Monthly Archive for May, 2010

Your “Say Yes to Life” Monday Motivator: Staying Away From the Borderline

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May is Borderline Personality Disorder Month. This month, in honor of this important topic, we began a new blog series that focuses on the nuts and bolts of borderline personality disorder (BPD), and each week in May we will address a different aspect of recovery from this highly treatable disorder.

This week, we look at the role of the professional in the recovery process.

Perhaps no other disorder has been so extensively misunderstood, misdiagnosed, or misrepresented as BPD, so much so that mental health professionals are often reluctant or downright resistant to working with BPD sufferers. “I stay away from the borderlines,” one professional was heard to say at a recent conference.

Three decades ago, before the creation of Dialectical Behavioral Therapy (DBT) by Dr. Marsha Linehan, a response like this would have been more than understandable. However, in light of all the resources professionals have at their disposal today to treat BPD sufferers, hearing this at a conference in 2010 is puzzling.

BPD is essentially a disorder of relationships. As such, understanding the nuts and bolts of how the disease arises and what sufferers need to overcome its effects can go a long way towards reducing stigma and offering sufferers the type of professional treatment they need to get better.

According to the National Education Alliance for Borderline Personality Disorder (NEA for BPD), representative BPD symptoms include:  fears of abandonment, intense mood shifts, impulsivity, problems with anger, recurrent suicidal behaviors or self-injurious behaviors, and patterns of unstable and intense relationships that often create chaos in the lives of sufferers and their families.

In short, individuals with DBT can’t stand to be with themselves, inside their own intensely emotionally-charged skins, but through their behaviors they often recreate the very relational abandonment they fear, which exacerbates their symptoms, and so on and so on. It is thought that the stage is set for BPD, which is often diagnosed in early adulthood and primarily in females, through early emotional invalidation with a possible genetic biological component.

What is most important for professionals to know, however, is that it is highly treatable.

Even with this awareness however, one initial challenge treating professionals will face is to separate out BPD symptoms from other frequently co-occurring disorders. As the NEA for BPD reports, borderline symptoms rarely occur in isolation, and are frequently exacerbated by other concerns such as substance abuse, eating disorders, depression, anxiety, and bipolar disorder. While individuals suffering from BPD symptoms are often medicated, it is also important to know that no medication has been specifically approved for use to treat BPD symptoms as of yet.

Additionally, there are many ways in which the core symptoms of BPD can manifest, and those symptoms may vary based on each individual’s background, life experience, and prior treatment experiences. With an estimated 2% of the population suffering from BPD symptoms, it can quickly become a source of professional frustration to find one method to treat so many individual cases.

This is where Dialectical Behavioral Therapy (DBT) comes in. Dr. Marsha Linehan, the founder of DBT, categorized the six major categories of BPD symptoms into four skills-building modules. These four core modules include Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. DBT, while used today to treat a variety of mood-based disorders, was created specifically to treat individuals with borderline symptoms, and is scientifically proven to be a highly effective and lasting treatment approach.

Dr. Linehan’s goal when developing DBT was not to separate out, categorize, and individually address all 200+ permutations of the core BPD symptoms. Rather, she aimed to – and succeeded at – identifying instead the four core areas of coping skills that were missing from each BPD sufferer’s internal life coping toolkit. BPD sufferers all struggle to maintain mindfulness about who they are and how they fit in with others. BPD sufferers all wrestle with regulating their emotions and managing feelings of distress. BPD sufferers all have trouble developing trust-based, healthy relationships with themselves and with others in their lives.

In summary, BPD sufferers can all benefit from the four core modules taught through DBT.

For sufferers, loved ones, and referring or treating professionals, DBT is a bright light of practical hope amidst the darkness of a struggle against BPD symptoms.

At Southlake Counseling, we have more than two decades of clinical expertise in treating individuals with BPD symptoms through our DBT outpatient programs. Our combination of individual and group support, with additional phone support if necessary, puts BPD sufferers on the road to lasting recovery. We are happy to talk with loved ones and referring professionals about how DBT skills-building treatment can positively intervene in the life of someone struggling with BPD. We have expertise with adolescents, females, and males and offer individual and group support for individuals at each stage of the recovery process. Visit us at www.southlakecounseling.com – we look forward to hearing from you.

Be Well,
Kimberly

Published on Monday May 24, 2010 in Borderline Personality Disorder. 0 Comments Tags: , , , .

Your “Say Yes to Life” Monday Motivator: Making It Across the Borderline

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May is Borderline Personality Disorder Month. Last week, in honor of this important topic, we began a new blog series that focuses on the nuts and bolts of borderline personality disorder (BPD) and each week in May we will address a different aspect of recovery from this highly treatable disorder.

