Julie Miller's Mental Health Blog

Archive for the ‘"B" Is for Borderline Personality’ Category

Treatment for borderline personality disorder is available; I don’t care what other mental health professionals say, it’s treatable and has as good a prognosis as any other mental health issue.

Three primary issues come into play with treatment of borderline personality disorder:  1) medication; 2) therapy; 3) time.

Given that I am not a medical professional, I can’t give anything even remotely like advice on medication issues.  What I have observed is that there are often co-occurring issues with borderline personality, including depression and anxiety.  A competent psychiatric physician (MD or DO) can make an appropriate assessment, diagnosis, and recommendation for medications that might be beneficial.  There is also some research I have read that Omega-3 fish oils (fatty acids) may be beneficial for some of the impulsiveness and other issues.  It’s true – check it out online.

There are a few short-term therapies that purport to help one learn to cope with borderline personality disorder.  DBT (dialectical behavior therapy) was developed at the end of the last century as a means to help anyone learn skills to cope more effectively with the symptoms of borderline personality or issues of similar complexity.  It’s basically a combination of CBT (cognitive behavioral therapy) and mindfulness; it can be very effective.  However, it doesn’t “cure” borderline personality; it increases coping skills.

Is there a cure?  Most mental health professionals would say no; however, there is some significant work based on Freud’s original psychoanalytic work that is designed to heal the attachment wounds that bring borderline personality patterns into being.

This form of therapy goes by a couple names (with small differences in my opinion), including “Object Relations Therapy” and “Self Psychology.”  I have observed this work and have seen its effectiveness in the long-term.  It is not a short-term therapy. A terrific book entitled “Search for the Self,” by James Masterson, MD, is written for the layperson and is very effective in explaining the theory behind this kind of treatment.

In this form of therapy, attachment wounds are healed through the relationship with the therapist.  It is neither an easy nor painless form of healing.  It requires a dogged determination to heal, and persistence, sometimes over a few years.  Not 10 or 15 years, but maybe 3 or 4 (or 5).  This form of treatment requires a highly trained and highly competent therapist.

The training for this kind of therapy is specialized, and not every therapist is interested in developing the skill required.  If you are looking for a therapist to help with borderline personality issues, you will need to find someone who knows what you’re talking about when you say “object relations therapy,” and who can refer you to someone who knows how to do it.  It’s not listed in the yellow pages.

As noted in my blog post entitled “Borderline #2,” borderline personality is sometimes confused with PTSD.  Indeed, if attachment trauma (lack of childhood attachment) underlies any personality disorder, trauma IS borderline personality disorder.  Effectively, then, any form of therapy that will assist with resolving unprocessed traumatic material will be of tremendous assistance in reducing the suffering of an individual with borderline personality disorder.  These forms of treatment include EMDR (eye movement desensitization and reprocessing) and TFCBT (trauma focused cognitive behavioral therapy).

Some say “time heals all wounds.”  Some mental health professionals say borderline personality “burns out” somewhere in middle-age.  Okay, but if you ask me, who wants to wait until they’re 45 or 50 before things get better just with time?  There is also an increased risk of suicide for individuals with borderline personality disorder, so just hanging around, waiting for someone’s borderline personality issues to “burnout” are not a great plan.

Borderline personality disorder is a painful problem.  There is treatment, however, that is effective if provided by well-trained, skills mental health professionals.  Seek competent help.  Ask for referrals.  Research the issues yourself to get more information.  Help is available.

Borderline personality disorder can be .  very complicated to define.  Like with any personality disorder, the specific behavioral and emotional criteria are pervasive and chronic.

Five or more of the following criteria are required for an official diagnosis of borderline personality disorder.  An individual can also have borderline “traits” or “features” and this would require only one or more of these criteria.

A personal with borderline personality might:

  • Avoid real or imagined abandonment at almost any cost
  • Experience a pattern of alternating between intense admiration and hatred of others
  • Experience an unstable self-image or even uncertainty about his or her own identity
  • Behave impulsively in ways that hurt themselves, including spending, frequent or  unprotected sex with many partners, substance abuse, disordered eating, reckless driving, etc.
  • Think about suicide often, make repeated suicide attempts, or self-injure through cutting or burning himself or herself
  • Experience frequent emotional overreactions or intense mood swings, including feeling depressed, irritable, or anxious, lasting for only a few hours at a time or a day or two
  • Feel a sense of emptiness on a long-term basis
  • Experience inappropriate, fierce anger or problems controlling anger
  • Experience temporary episodes of feeling suspicious of others without reason (paranoia) or losing a sense of reality

You may relate to several things listed above, or maybe just one or two.  Many individuals, who do not meet the full criteria for a borderline personality diagnosis, experience one or two of these criteria in their personality.

