusses where she purposely broke a gift given to her by her partner. With Valentine’s day having just past, we can imagine the pain this would cause to either party as they try to maintain control of their feelings, but also take their significant other’s feelings into account. She also goes on to discuss how BPD comes with emotional “Dr. Jekyll and Mr. Hyde” type symptoms:

“I did this because sometimes I get filled with rage that is hard to control. You may have hurt my feelings, and when I’m upset I get destructive. Weird as it sounds, destroying things you have given me hurts my feelings too. I may have felt a strong sense of self-hatred and may have wanted to inflict some emotional pain on myself too. At times people with borderline personality disorder can become masochistic due to repetition compulsion, a desire to repeat previous experiences of emotional pain in hopes they can be resolved on a conscious level…I have rapid mood swings, and with them come sudden and unpredictable personality changes. Often I experience emotional amnesia and my perspective on life oscillates with my constant mood swings. I need some more therapy, so there is little you can do about this right now beyond offering me a little validation.”

She goes on to discuss suicide; specifically, talking about suicide with her partner even though she knew it would hurt them. Seventy percent of individuals living with Borderline Personality Disorder attempt suicide, and ten percent of those with the diagnosis complete suicide. This makes the suicide rate is several times higher than that of any other mental illness:

“I have so much angst and depression that sometimes it seems like the only option. It’s nothing personal, and most things you’ll try do to cheer me up simply won’t work. I often cannot comprehend the profound impact my actions will have upon those around me. I may even feel like my death will be a relief to you so you will no longer need to deal with my disorder. Guilt, intense self loathing, emptiness and chronic inability to experience pleasure often cause my prolonged thoughts of suicide.”

Treatment is available to those diagnosed with BPD, and has shown results when looking at individuals in romantic relationships. It is largely a misconception that relationships with those who suffer from BPD are doomed to fail. While uniquely challenging, there are ways to reduce symptoms dramatically. The most important thing to remember is that with the proper treatment, individuals with BPD can learn to manage their symptoms, and establish inner tranquility. Along with individualized therapy, couples therapy is often an essential part of healing as both individuals and as a team. Dialectic behavior therapy (DBT), a cognitive-behavioral approach, stresses the psychosocial aspects of treatment- looking at the individual’s arousal (reactions) in emotional situations and how they increase dramatically quicker, and take much longer to return to an emotional homeostatic state than those without the disorder. DBT along with other clinical and holistic therapies have allowed a substantial number of individuals to achieve remission to a point where afterward they no longer meet the diagnostic criteria for Borderline Personality Disorder. Dr. Greenberg says, “I’ve seen a lot of [people with BPD] get so much better, I love working with borderlines. Because their emotion is all there, and acting that way is all they know, and then when you show them an easier way to be, and to act, they see how much easier life can be. Absolutely. There’s hope.”

References:

BPD Symptoms: Suicidal Behaviors. (2016, November 02). Retrieved from https://www.clearviewwomenscenter.com/borderline-personality-disorder-symptoms-suicide.html

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.

Grohol, J. (2016, July 17). An Overview of Dialectical Behavior Therapy. Retrieved from https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/

Hill, J., Stepp, S. D., Wan, M. W., Hope, H., Morse, J. Q., Steele, M., . . . Pilkonis, P. A. (2011). Attachment, Borderline Personality, and Romantic Relationship Dysfunction. Journal of Personality Disorders,25(6), 789-805. doi:10.1521/pedi.2011.25.6.789

It’s Nothing Personal: A Woman With BPD Explains Her Actions in Romantic Relationships. (n.d.). Retrieved February 11, 2017, from https://www.bpdcentral.com/help-for-families/bpd-articles/?It-s-Nothing-Personal-A-Woman-With-BPD-Explains-Her-Actions-in-Romantic-Relationships-1

Salters-Pedneault, K., Dr. (2016, November 17). Understanding Romantic BPD Relationships. Retrieved from https://www.verywell.com/understanding-romantic-bpd-relationships-425217

What You Need to Know When Dating Someone With Borderline Personality Disorder. (2016, November 22). Retrieved from https://www.bridgestorecovery.com/blog/what-you-need-to-know-when-dating-someone-with-borderline-personality-disorder/