This week, we look at the role of the family in the recovery process.

If your loved one has been diagnosed with borderline personality disorder (BPD), you probably reacted initially with equal parts relief and consternation.

The relief? “Well thank goodness we at least have a name for ‘it’ now!”

The consternation? “What can we do to help?”

The good news is that effective treatment is available. Two decades ago Dr. Marsha Linehan developed a (then) new therapeutic process known as “Dialectical Behavioral Therapy” or DBT. DBT was specifically created to effectively interrupt the BPD emotional cycle and replace those thoughts and behaviors with new coping skills. Students of DBT learn new skills in four core modules – Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. While DBT is used to treat a variety of mood-based disorders today, it was specifically designed to dramatically improve the lives of those diagnosed with BPD.

Family members and loved ones are also an important part of the individual’s recovery process, and knowing how to effectively participate can go a long way towards ensuring eventual full recovery.

In the absence of guidance, it can be tempting for family members and loved ones to pull away, thinking that less is more, and at least the person will not be harmed by the wrong kind of support.  However, this will be perceived by the individual suffering from BPD as yet another instance of abandonment, exacerbating symptoms and delaying recovery.

What is needed instead is a two-pronged approach beginning with the realization that no family member or loved one, no matter how well-intentioned, is equipped to manage the recovery process of an individual diagnosed with BPD. BPD is a serious, potentially fatal disease, and is worthy of both the highest respect and comprehensive professional treatment. BPD is not a self-willed disease – in other words, the sufferer cannot help their behavior outside of the intervention of trained professionals who know how to help break through the emotional gridlock inside and guide the sufferer to safety.

So the first step to take as a concerned family member is to ensure your loved one is receiving appropriate and adequate professional medical treatment.

Once this first step has been addressed, family members are now able to join in to support the individual through the recovery process. The National Education Alliance for Borderline Personality Disorder (NEA for BPD) has issued specific guidelines to help family members and loved ones participate effectively and constructively. A brief overview of these guidelines is found below and more information can be obtained on the NEA for BPD website at www.borderlinepersonalitydisorder.com.

The first recommendation is to “go slowly”. In other words – in the initial stages, fear of change and fear of abandonment through change is very high in the mind of the sufferer, who may exhibit resistance to treatment and change for precisely these reasons. This is not unique to a BPD sufferer – family members can build their “patience muscles” by considering areas of their own lives where change is both needed and feared. The NEA for BPD also advises family members to refrain from encouraging the sufferer with “you can do it” messages – these may increase anxiety and slow actual progress. Rather, family members are encouraged to eschew overt praise at noticeable progress and instead validate the hard work involved while still empathizing with how difficult the change process must be. Wrapped in with this is an encouragement to avoid discussion of achieving big goals – again, family members can flex their patience muscles by contemplating how desired change has happened in their own lives, and by setting small, realistic goals for the sufferer with the help of the professional treatment team.

The second recommendation is to modify the home environment in any way necessary to achieve what the NEA for BPD calls a “calm and cool” environment. This may mean something as simple as maintaining predictable daily family routines. Other ideas that are effective are making efforts to moderate intense emotional displays (whether positive or negative), minimize defensiveness in response to the individual’s thoughts and behaviors, and set limits on what will and won’t be tolerated to preserve the sanity and safety of the family unit.  Becoming educated about BPD symptoms and fears – for example, intolerance of being left alone, inability to discern “grey” emotional areas, and inability to self-sooth – will also assist family members with developing patience, compassion, and appropriate responses throughout the recovery process.

Finally, the NEA for BPD urges family members to seek prompt professional attention for BPD-related behaviors, such as self-harming, self-medicating through alcohol or other substances, or suicidal thoughts or behaviors. These behaviors are serious and reflect an intolerable inner environment that requires immediate professional intervention. Getting the sufferer prompt attention preserves not just safety and sanity but paves the way for development of secure emotional bonds that lead to eventual full recovery.

At Southlake Counseling, we have more than two decades of clinical training and experience implementing DBT-based treatment programs. Our wealth of individual and group support for males and females, adolescents and adults is unique in the Davidson area. If you or someone you love is exhibiting borderline personality disorder symptoms, contact us today at www.southlakecounseling.com to find out how DBT-based treatment can help.

Be Well,

 Kimberly

Published on Monday May 17, 2010 in Borderline Personality Disorder. 0 Comments Tags: , .

