The 4-year-old child spills the cereal on the floor when trying to put some in his own bowl. The mother’s response: “I told you not to take cereal yourself! No one listens to me. I’m a piece of garbage!” Storming, she jams the bowl, the cereal box, and everything else on the table, and then into the trash, then phones her husband at work.
“I can’t take it. I hate this family! I’m leaving now. If you don’t want our children alone in the house, get home immediately.”
The patient refuses to leave the psychologist’s office, after a session in which he hides behind his chair, refusing to speak. Silently, he crouches against the waiting room door to make a barricade against the doctor’s exit and the next client’s entrance.
The wife is enraged with her husband for forgetting to call the phone company. She has him paged at the baseball stadium; you can imagine how she screams in order to have her demand fulfilled. Fearfully, the husband races home, only to witness her dumping the dinner she had prepared into the garbage disposal.
Two college-age women take up a friendship, which is light and fun at first. Gradually one of the friends becomes jealous, demanding, hurt, and angry. She plays cruel games, texting late at night but refusing to return texts from the other woman. She invades her friend’s privacy, picking up her phone to read messages from others. When she begins following the friend’s whereabouts by means of binoculars, that is the end.
If these scenes ring a bell, maybe you’re familiar with the condition known as borderline personality disorder. You might be a sufferer, or perhaps you’re a family member or friend. And “suffer” is really the “mot juste.”
Borderline personality disorder, hereafter given the catchy “nickname” BPD, is a psychiatric diagnosis encompassing emotional dysregulation, depression, self-harm, and suicidality (a loose term referring to obsessions, threats, attempts, and, of course, the dreaded action itself). It first comes to clinical attention in teen-agers or young people in their 20’s. Sufferers tend to exhibit the following five clusters of experience:
1) Excessive, unstable, poorly regulated emotional responses. Anger is common, shifting readily into rage. Anxiety, depression, and deep feelings of emptiness and worthlessness add to the misery.
2) Impulsive behaviors which are often harmful to the patient or to others. The range includes reckless driving, spending or sexual behavior, binge eating, and suicidality.
3) An inaccurate and shifting sense of self (identity), running the gamut from grandiose to worthless.
4) Suspicious or paranoid beliefs about others, expecting negative and harmful attitudes and behaviors. Naturally, such expectations lead to impaired social reasoning. Black and white thinking is common.
5) Intense, unstable relationships, which exhibit the extremes of over-idealizing and under-valuing significant others. The BPD sufferer finds herself exerting frantic efforts to avoid real or imagined abandonment by family and friends, often causing exactly what she fears by her needy, demanding, or manipulative behavior.
Then there’s the co-morbidity piece. BPD patients often report migraines, panic attacks, and ADHD.
And the family piece. Loving someone with this disorder is not quite as miserable as actually having the diagnosis, but it’s a close second.
Sounds bad, no? And guess what? Although there are medications for the anxiety and depression components, there is nothing for the painful beliefs and frustrating behaviors. Pychotherapy? Well, that’s a challenge, too, because the BPD client experiences the same relationship issues with the therapist as with the significant people outside the office walls; re-read #5.
This disorder is so difficult to treat that some professionals despair. Take a look at a thoughtful piece called “Can Borderline Personality Disorder be cured?”
Most experts recommend a relatively new approach known as Dialectical Behavioral Therapy, DBT. This treatment is the brainchild of Marsha Linehan, an amazing lady who was very sick from the disease, got better through divine inspiration (literally), and devised a treatment program. Taking two and a half minutes out of your life to listen to her transformative story will provide you with inspiration.
I’m about to list the 5 elements of DBT, nicely paralleling the 5 demons of the BPD patient, but I warn you, the strategies are hard work for the patient and the therapeutic team.
1) Skills training, so the client has improved behavioral choices when distressed.
2) Motivation enhancement. (Believe it or don’t, after years of suffering, most patients aren’t willing to do the hard work to get better.)
3) Generalization, so the patient has access to help outside the therapy time slot (homework, family work, and pathways to reach the therapist outside the clinical setting).
4) Structuring the environment to re-enforce adaptive behaviors.
5) Enhancing therapist motivation. This is rare in the psych field, but it’s so exhausting to work with the BPD sufferer’s rage, suicidality, abandonment fears, demand for attention outside office hours (and this after refusing to speak one word during the scheduled appointment session), that the therapist needs a bone, too.
So, let’s say you already did all of the above, or don’t like it, can’t find or afford a program, or want some help this minute. Or your spouse, children, boss can’t take the shared pain one more minute. Here’s where the magic of on-line support comes in. Not only do the folks on the forums get who you are, but they’ve been there, they feel your pain (really), and someone is awake and on-line any time, any time zone. Of course, you use a screen name, so privacy remains intact. The following are reasonable places to start your search.
Maybe, with the thousands reachable world-wide through the internet, we can make something amazing happen–a cure, or even better yet, a prevention for BPD. Let’s pray when May comes back around next year we’ll have a better understanding of the brain. That wish applies to all mental illness. May is also Mental Health Awareness month, and BPD is, unfortunately, only one of the mental disorders which cause misery to the sufferers and their families.
Meanwhile the National Education Alliance for Borderline Personality Disorder has prepared a full month’s worth of educational events, ranging from video production launches to a call-in series with presentations from leading researchers on topics ranging from BPD and PTSD to DBT and Mentalization Difficulties to a think tank meeting on Early Identification/Early Intervention for Children and Adolescents at Risk for Borderline Personality Disorder. Get all the details and links at borderlinepersonalitydisorder.com.