There may be several possible reasons an individual may experience these conditions.  Sometimes, as discussed in the previous post, other issues may seem to be like a borderline personality feature, but if considered more carefully by the mental health professional, that particular symptom may really be part of some other condition.

I have met a client more than once who came with a label of “borderline” but who was not borderline; instead, perhaps they had PTSD (post-traumatic stress disorder; see “‘P’ is for PTSD” in upcoming posts), or bipolar disorder/manic or hypermanic phase, or even a different personality disorder such as histrionic or dependent.

It’s also helpful to think of borderline personality, along with any other personality, traits or features, as relating to problems with attachment, sometimes called “attachment trauma.”

Consider the first criteria listed above:  “avoid real or imagined abandonment at almost any cost.”  This is a fairly common symptom experienced by individuals from dysfunctional families in which they were abandoned (physically, emotionally, etc.) by important caregivers.  The degree to which a person is abandoned as an infant or child is very likely the degree to which they will avoid a recreation of that experience as an adult.

Given this perspective, one can perhaps understand the chronic, long-term, pervasive nature of a personality disorder like borderline personality.  The more chaotic the attachment experience as an infant or child, the more chaotic the attachment style will be as an adult, leading to frantic attempts to avoid abandonment, a highly volatile relationship style (“I hate you/don’t leave me”), difficulty regulating one’s own emotions (including attempts to do so in self-destructive ways), and difficulty with a solid sense of self.

Other symptoms often co-occur with borderline personality issues, including depression, anxiety, dissociation, addictions (chemical or “process” like spending, sex, gambling, relationships, etc.), eating disorders, etc. This is no simple problem, and treatment can be slow and complicated.

Next time, I’ll talk about treatment options.

“She’s borderline.”

“What a borderline.”

Ever hear these, or other such statements?  Many people today are familiar with the label “borderline” and use it indiscriminately.  I’ve heard even mental health professionals say such things with an attitude of disdain.

So what does “borderline” really mean?  It is a clinical diagnosis, officially “Borderline Personality Disorder,” and can easily be confused with other conditions like PTSD, bipolar, or other personality disorders.  It sometimes is used in a very dismissive manner, because “everyone knows you can’t treat borderline personality disorder.”

I couldn’t disagree more.  Of course borderline personality disorder is treatable.  Even if we don’t all agree on the cause of borderline personality (genetic?  attachment trauma?), we can treat these issues with therapy, medications, behavior modification, education, etc.

Could it be that the dismissive mental health professional attitude about borderline personality comes from frustration?  Many borderline personality behaviors do defy rational thought processes.  “I hate you, don’t leave me” is an example.  Black and white thinking.  Volatile personal relationships. Exquisite sensitivity to rejection or abandonment, even if it is imagined.  It isn’t easy to continue to express compassion for an individual who tests and pushes away and accuses and blames and angrily rejects and tearfully returns.

Borderline personality disorder is a terrible mental illness that causes horrific suffering for the individual, their family and friends.  The behavioral expression of the underlying trauma (or genetic vulnerability) can be unpredictible and mystifying, but it is no less deserving of compassion than any other mental health issue.  If an individual diagnosed with borderline personality is dismissed by a mental health professional who believes it’s a terrible pain to have a “borderline client” and “it can’t be fixed anyway,” the client will continue to suffer without hope of recovery. Plus, what if that “borderline client” really is suffering from something else, not borderline personality?

Having seen many individuals in treatment who have had personality testing, I have learned that what I had previously heard others talk about as as borderline personality could actually be diagnosed with another personality disorder, or with PTSD or bipolar, etc.  I’ve learned to look a little more closely and not make assumptions.

There is hope for anyone suffering with borderline personality disorder.  The treatment is available, and mental health professionals are responsible for learning how to treat this disorder, or referring to someone who can treat the individual.