This is a tough one.
Borderline Personality Disorder ~ BPD.
I have a few videos, they all may not interest everyone, some will, I feel they have a stronger impact and ability to teach… as the alternative is just my words, which you may skim over. prepare to learn.
This post is not just to provide a background on BPD for those that have none, but to show that this can be treated to the point the BPD classification is removed from the patient. WOW.
DBT is not the only treatment with success in working with BPD, There are a few. We are developing and learning new therapies to help cope/treat. Research is ongoing, over recent years there have been large leaps.
With borderline, therapy is successful, medication not so much. Meds can treat some symptoms, anxiety or depression, therapy can restore the patient.
While I hope this would not be the case,
So what is Borderline Personality Disorder, I have touched on this before, I won’t go into depth now, with the new release of the DSM 5 some of this may even change.
Now we have this, the nine traits. A person does not necessarily to have all of them to be classified as having a Borderline disorder.
oh wait… DSM.. what is this… Diagnostic and Statistical Manual of Mental Disorders. yes we have a guide. DSM-5
Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. The current edition, DSM-IV-TR, is used by professionals in a wide array of contexts, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors, as well as by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). It is used in both clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care) as well as with community populations. In addition to supplying detailed descriptions of diagnostic criteria, DSM is also a necessary tool for collecting and communicating accurate public health statistics about the diagnosis of psychiatric disorders.
Borderline… This is a personality disorder, sufferers are hypersensitive, social interaction is difficult, stressful, relationships suffer, emotions are hard to control. Mood swings, intense ones, rapidly changing. Impulsive behaviour can be devastating. Self harm and suicide risks are higher, very high. Sufferers react abnormally to emotional stimulation. There is a sense of invalidation, often low self worth. Emotion changes rapidly, so rapidly that coping with the intense surges is virtually impossible.
The current DSM-IV-TR (2000) criteria for Borderline Personality Disorder is as follows:
Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptom
Here is a video
What is Borderline personality disorder
This next video is good to show some of the difficulties the therapist encounters.
some of the role/plays are not that great
overall the video is good however.
was developed by Marsha M. Linehan
Here she is. This a 25 minute video
I always say this – Borderline is tough. Be tougher!
I wish I could show you the success stories.
People that struggled, like perhaps you are now.
suffered, even gave up… but now are leading great lives.
wait… I can.
This is powerful. get a tissue and watch it.
A patients view
“teach us how to live”
Therapy works. Tis proven. The problem is, not everyone is able to receive it. Waiting lists, expenses, all detriments to receiving the care needed. Because of the nature of BPD too, many may give up, maybe the therapists were not the right ones for them. Perhaps their therapy ended.. maybe they needed more, the system perhaps did not allow for this. Many may not like group therapy, but this is a viable part of some treatments.
You can not give up, Be Tough. If you can obtain therapy, take it. Engage it, FIGHT FOR YOU.
Lets look at the therapies
CBT Cognitive behavioral therapy, this is where DBT and SFT get their roots. This combines cognitive and behavioral therapies, hence the name. Cognitive is what a persons thoughts, assumptions and beliefs are. Perhaps how they think of themselves. Often they feel they are bad, unworthy, this process of therapy addresses these thought patterns, identifying them and restructuring them. Behavioral is how the person behaves, acts and responds to situations. Why something happens is irrelevant, it is more to change behavior to how you respond to it in a more healthy way.
DBT Dialectical behavioral therapy. As you saw if you watched the video, this addresses the dangerous behaviour, suicide, self harm. To teach management skills for day to day life, how to reduce those emotions and thought patterns that are destructive. This is team based, labour and time intensive. Phone calls to check on the patient, skill training, group therapy to help with social issues. Individual therapy. Therapists receive therapy to tweak motivation and skills. Many issues are addressed with DBT, it is comprehensive. With BPD success rates are high. the BPD classification is often removed from patients that undergo the therapy. Suicide rates and hospitalization rates plummet.
SFT Schema-focused Therapy. This newer treatment for BPD. I have discussed your Schema before. What makes you.. you. Therapists will assess your core, your schema, determine the problems and address them. There are four concepts, early maladaptive schemas, core emotional needs, Schema mode and maladaptive coping styles. This is a bit complex, I am sure I have already lost many of you. Early maladaptive schemas: relating to your childhood, needs that were not met (often abuse or abandonment issues) addressing them. Changing the way you adapt to those needs, they may be blocked or you may respond to them in unhealthy ways. Your schema is built over time, from your first breath. This is very involved, perhaps a future post.
MBT Mentalization-based therapy. This works on the premise that BPD suffers have hyperactive attachment systems giving them a reduced capacity to mentalize. This is not as directive as CBT or DBT. MBT addresses the patients perceptions of reality. BPD seems to be based on a biological predetermination or history, usually childhood. This therapy leans toward a social aspect, relationships. Therapy activates the attachment system reinforcing it in a positive manner in a safe setting with their therapist. The goal being to enable them to function in social settings more comfortably.
TFP Transference-focused Psychotherapy. This therapy is similar. Treatment to help patients to correct distored perceptions in social settings. This focuses more on significant others and their therapist. The therapist is a strong focus in this, plans are in place, set up by the patient and therapist, establishing parameters and goals to deal with threats to treatment and the patients well being. As treatment progresses and feelings unfold the patient is taught how to contain them. Often using the therapist as an example, when a calm patient suddenly becomes aggressive, the therapist calmly asks if the patient notices how they just change, this is explored in the session. A transference. This helps the patient learn to reflect on emotional states that they in the past may have just reacted to, often wrongly. As with most therapy this gives the patient tools to apply this to other difficulties, using the same approach. It gives the patient the ability to moderate their emotional chaos, to reflect on emotional states that they did not truly understand, to reduce impulsive behaviour.
TFP video Effectiveness of Tranference Focused Therapy for Borderline Personality
Again the stigma associated with mental health causes problems. People that desperately need and want care, can not have it. The more that we learn and understand, the more this becomes more visible, the less problems we will have. I know this post was long, perhaps not a perky recipe or poem, but did you learn something?
That is a big step in reducing the stigma. Maybe helping you too, to understand someone that suffers with BPD. How treatment can help them.
Maybe if you suffer with BPD you will not try to hold it in, deal with it alone, but seek help. For there is help, but you must take the first steps. Be Tougher.