Your “Say Yes to Life” Monday Motivator: On the Borderline

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May is Borderline Personality Disorder Month.  In honor of this important topic, we will spend the month of May addressing different aspects of recovery from this highly treatable disorder.

This week we will focus on the nuts and bolts of what borderline personality disorder (BPD) is, what treatments are available, and recommendations for finding support for yourself or a loved one.

Just hearing the phrase “borderline personality disorder” can strike fear into the hearts of the most resilient loved ones.

But for the individual who is diagnosed with borderline personality disorder (BPD), there is probably just a question mark where comprehension should be. This person is probably thinking, “BPD? What is that? This is just how I am!”

Therein lies the difficulty in accurately diagnosing, assessing, and treating BPD. To the professional untrained in BPD treatment, a sufferer can seem like an exercise in unpredictability, not to mention a source of continual professional self-doubt and frustration.

To the loved ones, often unwittingly caught in the disease’s trap along with the sufferer, BPD can appear as a nightmare of confused interpretations that never ends.

To the sufferer, it is just another day in a life filled with emotional pain.

Statistically-speaking, studies indicate that 2% of the population is thought to suffer from BPD. Additionally, up to 20% of all psychiatric hospitalizations stem from BPD. It is thought that nearly three-quarters of all sufferers are female, which is why current research and treatment continues to focus on females.

But what is it? What does “borderline personality disorder” even mean?

Simply put, BPD places the individual at odds with her own emotions. Emotional ups and downs are experienced as equally painful, chaotic, and unmanageable. Any other symptom traditionally associated with BPD can be traced back to this internal emotional war. Because the emotional instability is so severe, BPD is considered both serious and life-threatening. Self-harming and suicidal thoughts and behaviors are common. Relationships are a continual challenge due to continual mood swings and poor sense of self-identity. Treatment is a must – for the sufferer’s sake, and for the sake of those around them.

What causes BPD? While research is not yet able to pinpoint the exact causes, one thing is clear – it is not a self-willed disorder, and it is not the sufferer’s fault. Newer scientific evidence strongly points to a dual dance of biology and environmental triggers. For instance, while studying the brains of individuals diagnosed with BPD, researchers noted higher activity in parts of the brain that control emotional expression and experience, including the limbic system, the brain’s emotional processing center. For these and other reasons, it is widely thought that BPD-predisposed individuals’ brains differ not just in function but also in structure. This evidence also illuminates one possible reason for the tendency the disorder has shown to run in families.

Environmentally, an individual is considered at higher risk for developing BPD after experiencing childhood trauma or an invalidating emotional bond with early caregivers – or both. Since the disorder tends to first show itself in early adulthood, environmentally it appears that an earlier experience of traumatic emotional invalidation is a key factor in determining who is at risk for BPD later on in life.

But while it can be tempting to spend vast amounts of time digging into a sufferer’s past for clues as to why BPD has developed, the most important call to action is to get that person HELP.

Up until a few short decades ago, treatment options were scarce. But thanks to the pioneering work of Dr. Marsha Linehan, the founder of Dialectical Behavioral Therapy (DBT), there is much hope for successful treatment of this persistent and often resistant disorder. Dr. Linehan developed DBT specifically for the treatment of individuals suffering from BPD after studying their symptoms extensively and determining a range of four core building blocks needed to successfully overcome the disorder.

This is good news for sufferers, loved ones, and professionals. Sufferers who become students of DBT learn key coping techniques in Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. These four core modules are introduced over a period of time in an atmosphere of comprehensive individual and group support, including extra phone support if needed. The end result is an individual who is equipped with all the tools and resources she needs to combat her tendencies toward emotional overextension and self invalidation. Since the instruction is done in a nurturing and emotionally-validating environment, the individual is repairing old hurts while learning new skills, and emerges a stronger, more confident person within herself and in her interpersonal relationships.

If you or someone you love is exhibiting signs and symptoms of BPD, it is important to seek help immediately. BPD is a serious disorder and deserves the highest respect. Do not attempt to manage symptoms of BPD for yourself or a loved one. The professionals at Southlake Counseling have dedicated more than two decades to proficiency in supporting individuals with borderline symptoms through the recovery process. We are here to help. Southlake Counseling offers a wide variety of DBT-based individual and group support, including phone support. Our support groups are offered for both females and males, adolescents and adults. Our comprehensive DBT outpatient program is designed to make immediate, measurable progress in reduction of symptoms and improvement in emotional functioning. Visit us at www.southlakecounseling.com to learn more.

Be Well,

Kimberly


Published on Monday May 10, 2010 in Borderline Personality Disorder. 0 Comments Tags: , , , , .